Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Critical Care

LUNG SAFE Investigators and the ESICM Trials Group¹  John G. Laffey²  Frank Van Haren³  Massimo Antonelli⁴  Giacomo Grasselli⁵  Antonio Pesenti⁵  Cesare Gregoretti⁶  Andrea Cortegiani⁶  Antonino Giarratano⁶  Tai Pham⁷  Fabiana Madotto⁸  Giacomo Bellani⁹ 

[1] ;Anesthesia, School of Medicine, National University of Ireland;College of Medicine, Biology and Environment, Australian National University;Department of Anesthesiology and Intensive Care, Università Cattolica del Sacro Cuore – Fondazione Policlinico Universitario A. Gemelli;Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico;Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo;Interdepartemental Division of Critical Care Medicine, University of Toronto;Research Center on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca;School of Medicine and Surgery, University of Milano-Bicocca;

关键词: Acute respiratory failure;    ARDS;    Immunocompromised patients;    Mechanical ventilation;    Noninvasive ventilation;   

DOI  :  10.1186/s13054-018-2079-9

来源: DOAJ

【 摘 要 】

Abstract Background The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013.

【 授权许可】

Unknown