Introduction: The goal of this study is to describe clinical characteristics and outcomes of adult patients with severe community acquired pneumonia (sCAP) requiring ventilatory support. Methods: Multicenter cohort study of patients with sCAP requiring either non-invasive mechanical ventilation (NIMV) or invasive mechanical ventilation (IMV) admitted between January 1st, 2018 and December 31st, 2019 and January 1st, 2022 and December 31st, 2023 were included. We compared characteristics and survival between groups. Results: We included 11305 patients. Median age was 76 years (IQR 59 - 86), 55% female, most patients were frail or pre-frail (82%) and frequent comorbidities were hypertension (59%), diabetes (31%) and cancer (16%). Vasopressors were used by 25% of patients and renal replacement therapy by 2.7%. Non-invasive ventilation (NIV) was used by 73% of patients and 27% were invasively ventilated. ICU and hospital mortality were 19% and 23% respectively. Patients in the pre-pandemic period were older (78 vs 74; p< 0.001), more frail (88% vs. 79% p< 0.001). Resource utilization was higher in the first period (IMV 37% vs 21%, vasopressors 33% vs 21%, and renal replacement therapy 3.4% vs 2.4%; p=0.002). Both ICU and hospital length of stays were shorter in the second period (7 vs 5 and 13 vs 9). Mortality, however, was significantly higher in the first period - ICU mortality 24 vs 16% and hospital mortality 28 vs 20% (p< 0.001). In the IMV subgroup analysis, patients in the second period patients presented more organ dysfunctions (SOFA=7 vs 8 p=0.001) and SAPS3 (70 vs 72 p=0.001), and ICU mortality was slightly higher (43% vs 47% p=0.002). Factors related to higher mortality according to Cox regression model were older age, frailty, and need for invasive respiratory support. Conclusions: In this sCAP cohort, older age, frailty, and need for invasive respiratory support were associated with worse outcomes. Despite overall lower age and severity, we observed lower survival in the post-pandemic period among mechanically ventilated patients.
Pitrowsky et al. (Sun,) studied this question.