LAUSR

Background: Antibiotic combination and NIV have been widely applied in severe pneumonia patients, the advanced ventilation mode (e.g.average volume assured pressure support auto-titrating EPAP, AVAPS-AE) and its impact have been rarely reported. Objectives: To evaluate the effect of AVAPS-AE mode and antibiotic combination for severe pneumonia patients. Methods: A prospective, randomized and controlled study,64 young(27.3±8.9 yrs)patients were included, who had a history of chronic kidney disease (CKD)and immunosuppressant therapy. All subjects were randomly assigned(1:1:1:1) into 4 groups:"antibiotic monotherapy”,"combination”(without NIV) ,“combination+AVAPS ”, “combination+AVAPS-AE"group. Settings in AVAPS-AE:EPAPmax=20cmH2O, EPAPmin=4cmH2O, IPAP:12-25cmH2O, the same setting in AVAPS, except the EPAP. Results: There were no significant differences in 28-day mortality, intubation rate(Fig. 1), changes of procalcitonin and PO2/FiO2 among groups(p>0.05). Better comfort degree and lower incidence rate of patient-ventilator asynchrony during NIV in AVAPS-AE group than in AVAPS group (p Conclusions: This finding suggest that severe pneumonia patients with CKD maybe could not benefit from antibiotic combination. AVAPS-AE can improve comfort, but couldnot change prognosis. Clinicians should be on guard against sever adverse effects after combination therapy.