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Med. Sci. 2019, 7(1), 10;

Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review

Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, 20122 Milan, Italy
Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Infectious Diseases Unit, 20122 Milan, Italy
Division of Infectious Diseases, Duke University, 27710 Durham, NC, USA
Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
These two authors contributed equally and are considered first authors for this manuscript.
Author to whom correspondence should be addressed.
Received: 28 November 2018 / Revised: 3 January 2019 / Accepted: 8 January 2019 / Published: 14 January 2019
(This article belongs to the Section Pneumology and Respiratory Diseases)
PDF [457 KB, uploaded 14 January 2019]


Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). We performed a systematic review of the available English literature published in the period 1 January 1997 to 31 August 2017 and focused on ARF in CAP. The database searches identified 189 articles—of these, only 29 were retained for data extraction. Of these 29 articles, 12 addressed ARF in CAP without discussing its ventilatory management, while 17 evaluated the ventilatory management of ARF in CAP. In the studies assessing the ventilatory management, the specific treatments addressed were: high-flow nasal cannula (HFNC) (n = 1), continuous positive airway pressure (n = 2), non-invasive ventilation (n = 9), and invasive mechanical ventilation (n = 5). When analyzed, non-invasive ventilation (NIV) success rates ranged from 20% to 76% and they strongly predicted survival, while NIV failure led to an increased risk of adverse outcome. In conclusion, ARF in CAP patients may require both ventilatory and non-ventilatory management. Further research is needed to better evaluate the use of NIV and HFNC in those patients. Alongside the prompt administration of antimicrobials, the potential use of steroids and the implementation of severity scores should also be considered.
Keywords: pneumonia; ventilation; CPAP; NIV; BiLevel pneumonia; ventilation; CPAP; NIV; BiLevel
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Vanoni, N.M.; Carugati, M.; Borsa, N.; Sotgiu, G.; Saderi, L.; Gori, A.; Mantero, M.; Aliberti, S.; Blasi, F. Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review. Med. Sci. 2019, 7, 10.

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