Outcome of patients with initial non-mechanical ventilation management in severe pneumonia

Results During the period studied, 113 patients were admitted to our ICU due to severe pneumonia (78 % from community and 22 % from hospital) 36 (31.8 %) were treated initially with invasive ventilation (MV), 45 (39.2%) with non-invasive ventilation (NIV), 5 (4.4%) with highflow nasal cannula (HFNC) and 27 (23.9%) with conventional oxygen therapy (COT). NIV was applied to older and more sick (as measured by APACHE II) patients compared to HFNC and COT [63.3 years (CI 95% 58.2-68.5) vs 48.3 (41.5-55) p 0.001; APACHE 17.8 (16.1-19.4) vs 14.9 (12.8-17) p 0.03] ICU stay and mortality was higher in NIV group compared to conventional therapy [8 days (IQR 5-18) vs 4 (2-11) p 0.004; mortality 35.5 % vs 9.1 % p 0.007] Higher rate of delayed intubation was observed in NIV patients, not reaching statistical difference between groups (40 % vs 24.2 % p 0.15) In those with delayed intubation, duration of MV was higher [13 days (IQR 626) vs 8 (3-11) p 0.006] Those patients requiring escalation to mechanical ventilation presented, as was expected, double mortality (50 % vs 11.5 % p 0.001) Among all patients finally ventilated (63 patients), those with delayed MV had similar age an APACHE II but longer ICU and hospital stay and duration of mechanical ventilation [13 (5-17) vs 19 days (13-39) p 0.005; 18 (12-25) vs 30 days (15.5-47.5) p 0.032; 8 (3-11) vs 13 days (6-26) p 0.006] and a trend to higher mortality (46.4 vs 34.3 %; ns).