Noninvasive pressure support ventilation in non-COPD patients with acute cardiogenic pulmonary edema and severe community-acquired pneumonia: acute effects and outcome

Objective: To compare the acute effects of noninvasive pressure support ventilation (NIPSV) in non-COPD patients with acute cardiogenic pulmonary edema (CPE) and severe community-acquired pneumonia (CAP) presenting with a similar hypoxemic respiratory failure and exploring the ensuing impact on outcome. Design: Prospective, observational study. Setting: Multidisciplinary ICU, regional teaching hospital. Patients: Non-COPD patients with CPE or severe CAP. Measurements and results: Fifteen patients with CPE and eighteen with CAP were included. Both groups had similar low PaO2/FiO(2) ratios at admission; SAPS II, baseline pH(a) were lower in the CPE group than in the CAP group. Within the first NIPSV observation period (60 min), the oxygenation improved significantly in both CPE and CAP-groups; respiratory rate (RR) significantly decreased in the CPE group (P = 0.005), but it remained unchanged in the whole CAP group; heart rate and mean arterial pressure significantly decreased in both groups. One patient (6.6%) in the CPE group and seven patients (38%) in the CAP group were intubated (P = 0.04). The mean total time spent on NIPSV was 9.6 +/- 6.3 h in the CPE and 37.2 +/- 36 h in the CAP group (P = 0.01). Unit mortality rate was 6.6% in the CPE and 28% in the CAP group (P = 0.2). Upon inclusion, all but one CAP patients who were subsequently intubated had a bacteremic pneumonia; unit mortality rate was 57% in intubated- and 9% in non-intubated CAP patients (P = 0.05). Conclusions: NIPSV equally and rapidly improved oxygenation in non-COPD patients with CPE and severe CAP presenting with a similar hypoxemic respiratory failure, but the subsequent outcome was definitely different in the two groups, depending on the nature of the acute lung injury.