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1. Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study

Author

Demoule, Alexandre, Antonelli, Massimo, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Meyhoff, Tine Sylvest, Rello, Jordi, Bauer, Philippe, van de Louw, Andry, Lemiale, Virgine, Grimaldi, David, Martin-Loeches, Ignacio, Balik, Martin, Mehta, Sangeeta, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Reignier, Jean, Metaxa, Victoria, Moreau, Anne Sophie, Burghi, Gaston, Mokart, Djamel, Mayaux, Julien, Darmon, Michael, Azoulay, Elie, Amrein, Karin, Staundinger, Thomas, Heinz, Gottfried, Sengölge, Gürkan, Zauner, Christian, Jaksch, Peter, Taccone, Fabio S., Meert, Anne Pascale, Benoît, Dominique, Silva, Ulysses V.A., Pierre de Moraes, Ana Paula, Lishoa, Thiago, Salluh, Jorge, Viana, William, Moralez, Guilliana, Correa, Thiago Domingos, Shah, Umesh, Karvunidis, Thomas, Martin, Balik, Russinova, Katerina, Perner, Anders, Jonas, Nielsen, Bukan, Ramin Brandt, Moeller, Ann M., Nielsen, Lene B., Seguin, Amélie, Chermak, Akli, Terzi, Nicolas, Vinatier, Isabelle, Wallet, Florent, Klouche, Kada, Platon, Laura, Gaborit, Benjamin, Barbier, François, Pène, Frederic, Rabbat, Antoine, Lemiale, Virginie, N'Yunga, Martine, Girault, Christophe, Lemaitre, Caroline, Artaud-Macari, Elise, Bruneel, F., Kuitunen, Anne, Marsh, Brian, Misericordia, Mater, Mahon, Aisling Mc, Cinnella, Gilda, Cotoia, Antonella, Riuniti, Ospedali, Montini, Lucas, Spoelstra de Man, Angélique, Landburg, Precious Pearl, Bergmans, Dennis, Hemelaar, Pleun, Kaufmann, Thomas, Barrat-Due, Andreas, Klepstad, Pål, Encina, Belen, Moreno, Gabriel, Crespi, Llorenç Socias, Rodriguez-Ruiz, Emilio, Hemang, Yadav, Intensive care medicine, ACS - Atherosclerosis & ischemic syndromes, and ACS - Diabetes & metabolism

Subjects
Male, Respiratory Distress Syndrome, acute respiratory failure, diagnosis, driving pressure, Middle Aged, Prognosis, plateau pressure, Positive-Pressure Respiration, immunocompromised, Immunocompromised Host, Settore MED/41 - ANESTESIOLOGIA, outcome, Respiratory Mechanics, Tidal Volume, Humans, ARDS, Female, Prospective Studies, Aged, Follow-Up Studies
Abstract

Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. Research Question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). Study Design and Methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.

