a Medical Intensive Care Unit , University of Paris-Diderot, Saint Louis Hospital , Paris , France.
b Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B , Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier , Montpellier , France.
Expert Rev Respir Med. 2018 Oct;12(10):867-880. doi: 10.1080/17476348.2018.1511430. Epub 2018 Aug 28.
A growing number of immunocompromised (IC) patients with acute hypoxemic respiratory failure (ARF) is admitted to the intensive care unit (ICU) worldwide. Areas covered: This review provides an overview of the current knowledge of the ways to prevent intubation in IC patients with ARF. Expert commentary: Striking differences oppose ARF incidence, characteristics, etiologies and management between IC and non-IC patients. Survival benefits have been reported with early admission to ICU in IC patients. Then, while managing hypoxemia and associated organ dysfunction, the identification of the cause of ARF will be guided by a rigorous clinical assessment at the bedside, further assisted by an invasive or noninvasive diagnostic strategy based on clinical probability for each etiology. Finally, the initial respiratory support aims to avoid mechanical ventilation for the many yet recognizing those patients for whom delaying intubation expose them to suboptimal management. We advocate for not using noninvasive ventilation (NIV) in this setting. A proper evaluation of High-flow nasal cannula oxygen (HFNC) is required in IC patients as to demonstrate its superiority compared to standard oxygen therapy. Day-to-day decisions must strive to avoid delayed intubation, and make every effort to identify ARF etiology.
越来越多免疫功能低下（IC）的急性低氧性呼吸衰竭（ARF）患者被收入重症监护病房（ICU）。
这篇综述概述了预防 ARF 免疫功能低下患者插管的方法。
IC 和非 IC 患者的 ARF 发病率、特征、病因和治疗方法存在显著差异。IC 患者早期入住 ICU 可提高生存率。因此，在管理低氧血症和相关器官功能障碍时，通过严格的床边临床评估，结合针对每种病因的基于临床可能性的有创或无创诊断策略，确定 ARF 的病因。最后，初始呼吸支持旨在避免机械通气，对于许多尚未识别的患者，延迟插管会使他们的治疗效果不理想。我们不主张在此情况下使用无创通气（NIV）。需要对 IC 患者进行高流量鼻导管氧（HFNC）的适当评估，以证明其优于标准氧疗。日常决策必须努力避免延迟插管，并尽力确定 ARF 的病因。
