title: Early non-invasive ventilation treatment for respiratory failure due to severe community-acquired pneumonia.
abstract: OBJECTIVE
  Severe community-acquired pneumonia (sCAP) have been as defined pneumonia requiring admission to the intensive care unit or carrying a high risk of death. Currently, the treatment of sCAP consists of antibiotic therapy and ventilator support. The use of invasive ventilation causes several complications as does admission to ICU. For this reason, non-invasive ventilation (NIV) has been used for acute respiratory failure to avoid endotracheal intubation. However, few studies have currently assessed the usefulness of NIV in sCAP.
  
  
  METHODS
  We prospectively assessed 127 patients with sCAP and severe acute respiratory failure [oxygen arterial pressure/oxygen inspiratory fraction ratio (PaO2/FiO2) <250]. We defined successful NIV as avoidance of intubation and the achievement of PaO2/FiO2 >250 with spontaneous breathing. We assessed predictors of NIV failure and hospital mortality using univariate and multivariate analyses.
  
  
  RESULTS
  NIV failed in 32 patients (25.1%). Higher chest X-ray score at admission, chest X-ray worsening, and a lower PaO2/FiO2 and higher alveolar-arteriolar gradient (A-aDO2) after 1 h of NIV all independently predicted NIV failure. Higher lactate dehydrogenase and confusion, elevated blood urea, respiratory rate, blood pressure plus age ≥65 years at admission, higher A-aDO2, respiratory rate and lower PaO2/FiO2 after 1 h of NIV and intubation rate were directly related to hospital mortality.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Respiratory Diseases Unit, ASL4 Chiavarese, Sestri Levante, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Nicolini
authors.affiliation: Emergency Medicine Unit, ASL4 Chiavarese, Lavagna, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Ferraioli
authors.affiliation: Public Health Unit, ASL4 Chiavarese, Chiavari, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Ferrari-Bravo
authors.affiliation: Forensic Medicine, ASL4 Chiavarese, Chiavari, Italy.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Barlascini
authors.affiliation: Respiratory Diseases Unit, Umberto Parini Hospital, Aosta, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Santo
authors.affiliation: Respiratory Diseases Unit, Villa Scassi Hospital, Genova, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ferrera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000379:methods*; D018410:Pneumonia, Bacterial / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*
keywords: NIV platform dedicated ventilators; non-invasive ventilation; severe community-acquired pneumonia; severe respiratory failure