Ipratropium bromide nebulization plus SOM: Protective effects in severe pneumonia with respiratory failure

Background: The additional pharmacological effects of ipratropium bromide, a short-acting anticholinergic agent, remain controversial within the context of standardized stress-oriented management (SOM). Objectives: To evaluate the effects of SOM combined with ipratropium bromide nebulization therapy on oxygenation status, respiratory mechanics, inflammatory stress responses and clinical outcomes in patients with severe pneumonia (SP) complicated with respiratory failure (RF) (SP+RF). Methods: This study retrospectively analyzed 168 patients with SP and RF admitted between March 2024 and August 2025 were enrolled and divided into an observation group (n = 81) and a control group (n = 87) based on whether they received ipratropium bromide nebulization therapy. Primary outcome measures included: oxygenation status, respiratory mechanics parameters, incidence of multiple organ dysfunction syndrome (MODS) and organ function indicators, inflammatory and stress markers, and clinical outcomes. Results: Regarding oxygenation status, the observation group demonstrated superior PaO2/FiO2, SpO2 and blood lactate results compared to the control group at 24 hours post-treatment (T1) and 48 hours post-treatment (T2) (p<0.05). Respiratory mechanics parameters showed that airway resistance (Raw), peak airway pressure (Ppeak) and plateau pressure (Pplat) were lower in the observation group than in the control group at T1 (p<0.05); static lung compliance (Cst) showed more pronounced improvement at T2. Additionally, the incidence of MODS was lower in the observation group (p<0.05). Regarding inflammatory markers, the observation group exhibited lower levels of CRP and cortisol (p<0.05). Clinical outcomes demonstrated shorter DMV and length of hospital stay in the observation group (p<0.05), but no statistically significant difference was observed between the two groups in 28d-M (p>0.05). Conclusion: In patients with SP+RF, SOM plus ipratropium bromide nebulization significantly improves oxygenation status, respiratory mechanics, and inflammatory stress responses, shortens the duration of mechanical ventilation and the length of hospital stay, and reduces the risk of MODS.