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High flow nasal cannula oxygen therapy in immunocompromised patients with acute hypoxemic respiratory failure
Intensive Care Medicine Experimental volume 3, Article number: A425 (2015)
In the early 2000's, two randomized controlled trials have shown that non-invasive ventilation (NIV) could decrease mortality of immunocompromised patients admitted to ICU for acute respiratory failure (ARF) as compared to standard oxygen therapy (O2) [1, 2]. However, the benefits of NIV in immunocompetent patients with ARF failure are debated. High flow nasal cannula oxygen therapy (High-Flow Oxygen) may offer an alternative in hypoxemic patients. We recently found in a randomized controlled trial including 310 patients with ARF that High-Flow Oxygen decreased mortality as compared to NIV . Immunocompromised patients could be also included in this study, except those with profound neutropenia. Therefore, we assessed the benefits of High-Flow Oxygen or NIV in this subgroup of patients.
To compare intubation and mortality rates in the subset of immunocompromised patients admitted to ICU for ARF.
We performed a subgroup analysis of the FLORALI study. This study included all patients with non-hypercapnic (PaCO2 ≤ 45 mm Hg) ARF excluding patients with cardiogenic pulmonary edema and those with underlying chronic lung disease. Patients were assigned to three groups according to treatment: High-Flow Oxygen, O2 or NIV. The primary outcome was the intubation rate and secondary outcome included 90-day mortality. We focused on the subset of immunocompromised patients included in this study, knowing that patients with profound neutropenia were excluded.
Among the 310 patients with ARF, 82 (26%) were immunocompromised including 26 patients in the High-Flow Oxygen group, 30 in the O2 group, and 26 in the NIV group. Intubation rates were 31%, 43% and 55% in the High-Flow Oxygen, O2 and NIV groups, respectively (p = 0.04). The 90-day mortality rates were 15%, 27% and 46% in the High-Flow Oxygen, O2 and NIV groups (p = 0.046). Ventilator-free days at day 28 were 26 ± 6, 23 ± 10 and 14 ± 13 days in the High-Flow Oxygen, O2 and NIV groups, respectively (p < 0.0001).
In immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure, High-Flow Oxygen was associated with lower intubation and mortality rates, and a reduced duration of invasive mechanical ventilation as compared to O2 or NIV.
Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, et al: Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA. 2000, 283 (2): 235-241. 10.1001/jama.283.2.235.
Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, et al: Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med. 2001, 344 (7): 481-487. 10.1056/NEJM200102153440703.
Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al: High-Flow Nasal Cannulae Oxygen Therapy in Acute Hypoxemic Respiratory Failure. N Engl J Med. 2015, 372: 2185-2196. 10.1056/NEJMoa1503326.
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Frat, J., Ragot, S., Girault, C. et al. High flow nasal cannula oxygen therapy in immunocompromised patients with acute hypoxemic respiratory failure. ICMx 3, A425 (2015) doi:10.1186/2197-425X-3-S1-A425
- Respiratory Failure
- Pulmonary Edema
- Immunocompromised Patient
- Acute Respiratory Failure
- Chronic Lung Disease