Published
2020

2. Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

Author

Demoule, Alexandre, Antonelli, Massimo, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Meyhoff, Tine Sylvest, Rello, Jordi, Bauer, Philippe, Van De Louw, Andry, Lemiale, Virgine, Grimaldi, David, Martin-loeches, Ignacio, Balik, Martin, Mehta, Sangeeta, Kouatchet, Achille, Barratt-due, Andreas, Valkonen, Miia, Reignier, Jean, Metaxa, Victoria, Moreau, Anne Sophie, Burghi, Gaston, Mokart, Djamel, Mayaux, Julien, Darmon, Michael, Azoulay, Elie, Amrein, Karin, Staundinger, Thomas, Heinz, Gottfried, Sengölge, Gürkan, Zauner, Christian, Jaksch, Peter, Taccone, Fabio S., Meert, Anne Pascale, Benoît, Dominique, Silva, Ulysses V.a., Pierre De Moraes, Ana Paula, Lishoa, Thiago, Salluh, Jorge, Viana, William, Moralez, Guilliana, Correa, Thiago Domingos, Shah, Umesh, Karvunidis, Thomas, Martin, Balik, Russinova, Katerina, Perner, Anders, Jonas, Nielsen, Bukan, Ramin Brandt, Moeller, Ann M., Nielsen, Lene B., Seguin, Amélie, Chermak, Akli, Terzi, Nicolas, Vinatier, Isabelle, Wallet, Florent, Klouche, Kada, Platon, Laura, Gaborit, Benjamin, Barbier, François, Pène, Frederic, Rabbat, Antoine, Lemiale, Virginie, N'yunga, Martine, Girault, Christophe, Lemaitre, Caroline, Artaud-macari, Elise, Bruneel, F., Kuitunen, Anne, Marsh, Brian, Misericordia, Mater, Mahon, Aisling Mc, Cinnella, Gilda, Cotoia, Antonella, Riuniti, Ospedali, Montini, Lucas, Spoelstra De Man, Angélique, Landburg, Precious Pearl, Bergmans, Dennis, Hemelaar, Pleun, Kaufmann, Thomas, Barrat-due, Andreas, Klepstad, Pål, Encina, Belen, Moreno, Gabriel, Crespi, Llorenç Socias, Rodriguez-ruiz, Emilio, Hemang, Yadav, Demoule, Alexandre, Antonelli, Massimo, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Meyhoff, Tine Sylvest, Rello, Jordi, Bauer, Philippe, Van De Louw, Andry, Lemiale, Virgine, Grimaldi, David, Martin-loeches, Ignacio, Balik, Martin, Mehta, Sangeeta, Kouatchet, Achille, Barratt-due, Andreas, Valkonen, Miia, Reignier, Jean, Metaxa, Victoria, Moreau, Anne Sophie, Burghi, Gaston, Mokart, Djamel, Mayaux, Julien, Darmon, Michael, Azoulay, Elie, Amrein, Karin, Staundinger, Thomas, Heinz, Gottfried, Sengölge, Gürkan, Zauner, Christian, Jaksch, Peter, Taccone, Fabio S., Meert, Anne Pascale, Benoît, Dominique, Silva, Ulysses V.a., Pierre De Moraes, Ana Paula, Lishoa, Thiago, Salluh, Jorge, Viana, William, Moralez, Guilliana, Correa, Thiago Domingos, Shah, Umesh, Karvunidis, Thomas, Martin, Balik, Russinova, Katerina, Perner, Anders, Jonas, Nielsen, Bukan, Ramin Brandt, Moeller, Ann M., Nielsen, Lene B., Seguin, Amélie, Chermak, Akli, Terzi, Nicolas, Vinatier, Isabelle, Wallet, Florent, Klouche, Kada, Platon, Laura, Gaborit, Benjamin, Barbier, François, Pène, Frederic, Rabbat, Antoine, Lemiale, Virginie, N'yunga, Martine, Girault, Christophe, Lemaitre, Caroline, Artaud-macari, Elise, Bruneel, F., Kuitunen, Anne, Marsh, Brian, Misericordia, Mater, Mahon, Aisling Mc, Cinnella, Gilda, Cotoia, Antonella, Riuniti, Ospedali, Montini, Lucas, Spoelstra De Man, Angélique, Landburg, Precious Pearl, Bergmans, Dennis, Hemelaar, Pleun, Kaufmann, Thomas, Barrat-due, Andreas, Klepstad, Pål, Encina, Belen, Moreno, Gabriel, Crespi, Llorenç Socias, Rodriguez-ruiz, Emilio, and Hemang, Yadav

