title: Role of First-Line Noninvasive Ventilation in Non-COPD Subjects With Pneumonia.
abstract: BACKGROUND
  The use of noninvasive ventilation (NIV) in non-COPD patients with pneumonia is controversial due to its high rate of failure and the potentially harmful effects when NIV fails. The purpose of the study was to evaluate outcomes of the first ventilatory treatment applied, NIV or invasive mechanical ventilation (MV), and to identify predictors of NIV failure.
  
  
  METHODS
  Historical cohort study of 159 non-COPD patients with pneumonia admitted to the ICU with ventilatory support. Subjects were divided into 2 groups: invasive MV or NIV. Univariate and multivariate analyses with demographic and clinical data were performed. Analysis of mortality was adjusted for the propensity of receiving first-line invasive MV.
  
  
  RESULTS
  One hundred and thirteen subjects received first-line invasive MV and 46 received first-line NIV, of which 27 needed intubation. Hospital mortality was 35, 37 and 56%, respectively, with no significant differences among groups. In the propensity-adjusted analysis (expressed as OR [95% CI]), hospital mortality was associated with age (1.05 [1.02-1.08]), SAPS3 (1.03 [1.00-1.07]), immunosuppression (2.52 [1.02-6.27]) and NIV failure compared to first-line invasive MV (4.3 [1.33-13.94]). Compared with invasive MV, NIV failure delayed intubation (p=.004), and prolonged the length of invasive MV (p=.007) and ICU stay (p=.001). NIV failure was associated with need for vasoactive drugs (OR 7.8 [95% CI, 1.8-33.2], p=.006).
  
  
  CONCLUSIONS
  In non-COPD subjects with pneumonia, first-line NIV was not associated with better outcome compared with first-line invasive MV. NIV failure was associated with longer duration of MV and hospital stay, and with increased hospital mortality. The use of vasoactive drugs predicted NIV failure.
authors.affiliation: Servicio de Cuidados Intensivos, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España. Electronic address: grialp@gmail.com.
authors.forename: Gemma
authors.initials: G
authors.lastname: Rialp
authors.affiliation: Servicio de Cuidados Intensivos, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España.
authors.forename: Catalina
authors.initials: C
authors.lastname: Forteza
authors.affiliation: Servicio de Cuidados Intensivos, Hospital Comarcal d'Inca, Inca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España.
authors.forename: Daniel
authors.initials: D
authors.lastname: Muñiz
authors.affiliation: Servicio de Cuidados Intensivos, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España.
authors.forename: Maria
authors.initials: M
authors.lastname: Romero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data; D011014:Pneumonia / Q000401:mortality / Q000628:therapy*; D057216:Propensity Score; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents
keywords: Cuidados intensivos; Intensive care; Mortalidad; Mortality; Neumonía; Noninvasive ventilation; Pneumonia; Propensity score; Ventilación no invasiva; Índice de propensión