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

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.

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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Contributors

Author: Ahilanandan Dushianthan

Author: Kordo Saeed

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