Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit: An Italian multicenter observational study

3P study group, Anna Maria Brambilla, Elena Prina, Giovanni Ferrari, Viviana Bozzano, Rodolfo Ferrari, Paolo Groff, Giuseppina Petrelli, Raffaele Scala, Fabio Causin, Paola Noto, Emanuela Bresciani, Antonio Voza, Stefano Aliberti, Roberto Cosentini

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and objective: Non-Invasive Ventilation (NIV) represents a standard of care to treat some acute respiratory failure (ARF). Data on its use in pneumonia are lacking, especially in a setting outside the Intensive Care Unit (ICU). The aims of this study were to evaluate the use of NIV in ARF due to pneumonia outside the ICU, and to identify risk factors for in-hospital mortality. Methods: Prospective, observational study performed in 19 centers in Italy. Patients with ARF due to pneumonia treated outside the ICU with either continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) were enrolled over a period of at least 3 consecutive months in 2013. Independent factors related to in-hospital mortality were evaluated. Results: Among the 347 patients enrolled, CPAP was applied as first treatment in 176 (50.7%) patients,NPPV in 171 (49.3%). The NPPV compared with CPAP group showed a significant higher PaCO2 (55 [47–78] vs 37 [32–43] mmHg, p < 0.001), a lower arterial pH (7.30 [7.21–7.37] vs 7.43 [7.35–7.47], p < 0.001), higher HCO3– (28 [24–33] vs 24 [21–27] mmol/L, p < 0.001). De-novo ARF was more prevalent in CPAP group than in NPPV group (86/176 vs 31/171 patients,p < 0.001). In-hospital mortality was 23% (83/347). Do Not Intubate (DNI) order and Charlson Comorbidity Index (CCI) ≥3 were independent risk factors for in-hospital mortality. Conclusions: Outside ICU setting, CPAP was used mainly for hypoxemic non-hypercapnic ARF, NPPV for hypercapnic ARF. In-hospital mortality was mainly associated to patients' basal status (DNI status, CCI) rather than the baseline degree of ARF.

Original languageEnglish
Pages (from-to)21-26
JournalEuropean Journal of Internal Medicine
Volume59
DOIs
Publication statusPublished - 2019

Fingerprint

Positive-Pressure Respiration
Respiratory Insufficiency
Multicenter Studies
Observational Studies
Intensive Care Units
Continuous Positive Airway Pressure
Pneumonia
Hospital Mortality
Noninvasive Ventilation
Comorbidity
Standard of Care
Italy
Prospective Studies

Keywords

  • Continuous positive airway pressure
  • Emergency medicine
  • Noninvasive ventilation
  • Pneumonia
  • Respiratory insufficiency

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit : An Italian multicenter observational study. / 3P study group ; Brambilla, Anna Maria; Prina, Elena; Ferrari, Giovanni; Bozzano, Viviana; Ferrari, Rodolfo; Groff, Paolo; Petrelli, Giuseppina; Scala, Raffaele; Causin, Fabio; Noto, Paola; Bresciani, Emanuela; Voza, Antonio; Aliberti, Stefano; Cosentini, Roberto.

In: European Journal of Internal Medicine, Vol. 59, 2019, p. 21-26.

Research output: Contribution to journalArticle

3P study group, Brambilla, AM, Prina, E, Ferrari, G, Bozzano, V, Ferrari, R, Groff, P, Petrelli, G, Scala, R, Causin, F, Noto, P, Bresciani, E, Voza, A, Aliberti, S & Cosentini, R 2019, 'Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit: An Italian multicenter observational study', European Journal of Internal Medicine, vol. 59, pp. 21-26. https://doi.org/10.1016/j.ejim.2018.09.025
3P study group ; Brambilla, Anna Maria ; Prina, Elena ; Ferrari, Giovanni ; Bozzano, Viviana ; Ferrari, Rodolfo ; Groff, Paolo ; Petrelli, Giuseppina ; Scala, Raffaele ; Causin, Fabio ; Noto, Paola ; Bresciani, Emanuela ; Voza, Antonio ; Aliberti, Stefano ; Cosentini, Roberto. / Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit : An Italian multicenter observational study. In: European Journal of Internal Medicine. 2019 ; Vol. 59. pp. 21-26.
@article{bb76aa04536549e08a872e9c652a201a,
title = "Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit: An Italian multicenter observational study",
abstract = "Background and objective: Non-Invasive Ventilation (NIV) represents a standard of care to treat some acute respiratory failure (ARF). Data on its use in pneumonia are lacking, especially in a setting outside the Intensive Care Unit (ICU). The aims of this study were to evaluate the use of NIV in ARF due to pneumonia outside the ICU, and to identify risk factors for in-hospital mortality. Methods: Prospective, observational study performed in 19 centers in Italy. Patients with ARF due to pneumonia treated outside the ICU with either continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) were enrolled over a period of at least 3 consecutive months in 2013. Independent factors related to in-hospital mortality were evaluated. Results: Among the 347 patients enrolled, CPAP was applied as first treatment in 176 (50.7{\%}) patients,NPPV in 171 (49.3{\%}). The NPPV compared with CPAP group showed a significant higher PaCO2 (55 [47–78] vs 37 [32–43] mmHg, p < 0.001), a lower arterial pH (7.30 [7.21–7.37] vs 7.43 [7.35–7.47], p < 0.001), higher HCO3– (28 [24–33] vs 24 [21–27] mmol/L, p < 0.001). De-novo ARF was more prevalent in CPAP group than in NPPV group (86/176 vs 31/171 patients,p < 0.001). In-hospital mortality was 23{\%} (83/347). Do Not Intubate (DNI) order and Charlson Comorbidity Index (CCI) ≥3 were independent risk factors for in-hospital mortality. Conclusions: Outside ICU setting, CPAP was used mainly for hypoxemic non-hypercapnic ARF, NPPV for hypercapnic ARF. In-hospital mortality was mainly associated to patients' basal status (DNI status, CCI) rather than the baseline degree of ARF.",
keywords = "Continuous positive airway pressure, Emergency medicine, Noninvasive ventilation, Pneumonia, Respiratory insufficiency",
author = "{3P study group} and Brambilla, {Anna Maria} and Elena Prina and Giovanni Ferrari and Viviana Bozzano and Rodolfo Ferrari and Paolo Groff and Giuseppina Petrelli and Raffaele Scala and Fabio Causin and Paola Noto and Emanuela Bresciani and Antonio Voza and Stefano Aliberti and Roberto Cosentini",
year = "2019",
doi = "10.1016/j.ejim.2018.09.025",
language = "English",
volume = "59",
pages = "21--26",
journal = "European Journal of Internal Medicine",
issn = "0953-6205",
publisher = "Elsevier B.V.",

