Lemiale Virginie, Resche-Rigon Matthieu, Mokart Djamel, Pène Frédéric, Argaud Laurent, Mayaux Julien, Guitton Christophe, Rabbat Antoine, Girault Christophe, Kouatchet Achille, Vincent François, Bruneel Fabrice, Nyunga Martine, Seguin Amélie, Klouche Kada, Colin Gwenahel, Kontar Loay, Perez Pierre, Meert Anne-Pascale, Benoit Dominique D, Papazian Laurent, Demoule Alexandre, Chevret Sylvie, Azoulay Elie
1Medical ICU, Saint Louis Teaching Hospital, Paris, France. 2Biostatistics department, Saint Louis Teaching Hospital, Paris, France. 3Medical and surgical ICU, Paoli Calmettes Institut Marseilles, France. 4Medical ICU, Cochin Teaching Hospital, Paris, France. 5Medical and surgical ICU, Edouard Herriot Teaching hospital, Lyon, France. 6Medical ICU, Pitié-Salpétrière Teaching Hospital, Paris, France. 7Medical ICU, Hotel Dieu Teaching hospital, Nantes, France. 8Medical ICU, Respiratory Unit, Cochin Teaching Hospital, Paris, France. 9Medical ICU, C Nicolle Hospital, Rouen, France. 10Medical ICU, Angers Teaching Hospital, Angers, France. 11Medical and surgical ICU, Montfermeil Hospital, Montfermeil. France. 12Medical ICU, Mignot Hospital, Versailles, France. 13Medical and surgical ICU, Roubaix Hospital, France. 14Medical ICU, Caen Teaching Hospital, Caen, France. 15Medical ICU, Montpellier Teaching Hospital, Montpellier, France. 16Medical ICU, La Roche sur Yon Hospital, La Roche Sur Yon, France. 17Medical ICU, Amiens Teaching Hospital, Amiens, France. 18Medical ICU, Brabois Teaching Hospital, Nancy, France. 19Medical ICU, Institut J Bordet, Bruxelles, Belgium. 20Medical ICU, Ghent University Hospital, Ghent, Belgium. 21Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France. 22Aix-Marseille Université, Faculté de médecine, URMITE UMR CNRS 7278, Marseille, France.
Crit Care Med. 2017 Mar;45(3):e274-e280. doi: 10.1097/CCM.0000000000002085.
In immunocompromised patients with acute respiratory failure, invasive mechanical ventilation remains associated with high mortality. Choosing the adequate oxygenation strategy is of the utmost importance in that setting. High-flow nasal oxygen has recently shown survival benefits in unselected patients with acute respiratory failure. The objective was to assess outcomes of immunocompromised patients with hypoxemic acute respiratory failure treated with high-flow nasal oxygen.
We performed a post hoc analysis of a randomized controlled trial of noninvasive ventilation in critically ill immunocompromised patients with hypoxemic acute respiratory failure.
Twenty-nine ICUs in France and Belgium.
Critically ill immunocompromised patients with hypoxemic acute respiratory failure.
A propensity score-based approach was used to assess the impact of high-flow nasal oxygen compared with standard oxygen on day 28 mortality.
Among 374 patients included in the study, 353 met inclusion criteria. Underlying disease included mostly malignancies (n = 296; 84%). Acute respiratory failure etiologies were mostly pneumonia (n = 157; 44.4%) or opportunistic infection (n = 76; 21.5%). Noninvasive ventilation was administered to 180 patients (51%). Invasive mechanical ventilation was ultimately needed in 142 patients (40.2%). Day 28 mortality was 22.6% (80 deaths). Throughout the ICU stay, 127 patients (36%) received high-flow nasal oxygen whereas 226 patients received standard oxygen. Ninety patients in each group (high-flow nasal oxygen or standard oxygen) were matched according to the propensity score, including 91 of 180 (51%) who received noninvasive ventilation. High-flow nasal oxygen was neither associated with a lower intubation rate (hazard ratio, 0.42; 95% CI, 0.11-1.61; p = 0.2) nor day 28 mortality (hazard ratio, 0.80; 95% CI, 0.45-1.42; p = 0.45).
In immunocompromised patients with hypoxemic acute respiratory failure, high-flow nasal oxygen when compared with standard oxygen did not reduce intubation or survival rates. However, these results could be due to low statistical power or unknown confounders associated with the subgroup analysis. A randomized trial is needed.
在免疫功能低下且患有急性呼吸衰竭的患者中，有创机械通气的死亡率仍然很高。在这种情况下，选择适当的氧合策略至关重要。高流量鼻导管给氧最近已显示出对未选择的急性呼吸衰竭患者有生存益处。目的是评估接受高流量鼻导管给氧治疗的免疫功能低下的低氧性急性呼吸衰竭患者的预后。
我们对一项针对患有低氧性急性呼吸衰竭的重症免疫功能低下患者的无创通气随机对照试验进行了事后分析。
法国和比利时的29个重症监护病房。
患有低氧性急性呼吸衰竭的重症免疫功能低下患者。
采用基于倾向评分的方法来评估高流量鼻导管给氧与标准给氧相比对第28天死亡率的影响。
在纳入研究的374例患者中，353例符合纳入标准。基础疾病主要为恶性肿瘤（n = 296；84%）。急性呼吸衰竭的病因主要是肺炎（n = 157；44.4%）或机会性感染（n = 76；21.5%）。180例患者（51%）接受了无创通气。最终有142例患者（40.2%）需要有创机械通气。第28天的死亡率为22.6%（80例死亡）。在整个重症监护病房住院期间，127例患者（36%）接受了高流量鼻导管给氧，而226例患者接受了标准给氧。根据倾向评分在每组（高流量鼻导管给氧组或标准给氧组）中匹配90例患者，其中包括180例接受无创通气患者中的91例（51%）。高流量鼻导管给氧既未降低插管率（风险比，0.42；95%置信区间，0.11 - 1.61；p = 0.2），也未降低第28天的死亡率（风险比，0.80；95%置信区间，0.45 - 1.42；p = 0.45）。
在免疫功能低下的低氧性急性呼吸衰竭患者中，与标准给氧相比，高流量鼻导管给氧并未降低插管率或生存率。然而，这些结果可能是由于统计效力低或与亚组分析相关的未知混杂因素所致。需要进行一项随机试验。
