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Crit Care Med. 2017 Mar;45(3):e274-e280. doi: 10.1097/CCM.0000000000002085.

High-Flow Nasal Cannula Oxygenation in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study.

Author information

1
1Medical ICU, Saint Louis Teaching Hospital, Paris, France. 2Biostatistics department, Saint Louis Teaching Hospital, Paris, France. 3Medical and surgical ICU, Paoli Calmettes Institut Marseilles, France. 4Medical ICU, Cochin Teaching Hospital, Paris, France. 5Medical and surgical ICU, Edouard Herriot Teaching hospital, Lyon, France. 6Medical ICU, Pitié-Salpétrière Teaching Hospital, Paris, France. 7Medical ICU, Hotel Dieu Teaching hospital, Nantes, France. 8Medical ICU, Respiratory Unit, Cochin Teaching Hospital, Paris, France. 9Medical ICU, C Nicolle Hospital, Rouen, France. 10Medical ICU, Angers Teaching Hospital, Angers, France. 11Medical and surgical ICU, Montfermeil Hospital, Montfermeil. France. 12Medical ICU, Mignot Hospital, Versailles, France. 13Medical and surgical ICU, Roubaix Hospital, France. 14Medical ICU, Caen Teaching Hospital, Caen, France. 15Medical ICU, Montpellier Teaching Hospital, Montpellier, France. 16Medical ICU, La Roche sur Yon Hospital, La Roche Sur Yon, France. 17Medical ICU, Amiens Teaching Hospital, Amiens, France. 18Medical ICU, Brabois Teaching Hospital, Nancy, France. 19Medical ICU, Institut J Bordet, Bruxelles, Belgium. 20Medical ICU, Ghent University Hospital, Ghent, Belgium. 21Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France. 22Aix-Marseille Université, Faculté de médecine, URMITE UMR CNRS 7278, Marseille, France.

Abstract

OBJECTIVE:

In immunocompromised patients with acute respiratory failure, invasive mechanical ventilation remains associated with high mortality. Choosing the adequate oxygenation strategy is of the utmost importance in that setting. High-flow nasal oxygen has recently shown survival benefits in unselected patients with acute respiratory failure. The objective was to assess outcomes of immunocompromised patients with hypoxemic acute respiratory failure treated with high-flow nasal oxygen.

DESIGN:

We performed a post hoc analysis of a randomized controlled trial of noninvasive ventilation in critically ill immunocompromised patients with hypoxemic acute respiratory failure.

SETTING:

Twenty-nine ICUs in France and Belgium.

PATIENTS:

Critically ill immunocompromised patients with hypoxemic acute respiratory failure.

INTERVENTION:

A propensity score-based approach was used to assess the impact of high-flow nasal oxygen compared with standard oxygen on day 28 mortality.

MEASUREMENTS AND MAIN RESULTS:

Among 374 patients included in the study, 353 met inclusion criteria. Underlying disease included mostly malignancies (n = 296; 84%). Acute respiratory failure etiologies were mostly pneumonia (n = 157; 44.4%) or opportunistic infection (n = 76; 21.5%). Noninvasive ventilation was administered to 180 patients (51%). Invasive mechanical ventilation was ultimately needed in 142 patients (40.2%). Day 28 mortality was 22.6% (80 deaths). Throughout the ICU stay, 127 patients (36%) received high-flow nasal oxygen whereas 226 patients received standard oxygen. Ninety patients in each group (high-flow nasal oxygen or standard oxygen) were matched according to the propensity score, including 91 of 180 (51%) who received noninvasive ventilation. High-flow nasal oxygen was neither associated with a lower intubation rate (hazard ratio, 0.42; 95% CI, 0.11-1.61; p = 0.2) nor day 28 mortality (hazard ratio, 0.80; 95% CI, 0.45-1.42; p = 0.45).

CONCLUSIONS:

In immunocompromised patients with hypoxemic acute respiratory failure, high-flow nasal oxygen when compared with standard oxygen did not reduce intubation or survival rates. However, these results could be due to low statistical power or unknown confounders associated with the subgroup analysis. A randomized trial is needed.

PMID:
27655324
DOI:
10.1097/CCM.0000000000002085
[Indexed for MEDLINE]

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