Lemiale Virginie, Yvin Elise, Kouatchet Achille, Mokart Djamel, Demoule Alexandre, Dumas Guillaume
Service de Médecine Intensive et Réanimation, APHP Hopital Saint Louis, 1 Avenue Claude Vellefaux, Paris 75010, France.
Service de Réanimation Médicale et Médecine Hyperbare, Angers 49100, France.
J Intensive Med. 2021 Oct 29;1(2):81-89. doi: 10.1016/j.jointm.2021.09.003. eCollection 2021 Oct.
Acute respiratory failure (ARF) in immunocompromised patients remains challenging to treat. A large number of case require admission to intensive care unit (ICU) where mortality remains high. Oxygenation without intubation is important in this setting. This review summarizes recent studies assessing oxygenation devices for immunocompromised patients. Previous studies showed that non-invasive ventilation (NIV) has been associated with lower intubation and mortality rates. Indeed, in recent years, the outcomes of immunocompromised patients admitted to the ICU have improved. In the most recent randomized controlled trials, including immunocompromised patients admitted to the ICU with ARF, neither NIV nor high-flow nasal oxygen (HFNO) could reduce the mortality rate. In this setting, other strategies need to be tested to decrease the mortality rate. Early admission strategy and avoiding late failure of oxygenation strategy have been assessed in retrospective studies. However, objective criteria are still lacking to clearly discriminate time to admission or time to intubation. Also, diagnosis strategy may have an impact on intubation or mortality rates. On the other hand, lack of diagnosis has been associated with a higher mortality rate. In conclusion, improving outcomes in immunocompromised patients with ARF may include strategies other than the oxygenation strategy alone. This review discusses other unresolved questions to decrease mortality after ICU admission in such patients.
免疫功能低下患者的急性呼吸衰竭（ARF）治疗仍然具有挑战性。大量病例需要入住重症监护病房（ICU），而该病房的死亡率仍然很高。在这种情况下，不进行气管插管的氧疗很重要。这篇综述总结了近期评估免疫功能低下患者氧疗设备的研究。先前的研究表明，无创通气（NIV）与较低的气管插管率和死亡率相关。事实上，近年来，入住ICU的免疫功能低下患者的治疗结果有所改善。在包括因ARF入住ICU的免疫功能低下患者的最新随机对照试验中，NIV和高流量鼻导管吸氧（HFNO）均不能降低死亡率。在这种情况下，需要测试其他策略以降低死亡率。回顾性研究评估了早期入院策略和避免氧疗延迟失败策略。然而，仍然缺乏明确区分入院时间或气管插管时间的客观标准。此外，诊断策略可能会对气管插管率或死亡率产生影响。另一方面，未进行诊断与较高的死亡率相关。总之，改善ARF免疫功能低下患者的治疗结果可能需要除氧疗策略之外的其他策略。本综述讨论了降低此类患者入住ICU后死亡率的其他未解决问题。
