The Impact of NIV on Hospital Duration in Pneumonia with Comorbid Heart Failure

Background: Pneumonia is still a key source of morbidity and mortality worldwide, particularly in patients with pre-existing heart failure. In addition, the coexistence of both diseases makes respiratory management more challenging and recovery takes longer. Non-invasive ventilation (NIV) has been increasingly considered as an alternative to invasive mechanical ventilation with potential benefits in decreasing complications, hospital stay and treatment-related costs. Objectives: The aim of this study was to assess the impact of non-invasive ventilation on hospital stay among patients with pneumonia and comorbid heart failure and to compare results with invasive ventilation strategies. Study design: A Prospective study. Place and duration of study: Pulmonology Department, Fatima Jinnah Institute of Chest Diseases, Quetta, from 01 December 2024 to 31 May 2025. Methods: A Prospective study was performed in patients admitted with pneumonia and heart failure who needed mechanical ventilation. Subjects were divided into two groups, one treated first with non-invasive ventilation (NIV) and the other with invasive ventilation. Demographic information, clinical outcome, and duration of hospital stay were analysed. Student's t-test was used to compare continuous variables and chi-square tests were used for categorical data. A p-value of less than 0.05 was taken as statistically significant. Results: The total number of patients analyzed was 120. The mean age was 67.8 ± 10.2 years. Of these, 65 patients were first treated with NIV and 55 were treated with invasive ventilation. The mean LOS was significantly shorter in the NIV group (7.1 +- 2.6 days) compared with invasive ventilation (10.4 +- 3.0 days; p<0.001). Mortality was numerically lower in the NIV by 12.3% compared with invasive ventilation (19.6%), but not statistically significant (p=0.08). Patients that needed conversion from NIV to invasive support had longer hospital stay (11.2 + 2.9 days). Conclusion: NIV shortened the length of hospital stay in patients with pneumonia and comorbid heart failure compared with invasive ventilation and confirms the clinical utility of NIV for appropriately selected cases in the early stages of respiratory failure. Although the mortality benefit did not reach statistical significance, shorter hospitalization is efficient care. Also, consistent follow-up to quickly detect NIV failure is still key. These results argue for the need for a personalized approach to ventilation to maximize outcome in this high-risk group of patients.