Format

Send to:

Choose Destination
See comment in PubMed Commons below
JAMA. 2015 Oct 27;314(16):1711-9. doi: 10.1001/jama.2015.12402.

Effect of Noninvasive Ventilation vs Oxygen Therapy on Mortality Among Immunocompromised Patients With Acute Respiratory Failure: A Randomized Clinical Trial.

Author information

  • 1Saint-Louis University Hospital, Paris, France.
  • 2IPC, Lyon, France.
  • 3APHP, Paris, France.
  • 4Service de Pneumologie Et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.
  • 5Hospices Civils de Lyon, Lyon, France.
  • 6Roubaix, Roubaix, France.
  • 7Medical Intensive Care Unit, Charles Nicolle University Hospital-Rouen University, Rouen, France.
  • 8Centre Hospitalier Universitaire-Nancy, Nancy, France.
  • 9University Hospital of Nantes, Nantes, France.
  • 10The Institut Gustave-Roussy (IGR), France.
  • 11Intensive Care Unit, CHRU Angers, Angers, France.
  • 12Intensive Care Medicine, Ghent, Gent, Belgium.
  • 13Medical Intensive Care Unit, La Source Hospital-CHR Orleans, Orléans, France.
  • 14Intensive Care Unit, Hopital Andre Mignot-Le Chesnay, Paris, France.
  • 15Hôpital d'Avicenne, APHP, Bobigny, France.
  • 16Lapeyronie University Hospital, Montpellier, France.
  • 17Centre Hospitalier Universitaire-Amiens, Amiens, France.
  • 18Centre de Réanimation, CHRU Lille, Lille, France.
  • 19Centre Hospitalier Universitaire-Caen, Caen, France.
  • 20Institut Jules Bordet, Brussels, Belgium.
  • 21Réanimation Médicale, Centre Hospitalier Universitaire-Nantes, Nantes, France.
  • 22Réanimation DRIS, Hopital Nord, Marseille, France.
  • 23Centre Hospitalier Sud Francilien (CHSF), France.
  • 24The Hôpital civil de Strasbourg, Strasbourg, France.
  • 25The Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
  • 26Medical-Surgical ICU, Saint-Etienne University Hospital, Saint-Etienne, France.

Abstract

IMPORTANCE:

Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure. However, its effectiveness for this indication remains unclear.

OBJECTIVE:

To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acute hypoxemic respiratory failure.

DESIGN, SETTING, AND PARTICIPANTS:

Multicenter randomized trial conducted among 374 critically ill immunocompromised patients, of whom 317 (84.7%) were receiving treatment for hematologic malignancies or solid tumors, at 28 intensive care units (ICUs) in France and Belgium between August 12, 2013, and January 2, 2015.

INTERVENTIONS:

Patients were randomly assigned to early noninvasive ventilation (n = 191) or oxygen therapy alone (n = 183).

MAIN OUTCOMES AND MEASURES:

The primary outcome was day-28 mortality. Secondary outcomes were intubation, Sequential Organ Failure Assessment score on day 3, ICU-acquired infections, duration of mechanical ventilation, and ICU length of stay.

RESULTS:

At randomization, median oxygen flow was 9 L/min (interquartile range, 5-15) in the noninvasive ventilation group and 9 L/min (interquartile range, 6-15) in the oxygen group. All patients in the noninvasive ventilation group received the first noninvasive ventilation session immediately after randomization. On day 28 after randomization, 46 deaths (24.1%) had occurred in the noninvasive ventilation group vs 50 (27.3%) in the oxygen group (absolute difference, -3.2 [95% CI, -12.1 to 5.6]; P = .47). Oxygenation failure occurred in 155 patients overall (41.4%), 73 (38.2%) in the noninvasive ventilation group and 82 (44.8%) in the oxygen group (absolute difference, -6.6 [95% CI, -16.6 to 3.4]; P = .20). There were no significant differences in ICU-acquired infections, duration of mechanical ventilation, or lengths of ICU or hospital stays.

CONCLUSIONS AND RELEVANCE:

Among immunocompromised patients admitted to the ICU with hypoxemic acute respiratory failure, early noninvasive ventilation compared with oxygen therapy alone did not reduce 28-day mortality. However, study power was limited.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT01915719.

PMID:
26444879
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk