Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community-acquired pneumonia: an Egyptian multicenter prospective study
Signa Vitae
; 19(3):121-131, 2023.
Artículo
en Inglés
| CAB Abstracts | ID: covidwho-20238371
ABSTRACT
Non-invasive ventilation (NIV) might be successful if carefully selected in adult patients with cardiac dysfunction presenting with community-acquired pneumonia. The main objective of this study was to identify the early predictors of NIV failure. Adult patients with left ventricle ejection fraction (LV EF) <50% admitted to the intensive care unit (ICU) with community-acquired pneumonia and acute respiratory failure were enrolled in this multicenter prospective study after obtaining informed consents (study registrationID ISRCTN14641518). Non-invasive ventilation failure was defined as the requirement of intubation after initiation of NIV. All patients were assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores at admission, while their Heart rate Acidosis Consciousness Oxygenation and Respiratory rate (HACOR) and lung ultrasound (LUS) scores in addition to blood lactate were assessed at NIV initiation and 12 and 24 hours later. A total of 177 patients were prospectively enrolled from February 2019 to July 2020. Of them, 53 (29.9%) had failed NIV. The mean age of the study cohort was 64.1+or- 12.6 years, with a male predominance (73.4%) and a mean LV EF of 36.4 +or- 7.8%. Almost 55.9% of the studied patients had diabetes mellitus, 45.8% had chronic systemic hypertension, 73.4% had ischemic heart disease, 20.3% had chronic kidney disease, and 9.6% had liver cirrhosis. No significant differences were observed between the NIV success and NIV failure groups regarding underlying morbidities or inflammatory markers. Patients who failed NIV were significantly older and had higher mean SOFA and APACHE II scores than those with successful NIV. We also found that NIV failure was associated with longer ICU stay (p < 0.001), higher SOFA scores at 48 hours (p < 0.001) and higher mortality (p < 0.001) compared with the NIV success group. In addition, SOFA (Odds Ratio (OR) 4.52, 95% Confidence Interval (CI) 2.59-7.88, p < 0.001), HACOR (OR 2.01, 95% CI 0.97-4.18, p = 0.036) and LUS (OR 1.33, 95% CI 1.014-1.106, p = 0.027) scores and blood lactate levels (OR 9.35, 95% CI 5.32-43.26, p < 0.001) were independent factors for NIV failure. High initial HACOR and SOFA scores, persistent hyperlactatemia and non-decrementing LUS score were associated with early NIV failure in patients with cardiac dysfunction presenting with community-acquired pneumonia, and could be used as clinical and paraclinical variables for early decision making regarding invasive ventilation.
Non-communicable Human Diseases and Injuries [VV600]; Prion; Viral; Bacterial and Fungal Pathogens of Humans [VV210]; human diseases; mortality; risk factors; patients; respiratory diseases; adults; ventilation; heart; heart diseases; community acquired infections; community acquired pneumonia; pneumonia; cohort studies; age; diabetes mellitus; blood sugar; blood pressure; hypertension; chronic diseases; ischaemia; kidneys; kidney diseases; liver; cirrhosis; liver diseases; man; Severe acute respiratory syndrome coronavirus 2; Egypt; Homo; Hominidae; primates; mammals; vertebrates; Chordata; animals; eukaryotes; Severe acute respiratory syndrome-related coronavirus; Betacoronavirus; Coronavirinae; Coronaviridae; Nidovirales; positive-sense ssRNA Viruses; ssRNA Viruses; RNA Viruses; viruses; high Human Development Index countries; lower-middle income countries; Mediterranean Region; Middle East; North Africa; Africa; Egyptian; prospective studies; chronic renal insufficiency; death rate; lung diseases; SARS-CoV-2; coronary diseases; Misr; blood glucose; glucose in blood; high blood pressure; ischemia; kidney disorders; nephropathy; renal diseases; liver cirrhosis
Texto completo:
Disponible
Colección:
Bases de datos de organismos internacionales
Base de datos:
CAB Abstracts
Tipo de estudio:
Estudio de cohorte
/
Estudio experimental
/
Estudio observacional
/
Estudio pronóstico
/
Ensayo controlado aleatorizado
Idioma:
Inglés
Revista:
Signa Vitae
Año:
2023
Tipo del documento:
Artículo
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