Dados do Trabalho

Título

Severe CAP requiring ventilatory support in an upper-middle income country: A prospective multicenter cohort study of 11,305 patients admitted to Brazilian ICUs

Objetivo

Describe characteristics and outcomes of adult patients with severe community acquired pneumonia(sCAP) requiring ventilatory support admitted to Brazilian ICUs.

Métodos

Retrospective 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 descriptive statistics and survival between groups.

Resultados

We included 11305 patients: NIV was used by 73% of patients; and IMV, by 27%. ICU and hospital mortality were 19% and 23% respectively. Pre-pandemic patients were older (78 vs 74; p<0.001) and more frail (88% vs. 79% p<0.001). Pre-pandemic resource utilization at the first 24h was higher in the first period (IMV 37% vs 21%; vasopressors 33% vs 21%; renal replacement therapy 3.4% vs 2.4%; p=0.002); ICU and hospital length-of-stay were higher (7 vs 5; 13 vs 9; p< 0.001); ICU (24% vs 16%, p<0.001) and hospital mortality were higher (28% vs 20%, p<0.001). In the IMV subgroup analysis, post-pandemic patients had higher median SOFA (7 vs 8 p=0.001), SAPS3 (70 vs 72 p=0.001), and ICU mortality (43% vs 47% p=0.002). Factors associated with lower survival were older age (HR=1.86, 95%CI 1.72 - 2.00 p<0.001), active cancer (HR=1.59, 95%CI 1.49 - 1.70 p<0.001), vasopressor use (HR=1.68, 95%CI 1.59 - 1.78 p<0.001),and IMV support (HR=2.18, 95%CI 2.05 - 2.32 p<0.001).

Conclusão

In this sCAP cohort, we observed lower survival in the post-pandemic period among mechanically ventilated patients.