Non-invasive ventilation is less efficient in pneumonia than in chronic obstructive pulmonary disease exacerbation

Non-invasive ventilation (NIV) is especially valid for acute exacerbation in chronic obstructive pulmonary disease (COPD), but the trend has been to use it for all types of patients with acute respiratory failure (ARF). Recent data suggest that treatment failure occurs more often in patients with ARF from pneumonia than from COPD.

This was a retrospective study using data from patients with ARF admitted into the intensive care unit in a university-affiliated hospital in the period from 1 January 2009 to 31 December 2012 and treated with NIV. Patients with ARF due to acute exacerbation in COPD or ARF due to pneumonia were included. The primary end-point was treatment failure (intubation). The secondary end-point was in-hospital mortality. A total of 107 patients were included, 42 in the COPD group and 65 in the pneumonia group.

We found no significant difference between the two groups with regard to age (mean 65 ± 8 years (COPD) versus mean 64 ± 16 years (pneumonia)), sex (male/female 23/19 (COPD) versus male/female 26/39 (pneumonia)) or New Simplified Acute Physiology Score (SAPS II) (mean 47 ± 11 (COPD) versus mean 51 ± 15 (pneumonia)). Treatment failure occurred in five patients in the COPD group (12%) and in 32 patients in the pneumonia group (49%), p < 0.00001. In-hospital mortality occurred in six patients in the COPD group (14%) and in 21 patients in the pneumonia group (32%), p = 0.01.

NIV is less effective in the treatment of ARF due to pneumonia than in the treatment of ARF due to acute exacerbation in COPD.

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