Early noninvasive ventilation treatment for respiratory failure due to severe community-acquired pneumonia

INTRODUCTION: Acute respiratory failure (ARF) frequently complicates severe community-acquired pneumonia (CAP) that together with sepsis increases patient mortality. The background of the noninvasive ventilation (NIV) use is to overcome an episode of ARF avoiding invasive mechanical ventilation (IMV) and its associated morbidity. EVIDENCE ACQUISITION: We performed a systematic review of the available English literature published up to December 2018 inclusive and focused on ARF in adult CAP population. Database searches identified 177 articles; of these, only 16 were retained for data extraction. EVIDENCE SYNTHESIS: After analyzing all data, we observed that uncertainties in the current literature do not allow firm and definitive recommendations concerning the early use of NIV in hypoxemic CAP patients. IMV still remains a standard of care for many cases of severe CAP. CONCLUSIONS: Nonetheless, NIV is part of our armamentarium and some optimally selected patients clearly benefit from its use. However, in this setting NIV can be considered a valid and useful strategy in some well-selected patients.