Early non‐invasive ventilation treatment for respiratory failure due to severe community‐acquired pneumonia

Nicolini, Antonello; Ferraioli, Gianluca; Ferrari-Bravo, Maura; Barlascini, Cornelius; Santo, Mario; Ferrera, Lorenzo

doi:10.1111/crj.12184

Cited by 43 publications

(28 citation statements)

References 34 publications

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“…While invasive ventilation is an accepted risk factor for pneumonia, especially for nosocomial infections,[28] NIV has been used to reduce the risk of nosocomial pneumonia on the ICU[29] and to treat patients with acute pneumonia. [30]…”

Section: Discussionmentioning

confidence: 99%

Is survival improved by the use of NIV and PEG in amyotrophic lateral sclerosis (ALS)? A post-mortem study of 80 ALS patients

et al. 2017

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BackgroundNon-invasive ventilation (NIV) and percutaneous gastrostomy (PEG) are guideline-recommended interventions for symptom management in amyotrophic lateral sclerosis (ALS). Their effect on survival is controversial and the impact on causes of death is unknown.ObjectiveTo investigate the effect of NIV and PEG on survival and causes of death in ALS patients.MethodsEighty deceased ALS patients underwent a complete post mortem analysis for causes of death between 2003 and 2015. Forty-two of these patients consented for genetic testing. Effects of NIV and PEG on survival and causes of death were analyzed in a multivariable Cox proportional hazard regression.ResultsSix patients, who requested assisted suicide causing drug-induced hypoxia, were excluded from final analysis. Respiratory failure was the main cause of death in 72 out of 74 patients. Fifteen out of 74 died of aspiration pneumonia 23/74 of bronchopneumonia and 8/74 of a combination of aspiration pneumonia and bronchopneumonia. Twenty died of hypoxia without concomitant infection, and six patients had pulmonary embolism alone or in combination with pneumonia. NIV (p = 0.01) and PEG (p<0.01) had a significant impact on survival. In patients using NIV bronchopneumonia was significantly more frequent (p <0.04) compared to non-NIV patients. This effect was even more pronounced in limb onset patients (p<0.002). Patients with C9orf72 hexanucleotide repeat expansions showed faster disease progression and shorter survival (p = 0.01).ConclusionThe use of NIV and PEG prolongs survival in ALS. This study supports current AAN and EFNS guidelines which recommend NIV and PEG as a treatment option in ALS. The risk of bronchopneumonia as cause of death may be increased by NIV.

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Section: Discussionmentioning

confidence: 99%

Is survival improved by the use of NIV and PEG in amyotrophic lateral sclerosis (ALS)? A post-mortem study of 80 ALS patients

et al. 2017

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“…In short, good amenity, better tolerance, and universal application of the helmet ensured NIV was better used and reduced intubation (as shown in this analysis in Fig. 2b), which might contribute to preventing ventilator-associated pneumonia and decreasing hospital mortality [43]. …”

Section: Discussionmentioning

confidence: 99%

“…Some studies aimed to explore applying NIV through a mask in this kind of patient, however, the results were disappointing, successful treatment was lower with a limited effect on the prognosis [43–46]. This might be relevant to the different breathing patterns in hypoxemic ARF and hypercapnic ARF patients.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

et al. 2016

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BackgroundNoninvasive ventilation (NIV) has proved to be a useful technique for breathing support. However, complications, discomfort, and failure of NIV were commonly caused by the mask. Therefore, the helmet was developed to improve performance and reduce complications; however, there has been no conclusive results on its effect until now. Thus, we performed a systematic review and meta-analysis to investigate the effect of NIV with a helmet versus the control strategy in patients with acute respiratory failure (ARF).MethodsWe searched Cochrane Library, PubMed, Ovid, and Embase databases and bibliographies of relevant articles published before June 2016. Randomized and case-control studies that adopted the helmet as an NIV interface and compared it with another interface were included. The primary outcomes were hospital mortality, intubation rate, and complications. The secondary outcomes included the length of intensive care unit (ICU) stay, gas exchange, and respiratory rate. Pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated by the Mantel-Haenszel method and mean difference by the inverse variance method in a fixed effect model or random effects model according to the heterogeneity.ResultsA total of 11 studies involving 621 patients were included. The overall hospital mortality was 17.53 % in the helmet NIV group versus 30.67 % in the control group. Use of the helmet was associated with lower hospital mortality (OR 0.43, 95 % CI 0.26 to 0.69, p = 0.0005), intubation rate (OR 0.32, 95 % CI 0.21 to 0.47, P < 0.00001), and complications (OR 0.6, 95 % CI 0.4 to 0.92, P = 0.02). In contrast, there was no significant difference in gas exchange and ICU stay (P >0.05). Subgroup analysis found the helmet reduced mortality mainly in hypoxemic ARF patients (P < 0.05) and a lower intubation rate was shown in randomized trials; fewer complications caused by the helmet might be restricted to case-control trials. Additionally, the effect of the helmet on PaCO2 was influenced by type of ARF and ventilation mode (P <0.00001).ConclusionNIV with a helmet was associated with reduced hospital mortality and intubation requirement. The helmet was as effective as the mask in gas exchange with no additional advantage. Large randomized controlled trials are needed to provide more robust evidence.

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“…[19][20][21] Moreover, no study has investigated the difference between continuous PAP and BiPAP or pressure support ventilation (PSV) in severe respiratory failure due to pneumonia. 11,19,21,22 Regarding the interfaces used to administering NIV in patients with hypoxemic acute respiratory failure some studies compared the helmet to facial mask: 23,24 although the helmet group had a higher increase in oxygenation the total duration of NIV as well as the intubation rate and hospital mortality were similar in both groups. The mask group showed a higher intolerance to NIV.…”

Section: Discussionmentioning

confidence: 99%

“…The use of NIV in patients with pneumonia is controversial because of a greater variability in failure rates than those observed in other diagnoses. 9,10,11 On this regard, we report three cases of severe polymicrobial CAP: all of them required NIV with good outcome. Patients gave their consent to publish material related to them.…”

Section: Introductionmentioning

confidence: 89%

Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia

et al. 2017

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Early non‐invasive ventilation treatment for respiratory failure due to severe community‐acquired pneumonia

Abstract: Successful treatment is strongly related to less severe illness as well as to a good initial and sustained response to medical therapy and NIV treatment. Constant monitoring of these patients is mandatory.

Cited by 43 publications

References 34 publications

Is survival improved by the use of NIV and PEG in amyotrophic lateral sclerosis (ALS)? A post-mortem study of 80 ALS patients

Is survival improved by the use of NIV and PEG in amyotrophic lateral sclerosis (ALS)? A post-mortem study of 80 ALS patients

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia

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