Timing Of Sequential Noninvasive Mechanical Ventilation Following Early Extubation In Older Severe Community-acquired Pneumonia Patients

Objective: To explore the timing of sequential noninvasive positive pressure ventilation(NIPPV)after early extubation in older patients with severe community acquired pneumonia(SCAP).Methods: Older SCAP patients aged ? 75 years were recruited from the respiratory intensive care unit(RICU)of the First Affiliated Hospital of Xinjiang Medical University from July 2017 to August 2019.Endotracheal intubation mechanical ventilation(ETI-MV)was initially accepted as the respiratory support tool.Sequential NIPPV was performed immediately following extubation when the patients exhibited pulmonary infection abated window.Results: Fifty patients were included in the study.According to ETI duration,these patients were divided into two groups: ETI?7days group(24 cases)and ETI>7days group(26 cases).Compared with ETI>7days group,the mortality and rate of reintubation decreased significantly [12.5%(3/24)vs 38.5%(10/26),4.2%(1/24)vs 53.8%(14/26),respectively,both P<0.05].The duration of mechanical ventilation,the days of RICU stay and the inhospital time all shortened significantly(days: 11.3±3.1 vs 23.8±11.8,16.0±5.1 vs 30.6±14.1,and 20.2±6.1 vs 33.0±14.9,respectively,all P<0.05).Compared with ETI>7days group,the incidence of concurrent cerebrovascular diseases,VAP and the incidence of aspiration was significantly lower in ETI?7days group [16.7%(4/24)vs 46.2%(12/26),16.7%(4/24)vs 61.5 %(16/26)and 25.0%(6/24)vs 69.2%(18/26),respectively,all P<0.05].Multivariate logistic regression analysis showed that the incidence of aspiration and VAP could independently predict ETI>7days(OR=5.903,95%CI=1.474~23.635,P=0.012;OR=4.852,95%CI=1.076~21.877,P=0.040,respectively).The ROC curve of VAP showed that the area under curve(AUC),the sensitivity,the specificity,the positive predictive value(PPV),the negative predictive value(NPV),the positive likelihood ratio(PLR),the negative likelihood ratio(NLR)and the Youden index were of 0.724,61.54%,83.33%,80.00%,66.67%,3.69,0.46 and 0.45,respectively.Similarly,the ROC curve of aspiration showed that the AUC,the sensitivity,the specificity,the PPV,NPV,PLR,NLR and Youden index were of 0.721,69.23%,75.00%,75.00%,69.23%,2.77,0.41 and 0.44,respectively.Conclusion:If the sequential NIPPV following ETI within 7 days was performed in the older patients with SCAP,it may be helpful to reduce the mortality and shorten the period of mechanical ventilation.If aspiration or VAP occurred,the ETI duration could be prolonged.