Community-acquired pneumonia and non-invasive ventilation-a valid ICU avoidance strategy?

Abstract

The British Thoracic Society guidelines state that neither non-invasive ventilation (NIV) nor continuous positive airway pressure support is routinely indicated in the management of patients with respiratory failure due to community-acquired pneumonia (CAP).1 These guidelines were published some years ago—is there now more robust recent evidence to support the use of NIV in pneumonia? We therefore welcome the meta-analysis by Dr Klefti and colleagues at the University of Edinburgh which addresses this important question. In more recent times, the QJM has been publishing relevant meta-analysis on clinically relevant issues related to acute coronavirus disease 2019 (COVID-19) infection.2–5 As we learn to live with COVID, we welcome reviews relating to pertinent non-COVID clinical questions. In relation to the pertinent clinical question—is NIV indicated in the management of CAP—the authors report a significant benefit, in particular with regards to NIV significantly reducing the rate of endotracheal intubation (risk ratio (RR) 0.46, 95% confidence interval (CI) [0.26–0.79]), and ICU mortality rate (RR 0.3, 95% CI [0.09–0.93]). National clinical guidelines are the foundation stone for best clinical practice. The British Thoracic Society last published full clinical guidelines for the management of CAP 13 years ago—perhaps it is time for an update?