}

TY - JOUR

T1 - Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit

T2 - An Italian multicenter observational study

AU - 3P study group

AU - Brambilla, Anna Maria

AU - Prina, Elena

AU - Ferrari, Giovanni

AU - Bozzano, Viviana

AU - Ferrari, Rodolfo

AU - Groff, Paolo

AU - Petrelli, Giuseppina

AU - Scala, Raffaele

AU - Causin, Fabio

AU - Noto, Paola

AU - Bresciani, Emanuela

AU - Voza, Antonio

AU - Aliberti, Stefano

AU - Cosentini, Roberto

PY - 2019

Y1 - 2019

N2 - Background and objective: Non-Invasive Ventilation (NIV) represents a standard of care to treat some acute respiratory failure (ARF). Data on its use in pneumonia are lacking, especially in a setting outside the Intensive Care Unit (ICU). The aims of this study were to evaluate the use of NIV in ARF due to pneumonia outside the ICU, and to identify risk factors for in-hospital mortality. Methods: Prospective, observational study performed in 19 centers in Italy. Patients with ARF due to pneumonia treated outside the ICU with either continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) were enrolled over a period of at least 3 consecutive months in 2013. Independent factors related to in-hospital mortality were evaluated. Results: Among the 347 patients enrolled, CPAP was applied as first treatment in 176 (50.7%) patients,NPPV in 171 (49.3%). The NPPV compared with CPAP group showed a significant higher PaCO2 (55 [47–78] vs 37 [32–43] mmHg, p < 0.001), a lower arterial pH (7.30 [7.21–7.37] vs 7.43 [7.35–7.47], p < 0.001), higher HCO3– (28 [24–33] vs 24 [21–27] mmol/L, p < 0.001). De-novo ARF was more prevalent in CPAP group than in NPPV group (86/176 vs 31/171 patients,p < 0.001). In-hospital mortality was 23% (83/347). Do Not Intubate (DNI) order and Charlson Comorbidity Index (CCI) ≥3 were independent risk factors for in-hospital mortality. Conclusions: Outside ICU setting, CPAP was used mainly for hypoxemic non-hypercapnic ARF, NPPV for hypercapnic ARF. In-hospital mortality was mainly associated to patients' basal status (DNI status, CCI) rather than the baseline degree of ARF.

AB - Background and objective: Non-Invasive Ventilation (NIV) represents a standard of care to treat some acute respiratory failure (ARF). Data on its use in pneumonia are lacking, especially in a setting outside the Intensive Care Unit (ICU). The aims of this study were to evaluate the use of NIV in ARF due to pneumonia outside the ICU, and to identify risk factors for in-hospital mortality. Methods: Prospective, observational study performed in 19 centers in Italy. Patients with ARF due to pneumonia treated outside the ICU with either continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) were enrolled over a period of at least 3 consecutive months in 2013. Independent factors related to in-hospital mortality were evaluated. Results: Among the 347 patients enrolled, CPAP was applied as first treatment in 176 (50.7%) patients,NPPV in 171 (49.3%). The NPPV compared with CPAP group showed a significant higher PaCO2 (55 [47–78] vs 37 [32–43] mmHg, p < 0.001), a lower arterial pH (7.30 [7.21–7.37] vs 7.43 [7.35–7.47], p < 0.001), higher HCO3– (28 [24–33] vs 24 [21–27] mmol/L, p < 0.001). De-novo ARF was more prevalent in CPAP group than in NPPV group (86/176 vs 31/171 patients,p < 0.001). In-hospital mortality was 23% (83/347). Do Not Intubate (DNI) order and Charlson Comorbidity Index (CCI) ≥3 were independent risk factors for in-hospital mortality. Conclusions: Outside ICU setting, CPAP was used mainly for hypoxemic non-hypercapnic ARF, NPPV for hypercapnic ARF. In-hospital mortality was mainly associated to patients' basal status (DNI status, CCI) rather than the baseline degree of ARF.

KW - Continuous positive airway pressure

KW - Emergency medicine

KW - Noninvasive ventilation

KW - Pneumonia

KW - Respiratory insufficiency

UR - http://www.scopus.com/inward/record.url?scp=85055535075&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055535075&partnerID=8YFLogxK

U2 - 10.1016/j.ejim.2018.09.025

DO - 10.1016/j.ejim.2018.09.025

M3 - Article

AN - SCOPUS:85055535075

VL - 59

SP - 21

EP - 26

JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

ER -