Back to Search
Start Over
Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study
- Source :
- Azoulay, E, Pickkers, P, Soares, M, Perner, A, Rello, J, Bauer, P R, van de Louw, A, Hemelaar, P, Lemiale, V, Taccone, F S, Martin Loeches, I, Meyhoff, T S, Salluh, J, Schellongowski, P, Rusinova, K, Terzi, N, Mehta, S, Antonelli, M, Kouatchet, A, Barratt-Due, A, Valkonen, M, Landburg, P P, Bruneel, F, Bukan, R B, Pène, F, Metaxa, V, Moreau, A S, Souppart, V, Burghi, G, Girault, C, Silva, U V A, Montini, L, Barbier, F, Nielsen, L B, Gaborit, B, Mokart, D, Chevret, S & Efraim investigators and the Nine-I study group 2017, ' Acute hypoxemic respiratory failure in immunocompromised patients : the Efraim multinational prospective cohort study ', Intensive Care Medicine, vol. 43, no. 12, pp. 1808–1819 . https://doi.org/10.1007/s00134-017-4947-1, Intensive Care Medicine, 43(12), 1808-1819. Springer Verlag, Intensive Care Medicine, 43, 1808-1819, Intensive Care Medicine, 43, 12, pp. 1808-1819, Azoulay, E, Pickkers, P, Soares, M, Perner, A, Rello, J, Bauer, P R, van de Louw, A, Hemelaar, P, Lemiale, V, Taccone, F S, Martin Loeches, I, Meyhoff, T S, Salluh, J, Schellongowski, P, Rusinova, K, Terzi, N, Mehta, S, Antonelli, M, Kouatchet, A, Barratt-Due, A, Valkonen, M, Landburg, P P, Bruneel, F, Bukan, R B, Pène, F, Metaxa, V, Moreau, A S, Souppart, V, Burghi, G, Girault, C, Silva, U V A, Montini, L, Barbier, F, Nielsen, L B, Gaborit, B, Mokart, D, Chevret, S, Rabbat, A, Vinatier, I, Darmon, M, Klouche, K, Platon, L, Demoule, A, Mayaux, J, Wallet, F, Chermak, A, Lemaitre, C, Artaud-Macari, E, Nelsen, J, Spoelstra de Man, A & for the Efraim investigators and the Nine-I study group 2017, ' Acute hypoxemic respiratory failure in immunocompromised patients : the Efraim multinational prospective cohort study ', Intensive Care Medicine, vol. 43, no. 12, pp. 1808-1819 . https://doi.org/10.1007/s00134-017-4947-1, Intensive Care Medicine, 43(12), 1808-1819. SPRINGER
- Publication Year :
- 2017
-
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.
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 03424642 and 18081819
- Database :
- OpenAIRE
- Journal :
- Azoulay, E, Pickkers, P, Soares, M, Perner, A, Rello, J, Bauer, P R, van de Louw, A, Hemelaar, P, Lemiale, V, Taccone, F S, Martin Loeches, I, Meyhoff, T S, Salluh, J, Schellongowski, P, Rusinova, K, Terzi, N, Mehta, S, Antonelli, M, Kouatchet, A, Barratt-Due, A, Valkonen, M, Landburg, P P, Bruneel, F, Bukan, R B, Pène, F, Metaxa, V, Moreau, A S, Souppart, V, Burghi, G, Girault, C, Silva, U V A, Montini, L, Barbier, F, Nielsen, L B, Gaborit, B, Mokart, D, Chevret, S & Efraim investigators and the Nine-I study group 2017, ' Acute hypoxemic respiratory failure in immunocompromised patients : the Efraim multinational prospective cohort study ', Intensive Care Medicine, vol. 43, no. 12, pp. 1808–1819 . https://doi.org/10.1007/s00134-017-4947-1, Intensive Care Medicine, 43(12), 1808-1819. Springer Verlag, Intensive Care Medicine, 43, 1808-1819, Intensive Care Medicine, 43, 12, pp. 1808-1819, Azoulay, E, Pickkers, P, Soares, M, Perner, A, Rello, J, Bauer, P R, van de Louw, A, Hemelaar, P, Lemiale, V, Taccone, F S, Martin Loeches, I, Meyhoff, T S, Salluh, J, Schellongowski, P, Rusinova, K, Terzi, N, Mehta, S, Antonelli, M, Kouatchet, A, Barratt-Due, A, Valkonen, M, Landburg, P P, Bruneel, F, Bukan, R B, Pène, F, Metaxa, V, Moreau, A S, Souppart, V, Burghi, G, Girault, C, Silva, U V A, Montini, L, Barbier, F, Nielsen, L B, Gaborit, B, Mokart, D, Chevret, S, Rabbat, A, Vinatier, I, Darmon, M, Klouche, K, Platon, L, Demoule, A, Mayaux, J, Wallet, F, Chermak, A, Lemaitre, C, Artaud-Macari, E, Nelsen, J, Spoelstra de Man, A & for the Efraim investigators and the Nine-I study group 2017, ' Acute hypoxemic respiratory failure in immunocompromised patients : the Efraim multinational prospective cohort study ', Intensive Care Medicine, vol. 43, no. 12, pp. 1808-1819 . https://doi.org/10.1007/s00134-017-4947-1, Intensive Care Medicine, 43(12), 1808-1819. SPRINGER
- Accession number :
- edsair.doi.dedup.....74ff79e768a8c0ec7bedc791090e7785