Ganador de la convocatoria del Premio de Investigación Mateu Orfila 2015:
Autores: Gemma Rialp, MDa,c , Catalina Forteza, M03·c, Daniel Muñiz, MDb,c. Maria Romero, MDa.c.
Título del trabajo: Role of noninvasive ventilation in non-COPD subjects with pneumonia in a critical care setting.
Resumen del trabajo:
Introduction
The use of noninvasive ventilation (NIV) in non-COPD subjects with pneumonia is controversial due to its high rates of failure and its potentially harmful effects when NIV fails. The purpose of the study was to evaluate the outcome of subjects according to the first ventilatory treatment applied, NIV or invasive mechanical ventilation (MV), and to identify which factors predicted NIV failure.
Methods
Historical cohort study with 159 non-COPD subjects with pneumonia admitted in ICU with ventilatory support. Subjects were classified in invasive MV or NIV group. Univariable and multivariable analysis with demographic and clinical data were performed. Analysis of mortality was adjusted by the propensity score of receiving first-line invasive MV.
Results
113 subjects received first-line invasive MV and 46 received first-line NIV, 27 of whom needed intubation. Hospital mortality was 35%, 37% and 56%, respectively, without 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 [1.04, (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=0.004), prolonged the length of invasive MV (p=0.007) and ICU stay (p=0.001). NIV failure was associated with the need of vasoactive drugs [OR 7.8 (95%CI, 1.8-33.2), p=0.006].
Conclusions
In non-COPD subjects with pneumonia, first-line NIV was not associated with better outcome than 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.
