RV systolic performance and hospital length of stay differed across clinically selected respiratory support groups (NIV, HFNC, Venturi mask) in severe CAP outside the ICU, but these associations may reflect clinical severity rather than device-related effects.
Key Findings
Results
RV longitudinal systolic function (TAPSE and lateral tricuspid annular S') showed a graded pattern across respiratory support modalities, lowest with NIV, intermediate with HFNC, and highest with Venturi mask.
Seventy patients with severe CAP (Pneumonia Severity Index class IV-V) were included: NIV n=21, HFNC n=22, Venturi mask n=27.
Both TAPSE and S' differed across groups with p < 0.001.
Echocardiography was performed shortly after ward admission while patients remained on their initial support modality.
Results
Hospital length of stay was substantially longer in the NIV and HFNC groups than in the Venturi mask group.
Mean LOS was 27.8 ± 5.0 days (NIV), 27.4 ± 2.9 days (HFNC), and 15.2 ± 4.0 days (Venturi mask).
The difference across groups was significant (p < 0.001).
Results
In multivariable analysis, age and respiratory support modality were associated with length of stay.
The abstract reports that both age and respiratory support modality were associated with LOS in the multivariable model.
Specific effect estimates are not given in the abstract.
Results
Baseline demographic and cardiometabolic characteristics were comparable across the three respiratory support groups.
Groups were NIV (n=21), HFNC (n=22), and Venturi mask (n=27).
Despite comparable baseline characteristics, the modality was selected in the emergency department by the treating physician based on clinical and gas-exchange assessment, not randomized.
Discussion
The authors state the observed associations may reflect clinical severity (confounding by indication) rather than device-related effects.
This was a single-centre prospective observational study without randomization to modality.
Support modality was chosen according to physician judgment of clinical and gas-exchange status.
Conclusions
The findings extend observations of RV dysfunction in acute respiratory failure from ARDS cohorts to severe CAP outside the ICU.
The authors say the results reinforce the often-overlooked clinical importance of RV assessment in acute respiratory failure.
The study setting was ward-level care after emergency department modality selection.
What This Means
This study followed 70 adults hospitalized with severe community-acquired pneumonia who needed extra oxygen or breathing support outside the intensive care unit. Patients received one of three types of support: non-invasive ventilation (a mask delivering pressurized air), high-flow nasal cannula, or a simple Venturi oxygen mask. Doctors chose the type based on how sick each patient looked. Shortly after ward admission, the researchers used heart ultrasound to measure how well the right side of the heart, which pumps blood to the lungs, was contracting.
Right heart pumping measures were lowest in patients on non-invasive ventilation, in the middle for those on high-flow oxygen, and highest for those on the Venturi mask. Hospital stays followed a similar pattern: about 28 days for the first two groups versus about 15 days for the Venturi mask group. Age and type of respiratory support were both linked to length of stay.
This research suggests that right heart function may be worth checking in severe pneumonia. However, because doctors picked the support type based on how ill patients were, the differences probably reflect illness severity rather than the devices harming the heart or prolonging stays. The study was small, from one centre, and not randomized, so it cannot show that any device causes these differences.
Maida C, Pacinella G, Daidone M, Ferrantelli S, Geraci G, Vassallo G, et al.. (2026). Right ventricular function across different non-invasive respiratory support strategies in severe community-acquired pneumonia.. Heart & lung : the journal of critical care. https://doi.org/10.1016/j.hrtlng.2026.102979