title: Why do nonsurvivors from community-acquired pneumonia not receive ventilatory support?
abstract: OBJECTIVE
  We investigated rates and predictors of ventilatory support during hospitalization in seemingly not severely compromised nonsurvivors of community-acquired pneumonia (CAP).
  
  
  METHODS
  We used the database from the German nationwide mandatory quality assurance program including all hospitalized patients with CAP from 2007 to 2011. We selected a population not residing in nursing homes, not bedridden, and not referred from another hospital. Predictors of ventilatory support were identified using a multivariate analysis.
  
  
  RESULTS
  Overall, 563,901 patients (62.3% of the whole population) were included. Mean age was 69.4 ± 16.6 years; 329,107 (58.4%) were male. Mortality was 39,895 (7.1%). A total of 28,410 (5.0%) received ventilatory support during the hospital course, and 76.3% of nonsurvivors did not receive ventilatory support (62.6% of those aged <65 years and 78% of those aged ≥65 years). Higher age (relative risk (RR) 0.48, 95% confidence interval (CI) 0.44-0.51), failure to assess gas exchange (RR 0.18, 95% CI 0.14-0.25) and to administer antibiotics within 8 h of hospitalization (RR 0.48, 95% CI 0.39-0.59) were predictors of not receiving ventilatory support during hospitalization. Death from CAP occurred significantly earlier in the nonventilated group (8.2 ± 8.9 vs. 13.1 ± 14.1 days; p < 0.0001).
  
  
  CONCLUSIONS
  The number of nonsurvivors without obvious reasons for withholding ventilatory support is disturbingly high, particularly in younger patients. Both performance predictors for not being ventilated remain ambiguous, because they may reflect either treatment restrictions or deficient clinical performance. Elucidating this ambiguity will be part of the forthcoming update of the quality assurance program.
authors: HELIOS Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany.
authors: Torsten T
authors: TT
authors: Bauer
authors: Tobias
authors: T
authors: Welte
authors: Richard
authors: R
authors: Strauss
authors: Helge
authors: H
authors: Bischoff
authors: Klaus
authors: K
authors: Richter
authors: Santiago
authors: S
authors: Ewig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000401:mortality* / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D005858:Germany / Q000453:epidemiology; D006297:Health Services Accessibility / Q000592:standards; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011014:Pneumonia / Q000401:mortality* / Q000628:therapy*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012121:Respiration, Artificial / Q000592:standards; D012307:Risk Factors; D016896:Treatment Outcome
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