Published
2020

3. Influenza and associated co-infections in critically ill immunosuppressed patients

Author

Martin-Loeches, Ignacio, Lemiale, Virginie, Geoghegan, Pierce, McMahon, Mary Aisling, Pickkers, Peter, Soares, Marcio, Perner, Anders, Meyhoff, Tine Sylvest, Bukan, Ramin Brandt, Rello, Jordi, Bauer, Philippe R., Van De Louw, Andry, Taccone, Fabio Silvio, Salluh, Jorge, Hemelaar, Pleun, Schellongowski, Peter, Rusinova, Katerina, Terzi, Nicolas, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Klepstad, Pål, Valkonen, Miia, Landburg, Precious Pearl, Barratt-Due, Andreas, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Souppart, Virginie, Burghi, Gaston, Girault, Christophe, Silva, Ulysses V.A., Montini, Luca, Barbier, Francois, Nielsen, Lene B., Gaborit, Benjamin, Mokart, Djamel, Chevret, Sylvie, Azoulay, Elie, Martin-Loeches, Ignacio, Lemiale, Virginie, Geoghegan, Pierce, McMahon, Mary Aisling, Pickkers, Peter, Soares, Marcio, Perner, Anders, Meyhoff, Tine Sylvest, Bukan, Ramin Brandt, Rello, Jordi, Bauer, Philippe R., Van De Louw, Andry, Taccone, Fabio Silvio, Salluh, Jorge, Hemelaar, Pleun, Schellongowski, Peter, Rusinova, Katerina, Terzi, Nicolas, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Klepstad, Pål, Valkonen, Miia, Landburg, Precious Pearl, Barratt-Due, Andreas, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Souppart, Virginie, Burghi, Gaston, Girault, Christophe, Silva, Ulysses V.A., Montini, Luca, Barbier, Francois, Nielsen, Lene B., Gaborit, Benjamin, Mokart, Djamel, Chevret, Sylvie, and Azoulay, Elie

Abstract

Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was

Published
2019

4. Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study

Author

Azoulay, Elie, Pickkers, Peter, Soares, Marcio, Perner, Anders, Rello, Jordi, Bauer, Philippe R., van de Louw, Andry, Hemelaar, Pleun, Lemiale, Virginie, Taccone, Fabio Silvio, Martin Loeches, Ignacio, Meyhoff, Tine Sylvest, Salluh, Jorge, Schellongowski, Peter, Rusinova, Katerina, Terzi, Nicolas, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Landburg, Precious Pearl, Bruneel, Fabrice, Bukan, Ramin Brandt, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Souppart, Virginie, Burghi, Gaston, Girault, Christophe, Silva, Ulysses V.A., Montini, Luca, Barbier, François, Nielsen, Lene B., Gaborit, Benjamin, Mokart, Djamel, Chevret, Sylvie, Rabbat, Antoine, Vinatier, Isabelle, Darmon, Michael, Klouche, Kada, Platon, Laura, Demoule, Alexandre, Mayaux, Julien, Wallet, Florent, Chermak, Akli, Lemaitre, Caroline, Artaud-Macari, Elise, Nelsen, Jonas, Spoelstra de Man, Angélique, Clinicum, Anestesiologian yksikkö, Department of Diagnostics and Therapeutics, University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine, Intensive care medicine, ACS - Atherosclerosis & ischemic syndromes, and ACS - Diabetes & metabolism

Subjects
Male, BIOLOGIC THERAPIES, High flow oxygen, Organ Dysfunction Scores, medicine.medical_treatment, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Comorbidity, Critical Care and Intensive Care Medicine, Severity of Illness Index, Hematological malignancies, 0302 clinical medicine, Intubation, Hospital Mortality, Prospective Studies, Hypoxia, Prospective cohort study, OUTCOMES, IMMUNOSUPPRESSION, Mortality rate, Age Factors, Middle Aged, CANCER, 3. Good health, Female, TRIAL, Respiratory Insufficiency, Noninvasive ventilation, CRITICALLY-ILL PATIENTS, medicine.medical_specialty, Critical Illness, NONINVASIVE VENTILATION, Immunocompromised Host, 03 medical and health sciences, MALIGNANCIES, INFLAMMATORY DISEASES, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, Intubation, Intratracheal, medicine, Humans, Systemic diseases, HEMATOLOGY PATIENTS, Aged, Mechanical ventilation, Transplantation, business.industry, Pneumocystis, Oxygen Inhalation Therapy, 030208 emergency & critical care medicine, Odds ratio, Surgery, 030228 respiratory system, 3121 General medicine, internal medicine and other clinical medicine, Propensity score matching, Etiology, business
Abstract

