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Oxygenation/non-invasive ventilation strategy and risk for intubation in immunocompromised patients with hypoxemic acute respiratory failure.
Oncotarget. 2018 Sep 14;9(72):33682-33693
Authors: Dumas G, Chevret S, Lemiale V, Pène F, Demoule A, Mayaux J, Kouatchet A, Nyunga M, Perez P, Argaud L, Barbier F, Vincent F, Bruneel F, Klouche K, Kontar L, Moreau AS, Reignier J, Papazian L, Cohen Y, Mokart D, Azoulay E
Abstract
We investigated how the initial ventilation/oxygenation management may influence the need for intubation on the coming day in a cohort of immunocompromised patients with acute hypoxemic respiratory failure (ARF). Data from 847 immunocompromised patients with ARF were used to estimate the probability of intubation at day+1 within the first 3 days of ICU admission, according to oxygenation management. First, noninvasive ventilation (NIV) was compared to oxygen therapy whatever the administration device; then standard oxygen was compared to High Flow Nasal Cannula therapy alone (HFNC), NIV alone or NIV+HFNC. To take into account the oxygenation regimens over time and to handle confounders, propensity score weighting models were used. In the original sample, the probability of intubation at day+1 was higher in the NIV group vs oxygenation therapy (OR = 1.64, 95CI, 1.09-2.48) or vs the standard oxygen group (OR = 2.05, 95CI: 1.29-3.29); it was also increased in the HFNC group compared to standard oxygen (OR = 2.85, 95CI: 1.37-5.67). However, all these differences disappeared by handling confounding-by-indication in the weighted samples, as well as in the pooled model. Note that adjusted OR for day-28 mortality increased with the day of intubation. In this large cohort of immunocompromised patients, ventilation/oxygenation management had no impact on the probability of intubation on the coming day.
PMID: 30263094 [PubMed]