OBJECTIVE: We investigated rates and predictors of ventilatory support during hospitalization in seemingly not severely compromised nonsurvivors of community-acquired pneumonia (CAP). METHODS: We used the database from the German nationwide mandatory quality assurance program including all hospitalized patients with CAP from 2007 to 2011. We selected a population not residing in nursing homes, not bedridden, and not referred from another hospital. Predictors of ventilatory support were identified using a multivariate analysis. RESULTS: Overall, 563,901 patients (62.3% of the whole population) were included. Mean age was 69.4 ± 16.6 years; 329,107 (58.4%) were male. Mortality was 39,895 (7.1%). A total of 28,410 (5.0%) received ventilatory support during the hospital course, and 76.3% of nonsurvivors did not receive ventilatory support (62.6% of those aged <65 years and 78% of those aged ≥65 years). Higher age (relative risk (RR) 0.48, 95% confidence interval (CI) 0.44-0.51), failure to assess gas exchange (RR 0.18, 95% CI 0.14-0.25) and to administer antibiotics within 8 h of hospitalization (RR 0.48, 95% CI 0.39-0.59) were predictors of not receiving ventilatory support during hospitalization. Death from CAP occurred significantly earlier in the nonventilated group (8.2 ± 8.9 vs. 13.1 ± 14.1 days; p < 0.0001). CONCLUSIONS: The number of nonsurvivors without obvious reasons for withholding ventilatory support is disturbingly high, particularly in younger patients. Both performance predictors for not being ventilated remain ambiguous, because they may reflect either treatment restrictions or deficient clinical performance. Elucidating this ambiguity will be part of the forthcoming update of the quality assurance program.
OBJECTIVE: We investigated rates and predictors of ventilatory support during hospitalization in seemingly not severely compromised nonsurvivors of community-acquired pneumonia (CAP). METHODS: We used the database from the German nationwide mandatory quality assurance program including all hospitalized patients with CAP from 2007 to 2011. We selected a population not residing in nursing homes, not bedridden, and not referred from another hospital. Predictors of ventilatory support were identified using a multivariate analysis. RESULTS: Overall, 563,901 patients (62.3% of the whole population) were included. Mean age was 69.4 ± 16.6 years; 329,107 (58.4%) were male. Mortality was 39,895 (7.1%). A total of 28,410 (5.0%) received ventilatory support during the hospital course, and 76.3% of nonsurvivors did not receive ventilatory support (62.6% of those aged <65 years and 78% of those aged ≥65 years). Higher age (relative risk (RR) 0.48, 95% confidence interval (CI) 0.44-0.51), failure to assess gas exchange (RR 0.18, 95% CI 0.14-0.25) and to administer antibiotics within 8 h of hospitalization (RR 0.48, 95% CI 0.39-0.59) were predictors of not receiving ventilatory support during hospitalization. Death from CAP occurred significantly earlier in the nonventilated group (8.2 ± 8.9 vs. 13.1 ± 14.1 days; p < 0.0001). CONCLUSIONS: The number of nonsurvivors without obvious reasons for withholding ventilatory support is disturbingly high, particularly in younger patients. Both performance predictors for not being ventilated remain ambiguous, because they may reflect either treatment restrictions or deficient clinical performance. Elucidating this ambiguity will be part of the forthcoming update of the quality assurance program.
Authors: Stefano Aliberti; Asad Amir; Paula Peyrani; Mehdi Mirsaeidi; Marty Allen; Brian K Moffett; John Myers; Fidaa Shaib; Maria Cirino; Jose Bordon; Francesco Blasi; Julio A Ramirez Journal: Chest Date: 2008-06-26 Impact factor: 9.410
Authors: Vicente F Corrales-Medina; Daniel M Musher; George A Wells; Julio A Chirinos; Li Chen; Michael J Fine Journal: Circulation Date: 2012-01-04 Impact factor: 29.690
Authors: James D Chalmers; Joanne K Taylor; Pallavi Mandal; Gourab Choudhury; Aran Singanayagam; Ahsan R Akram; Adam T Hill Journal: Clin Infect Dis Date: 2011-09 Impact factor: 9.079
Authors: R Menéndez; A Torres; S Reyes; R Zalacain; A Capelastegui; J Aspa; L Borderías; J J Martín-Villasclaras; S Bello; I Alfageme; F R de Castro; J Rello; L Molinos; J Ruiz-Manzano Journal: Eur Respir J Date: 2011-08-04 Impact factor: 16.671
Authors: T P Meehan; M J Fine; H M Krumholz; J D Scinto; D H Galusha; J T Mockalis; G F Weber; M K Petrillo; P M Houck; J M Fine Journal: JAMA Date: 1997-12-17 Impact factor: 56.272
Authors: S Ewig; N Birkner; R Strauss; E Schaefer; J Pauletzki; H Bischoff; P Schraeder; T Welte; G Hoeffken Journal: Thorax Date: 2009-05-18 Impact factor: 9.139