Contains fulltext : 182567.pdf (Publisher’s version ) (Closed access) BACKGROUND: In immunocompromised patients with acute hypoxemic respiratory failure (ARF), initial management aims primarily to avoid invasive mechanical ventilation (IMV). METHODS: To assess the impact of initial management on IMV and mortality rates, we performed a multinational observational prospective cohort study in 16 countries (68 centers). RESULTS: A total of 1611 patients were enrolled (hematological malignancies 51.9%, solid tumors 35.2%, systemic diseases 17.3%, and solid organ transplantation 8.8%). The main ARF etiologies were bacterial (29.5%), viral (15.4%), and fungal infections (14.7%), or undetermined (13.2%). On admission, 915 (56.8%) patients were not intubated. They received standard oxygen (N = 496, 53.9%), high-flow oxygen (HFNC, N = 187, 20.3%), noninvasive ventilation (NIV, N = 153, 17.2%), and NIV + HFNC (N = 79, 8.6%). Factors associated with IMV included age (hazard ratio = 0.92/year, 95% CI 0.86-0.99), day-1 SOFA (1.09/point, 1.06-1.13), day-1 PaO2/FiO2 (1.47, 1.05-2.07), ARF etiology (Pneumocystis jirovecii pneumonia (2.11, 1.42-3.14), invasive pulmonary aspergillosis (1.85, 1.21-2.85), and undetermined cause (1.46, 1.09-1.98). After propensity score matching, HFNC, but not NIV, had an effect on IMV rate (HR = 0.77, 95% CI 0.59-1.00, p = 0.05). ICU, hospital, and day-90 mortality rates were 32.4, 44.1, and 56.4%, respectively. Factors independently associated with hospital mortality included age (odds ratio = 1.18/year, 1.09-1.27), direct admission to the ICU (0.69, 0.54-0.87), day-1 SOFA excluding respiratory score (1.12/point, 1.08-1.16), PaO2/FiO2 < 100 (1.60, 1.03-2.48), and undetermined ARF etiology (1.43, 1.04-1.97). Initial oxygenation strategy did not affect mortality; however, IMV was associated with mortality, the odds ratio depending on IMV conditions: NIV + HFNC failure (2.31, 1.09-4.91), first-line IMV (2.55, 1.94-3.29), NIV failure (3.65, 2.05-6.53), standard oxygen failure (4.16, 2.91-5.93), and HFNC failure (5.54, 3.27-9.38). CONCLUSION: HFNC has an effect on intubation but not on mortality rates. Failure to identify ARF etiology is associated with higher rates of both intubation and mortality. This suggests that in addition to selecting the appropriate oxygenation device, clinicians should strive to identify the etiology of ARF.

Published
2017

5. Effects of Organizational Characteristics on Outcomes and Resource Use in Patients With Cancer Admitted to Intensive Care Units

Author

Soares, Marcio, primary, Bozza, Fernando A., additional, Azevedo, Luciano C.P., additional, Silva, Ulysses V.A., additional, Corrêa, Thiago D., additional, Colombari, Fernando, additional, Torelly, André P., additional, Varaschin, Pedro, additional, Viana, William N., additional, Knibel, Marcos F., additional, Damasceno, Moyzés, additional, Espinoza, Rodolfo, additional, Ferez, Marcus, additional, Silveira, Juliana G., additional, Lobo, Suzana A., additional, Moraes, Ana Paula P., additional, Lima, Ricardo A., additional, de Carvalho, Alexandre G.R., additional, do Brasil, Pedro E.A.A., additional, Kahn, Jeremy M., additional, Angus, Derek C., additional, and Salluh, Jorge I.F., additional

Published
2016
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6. Outcomes for Patients With Cancer Admitted to the ICU Requiring Ventilatory Support

Author

Azevedo, Luciano C.P., primary, Caruso, Pedro, additional, Silva, Ulysses V.A., additional, Torelly, André P., additional, Silva, Eliézer, additional, Rezende, Ederlon, additional, Netto, José J., additional, Piras, Claudio, additional, Lobo, Suzana M.A., additional, Knibel, Marcos F., additional, Teles, José M., additional, Lima, Ricardo. A., additional, Ferreira, Bruno S., additional, Friedman, Gilberto, additional, Rea-Neto, Alvaro, additional, Dal-Pizzol, Felipe, additional, Bozza, Fernando A., additional, Salluh, Jorge I.F., additional, and Soares, Márcio, additional

Published
2014
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