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Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients

Miquel Ferrer Monreal, Chiara Travierso, Catia Cilloniz, Albert Gabarrus, Eva Polverino, Adamantia Liapikou, Francesco Blasi, Antoni Torres
European Respiratory Journal 2016 48: OA3025; DOI: 10.1183/13993003.congress-2016.OA3025
Miquel Ferrer Monreal
1Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes, University of Barcelona, Barcelona, Spain
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Chiara Travierso
2Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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Catia Cilloniz
1Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes, University of Barcelona, Barcelona, Spain
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Albert Gabarrus
1Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes, University of Barcelona, Barcelona, Spain
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Eva Polverino
1Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes, University of Barcelona, Barcelona, Spain
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Adamantia Liapikou
36th Department of Respiratory Medicine, Sotiria Chest Diseases Hospital, Athens, Greece
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Francesco Blasi
2Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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Antoni Torres
1Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes, University of Barcelona, Barcelona, Spain
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Abstract

Background: Severe community-acquired pneumonia (SCAP) is associated with significant morbidity and mortality. Patients with SCAP and life-threatening acute respiratory failure may require invasive mechanical ventilation (IMV); however, there is limited information on these patients.

Methods: We prospectively studied consecutive patients with SCAP. We assessed the characteristics and outcomes of patients on IMV, compared with those who needed non-invasive ventilation (NIV) and no ventilatory support, and determined predictors for mortality and evolution of mortality over time in this population.

Results: Among 3,719 patients diagnosed of CAP during 12 years, 664 (18%) had criteria for SCAP; 154 (23%) were allocated to the IMV group, 94 (14%) to the NIV group, and 416 (63%) did not require any ventilatory support; 198 (30%) presented septic shock. In 370 (56%) cases the diagnosis of SCAP was based solely on the presence of 3 or more IDSA/ATS minor criteria. Streptococcus pneumoniae was the main pathogen in all groups. The 30-day mortality was higher in the IMV, compared to the NIV and non-ventilated groups (51, 33%, vs. 17, 18% and 77, 19%, respectively, p=0·001). IMV, but neither NIV nor shock, independently predicted 30-day mortality in multivariate analysis (adjusted odds-ratio 2.18, 95% confidence interval 1·12-4·24, p=0·022). The 30-day mortality did not significantly change over time during the study period.

Conclusion: The need for IMV independently predicted 30-day mortality in patients with SCAP. Patients needing IMV should be a target population for future clinical trials on new interventions addressed to improve mortality of SCAP.

  • Pneumonia
  • Acute respiratory failure
  • Mechanical ventilation - interactions and complications
  • Copyright ©the authors 2016
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Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients
Miquel Ferrer Monreal, Chiara Travierso, Catia Cilloniz, Albert Gabarrus, Eva Polverino, Adamantia Liapikou, Francesco Blasi, Antoni Torres
European Respiratory Journal Sep 2016, 48 (suppl 60) OA3025; DOI: 10.1183/13993003.congress-2016.OA3025

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Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients
Miquel Ferrer Monreal, Chiara Travierso, Catia Cilloniz, Albert Gabarrus, Eva Polverino, Adamantia Liapikou, Francesco Blasi, Antoni Torres
European Respiratory Journal Sep 2016, 48 (suppl 60) OA3025; DOI: 10.1183/13993003.congress-2016.OA3025
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