AB 71. Non invasive ventilation in community acquired pneumonia
Background: Non invasive ventilation (NIV) has been used in a number of clinical situations, but it seems to be most effective in patients with acute respiratory failure due to underlying chronic pulmonary disease or cardiogenic pulmonary edema. In community acquired pneumonia (CAP), NIV is not established to be beneficial. In our case, the use of NIV reverses the hypoxemia in a patient with CAP.
Patients and methods: A 73years old male patient with clinical history of diabetes mellitus and hypertension was admitted to our hospital due to severe dyspnea with tachypnea >30 breaths/min, fever (39.2 ℃) and hypoxaemia (Sat: 68%). Chest X-ray showed the presence of right bilobar pneumonia. Also, arterial blood gases were measured: pH: 7.30, pCO2: 47 mm/Hg, pO2: 51 mm/Hg. Due to not availability of ICU, the patient was treated with NIV via full face mask (VPAP settings: IPAP: 16 cm H2O, EPAP: 6 cm H2O 10 lt/min).
Results: 20 min after the use of ICU, the hypoxaemia dramatically resolved (arterial blood gases: pH: 7.35, pCO2:43 mm/Hg, pO2: 88 mmHg). A few days later of NIV application and co- administration of antibiotic treatment, the patient was improved.
Conclusions: Albeit the use of NIV has increased and now become an integral tool in the management of acute and chronic respiratory failure, there are limited data about the use in CAP. Improvement of these patients, with the use of NIV, may decrease intubation rate and complications of invasive ventilation, reduction in length of stay in the ICU and the cost of health care.
