Bibliographic record
Abstract
Introduction: The role of non invasive ventilation (NIV) in community acquired pneumonia (CAP) is controversial. Despite a lack of data supporting its use, NIV is commonly used in the management of patients with CAP. It is unclear which patients benefit from NIV and avoid endotracheal intubation Hypothesis: The objectives of this study were 1) to describe baseline clinical characteristics and outcomes of patients with CAP receiving NIV, 2) identify parameters predicting NIV success and 3) compare complications of NIV to invasive ventilation (IV). Methods: A retrospective cohort study with patients admitted to three critical care units from 2007 to 2012 with a diagnosis of CAP requiring either NIV or IV was employed. Data collected consisted of baseline characteristics, co-morbidities, duration and type of ventilation applied. The primary study outcome was intubation rate in patients on NIV. Secondary outcomes were mortality, critical care unit and hospital length of stay (LOS), and complications during ventilation. Results: The total cohort consisted of 229 patients who were ventilated with either NIV or IV for CAP. Ninety-three patients received IV while 136 received NIV. The median age was 73 years in the NIV group and 68 in the IV group. Prior illness was present in 94.9% of the NIV group and 90.3% of the IV group. No significant differences in baseline characteristics existed between the two groups. There was no difference in mortality (46 vs 33 p=0.61), critical care unit LOS (9 vs 9 days p=0.74), and hospital LOS (20 vs 17 days p=0.52) between the two groups. From the 136 patients in the NIV group 74% failed and required endotracheal intubation. Fifty patients (49.5%) in the NIV failure group and 4 patients (11.4%) in the NIV success group required vasopressors. There was an increase in mortality (53 vs 8 p=0.002), hemodynamic instability (54 vs 8 p<0.001), and lactic acidosis (31 vs 2 p=0.003) in the NIV failure group. Conclusions: NIV is often initiated for CAP in elderly patients with prior illnesses. The majority of patients started on NIV required intubation. Patients who failed NIV were more likely to be hemodynamically unstable and have a higher rate of complications.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.596 | 0.473 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".