Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community acquired pneumonia; an Egyptian multicenter prospective study

Type of funding sources: None.

Non-invasive ventilation (NIV) might be successful if properly selected in adult patients with cardiac dysfunction presenting with community acquired pneumonia. The main objective was to identify contributing factors to NIV failure.

All adult patients with LV EF less than 50% admitted to the ICU with community acquired pneumonia and acute respiratory failure were enrolled in our multicenter prospective study after getting informed consents . The study was registered and given a number (ID ISRCTN14641518). Non-invasive ventilation failure was defined as requirement of intubation after institution of NIV intervention.

We prospectively enrolled 177 patients between February 2019 to July 2020. Fifty-three patients (29.9%) were considered failed NIV. The mean age of studied patients was 64.1±12.6 years with a male predominance (73.4%) and a mean left ventricle EF of 36.4±7.8%. There were insignificant differences between the NIV success and NIV failure groups regarding the underlying morbidities nor the inflammatory markers. The patients who failed NIV were significantly older with higher mean SOFA and APACHE II scores compared to the patients with succeeded NIV. Non-invasive Ventilation failure was associated with longer ICU stay (p<0.001), higher SOFA at 48 hours (p<0.001) and higher mortality (p<0.001) compared to the NIV success group. NIV failure was independently predicted with APACHE II (OR:1.420, p 0.01, 95% CI:1.224 – 1.647), SOFA (OR:17.6 , p <0.001, 95% CI: 4.148-74.68), baseline HACOR (OR:2.041, P 0.026, 95% CI:1.225 –3.401), lung ultrasound score (OR:1.209,P 0.017,95% CI:1.014–1.441) and blood lactate (OR:9.702,P <0.001,95%CI:1.357–69.37).Conclusion: High initial APACHE II and SOFA scores , hindered lactate clearance as well as non-decrementing patterns of HACOR and LUS scores were associated with early NIV failure in patients with heart failure presenting with community acquired pneumonia.

ROC to predict NIV failure at initiation

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ROC to predict NIV failure at T12.

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