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Predictors of non‑invasive ventilation failure for community acquired pneumonia: a retrospective cohort study

Predictors of non‑invasive ventilation failure for community acquired pneumonia: a retrospective cohort study
Predictors of non‑invasive ventilation failure for community acquired pneumonia: a retrospective cohort study
Introduction: the use of non-invasive ventilation (NIV) for community acquired pneumonia (CAP) is not routinely recommended. NIV failure is associated with increased mortality, highlighting the need for careful patient selection. We aimed to identify predictors of NIV failure for severe CAP in our ICU.

Methods: in this single-center retrospective cohort study, we included consecutive adults with CAP who received NIV as their initial respiratory support on our ICU. The study data was collected for the period between 1st February 2016 and 30th April 2017. We categorized patients as either NIV success (defined as discharged alive from ICU) or NIV failure (defined as requirement for mechanical ventilation or death). Sequential Organ Failure Assessment (SOFA) score, Heart Rate, Acidosis, Consciousness, Oxygenation, and Respiratory Rate (HACOR) score and ratio of oxygen saturations (ROX) index at various timepoints are reported.

Results: we included 106 patients (median age 63 years, 56% male). Median PaO2/FiO2 ratio and SOFA score on ICU admission were 155 mmHg and 5 respectively. Overall, our NIV success rate was 59% and in patients with NIV success, 28-day mortality was lower than for patients who failed NIV (13 vs 35%, p = 0.0085). In univariate analysis, NIV failure was associated with SOFA score (OR 1.33), HACOR score (OR 1.14) and presence of septic shock (OR 3.99). SOFA score has an AUC of 0.75 for NIV failure on ICU admission, whilst HACOR has an AUC of 0.76 after 2 h of NIV. A threshold of HACOR ≤ 5 after 2 h of NIV predicts success with sensitivity and specificity of 53% and 85%, whereas SOFA ≤ 4 has a sensitivity and specificity of 61% and 72%. There were no differences in pH, PaO2/FiO2 ratio, PaCO2 or ROX index between NIV success or failure at any timepoint.

Conclusions: our results suggest that SOFA ≤ 4 and HACOR ≤ 5 are reasonable thresholds to identify patients with severe CAP likely to benefit from NIV.
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
Fritche, Dominic
918e6453-3c9a-4e15-9e27-22ca6ec09efb
WATSON, ADAM
502a836d-bf39-47cb-8240-318034005e9a
Roe, Thomas
a636f94c-9bd2-46b6-b762-455a13159113
Thomas, Charlotte
aba2b825-5500-4d37-8893-7312bbebc5df
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
Fritche, Dominic
918e6453-3c9a-4e15-9e27-22ca6ec09efb
WATSON, ADAM
502a836d-bf39-47cb-8240-318034005e9a
Roe, Thomas
a636f94c-9bd2-46b6-b762-455a13159113
Thomas, Charlotte
aba2b825-5500-4d37-8893-7312bbebc5df
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39

Dushianthan, Ahilanandan, Fritche, Dominic, WATSON, ADAM, Roe, Thomas, Thomas, Charlotte and Saeed, Kordo (2024) Predictors of non‑invasive ventilation failure for community acquired pneumonia: a retrospective cohort study. 43rd International Symposium on Intensive Care & Emergency Medicine, , Brussels, Belgium.

Record type: Conference or Workshop Item (Other)

Abstract

Introduction: the use of non-invasive ventilation (NIV) for community acquired pneumonia (CAP) is not routinely recommended. NIV failure is associated with increased mortality, highlighting the need for careful patient selection. We aimed to identify predictors of NIV failure for severe CAP in our ICU.

Methods: in this single-center retrospective cohort study, we included consecutive adults with CAP who received NIV as their initial respiratory support on our ICU. The study data was collected for the period between 1st February 2016 and 30th April 2017. We categorized patients as either NIV success (defined as discharged alive from ICU) or NIV failure (defined as requirement for mechanical ventilation or death). Sequential Organ Failure Assessment (SOFA) score, Heart Rate, Acidosis, Consciousness, Oxygenation, and Respiratory Rate (HACOR) score and ratio of oxygen saturations (ROX) index at various timepoints are reported.

Results: we included 106 patients (median age 63 years, 56% male). Median PaO2/FiO2 ratio and SOFA score on ICU admission were 155 mmHg and 5 respectively. Overall, our NIV success rate was 59% and in patients with NIV success, 28-day mortality was lower than for patients who failed NIV (13 vs 35%, p = 0.0085). In univariate analysis, NIV failure was associated with SOFA score (OR 1.33), HACOR score (OR 1.14) and presence of septic shock (OR 3.99). SOFA score has an AUC of 0.75 for NIV failure on ICU admission, whilst HACOR has an AUC of 0.76 after 2 h of NIV. A threshold of HACOR ≤ 5 after 2 h of NIV predicts success with sensitivity and specificity of 53% and 85%, whereas SOFA ≤ 4 has a sensitivity and specificity of 61% and 72%. There were no differences in pH, PaO2/FiO2 ratio, PaCO2 or ROX index between NIV success or failure at any timepoint.

Conclusions: our results suggest that SOFA ≤ 4 and HACOR ≤ 5 are reasonable thresholds to identify patients with severe CAP likely to benefit from NIV.

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More information

Published date: March 2024
Venue - Dates: 43rd International Symposium on Intensive Care & Emergency Medicine, , Brussels, Belgium, 2024-03-19

Identifiers

Local EPrints ID: 494920
URI: http://eprints.soton.ac.uk/id/eprint/494920
PURE UUID: f47364bf-c844-47b3-98a8-20b65cede87e
ORCID for Ahilanandan Dushianthan: ORCID iD orcid.org/0000-0002-0165-3359
ORCID for Kordo Saeed: ORCID iD orcid.org/0000-0003-0123-0302

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Date deposited: 23 Oct 2024 16:44
Last modified: 24 Oct 2024 01:57

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Contributors

Author: Ahilanandan Dushianthan ORCID iD
Author: Dominic Fritche
Author: ADAM WATSON
Author: Thomas Roe
Author: Charlotte Thomas
Author: Kordo Saeed ORCID iD

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