Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review.

Nicolò Maria Vanoni,Laura Saderi,Andrea Gori,Francesco Blasi,Noemi Borsa,Marco Mantero,Stefano Aliberti,Manuela Carugati,Giovanni Sotgiu

doi:10.3390/medsci7010010

Abstract

Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). We performed a systematic review of the available English literature published in the period 1 January 1997 to 31 August 2017 and focused on ARF in CAP. The database searches identified 189 articles—of these, only 29 were retained for data extraction. Of these 29 articles, 12 addressed ARF in CAP without discussing its ventilatory management, while 17 evaluated the ventilatory management of ARF in CAP. In the studies assessing the ventilatory management, the specific treatments addressed were: high-flow nasal cannula (HFNC) (n = 1), continuous positive airway pressure (n = 2), non-invasive ventilation (n = 9), and invasive mechanical ventilation (n = 5). When analyzed, non-invasive ventilation (NIV) success rates ranged from 20% to 76% and they strongly predicted survival, while NIV failure led to an increased risk of adverse outcome. In conclusion, ARF in CAP patients may require both ventilatory and non-ventilatory management. Further research is needed to better evaluate the use of NIV and HFNC in those patients. Alongside the prompt administration of antimicrobials, the potential use of steroids and the implementation of severity scores should also be considered.

Highlights

The Global Burden of Disease (GBD) 2016 Lower Respiratory Infections Collaborators estimated the morbidity and mortality from lower respiratory infections: lower respiratory infections represented a leading global infectious cause of mortality in all age groups (2,377,697 deaths, 95% UI2,145,584–2,512,809), including in children younger than 5 years (652,572 deaths, 586,475–720,612)and among adults older than 70 years (1,080,958 deaths, 943,749–1,170,638) [1]
The papers were divided into two groups: those evaluating acute respiratory failure (ARF) in Community-acquired pneumonia (CAP) but not its ventilatory management (n = 12) [10,20,21,22,23,24,25,26,27,28,29,30] and those evaluating ventilatory management of ARF in CAP
Our review raised several important points regarding the management of ARF in CAP

Summary

Introduction

Among adults older than 70 years (1,080,958 deaths, 943,749–1,170,638) [1]. Community-acquired pneumonia (CAP) is defined as pneumonia presenting before hospitalization or within 48 h from hospital admission. Community-acquired pneumonia is a leading cause of emergency department (ED) visits and hospitalizations worldwide (e.g., 423,000 ED visits occurred in 2014 in the United States) [3]. CAP may be characterized by a severe clinical presentation, requiring a high level of care, such as admission to an intensive care unit (ICU) [4]. It has been estimated that CAP accounts for approximately 6% of all ICU admissions, with an ICU mortality of 35%, and overall in-hospital mortality of 50% [5]

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Results

Conclusion