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.
| Original language | English |
|---|---|
| Article number | 157 |
| Journal | Critical Care |
| Volume | 22 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jun 12 2018 |
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Keywords
- Acute respiratory failure
- ARDS
- Immunocompromised patients
- Mechanical ventilation
- Noninvasive ventilation
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database. / Cortegiani, Andrea; Madotto, Fabiana; Gregoretti, Cesare; Bellani, Giacomo; Laffey, John G.; Pham, Tai; Van Haren, Frank; Giarratano, Antonino; Antonelli, Massimo; Pesenti, Antonio; Grasselli, Giacomo; Sula, Hektor; Nunci, Lordian; Cani, Alma; Zazu, Alan; Dellera, Christian; Insaurralde, Carolina S.; Alejandro, Risso V.; Daldin, Julio; Vinzio, Mauricio; Fernandez, Ruben O.; Cardonnet, Luis P.; Bettini, Lisandro R.; Bisso, Mariano Carboni; Osman, Emilio M.; Setten, Mariano G.; Lovazzano, Pablo; Alvarez, Javier; Villar, Veronica; Pozo, Norberto C.; Grubissich, Nicolas; Plotnikow, Gustavo A.; Vasquez, Daniela N.; Ilutovich, Santiago; Tiribelli, Norberto; Chena, Ariel; Pellegrini, Carlos A.; Saenz, María G.; Estenssoro, Elisa; Brizuela, Matias; Gianinetto, Hernan; Gomez, Pablo E.; Protti, Alessandro; Panarello, Giovanna; Occhipinti, Giovanna; Monti, Giacomo; Mojoli, Francesco; Braschi, Antonio; Iotti, Giorgio A.; Venti, Aaron.
In: Critical Care, Vol. 22, No. 1, 157, 12.06.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Immunocompromised patients with acute respiratory distress syndrome
T2 - Secondary analysis of the LUNG SAFE database
AU - Cortegiani, Andrea
AU - Madotto, Fabiana
AU - Gregoretti, Cesare
AU - Bellani, Giacomo
AU - Laffey, John G.
AU - Pham, Tai
AU - Van Haren, Frank
AU - Giarratano, Antonino
AU - Antonelli, Massimo
AU - Pesenti, Antonio
AU - Grasselli, Giacomo
AU - Sula, Hektor
AU - Nunci, Lordian
AU - Cani, Alma
AU - Zazu, Alan
AU - Dellera, Christian
AU - Insaurralde, Carolina S.
AU - Alejandro, Risso V.
AU - Daldin, Julio
AU - Vinzio, Mauricio
AU - Fernandez, Ruben O.
AU - Cardonnet, Luis P.
AU - Bettini, Lisandro R.
AU - Bisso, Mariano Carboni
AU - Osman, Emilio M.
AU - Setten, Mariano G.
AU - Lovazzano, Pablo
AU - Alvarez, Javier
AU - Villar, Veronica
AU - Pozo, Norberto C.
AU - Grubissich, Nicolas
AU - Plotnikow, Gustavo A.
AU - Vasquez, Daniela N.
AU - Ilutovich, Santiago
AU - Tiribelli, Norberto
AU - Chena, Ariel
AU - Pellegrini, Carlos A.
AU - Saenz, María G.
AU - Estenssoro, Elisa
AU - Brizuela, Matias
AU - Gianinetto, Hernan
AU - Gomez, Pablo E.
AU - Protti, Alessandro
AU - Panarello, Giovanna
AU - Occhipinti, Giovanna
AU - Monti, Giacomo
AU - Mojoli, Francesco
AU - Braschi, Antonio
AU - Iotti, Giorgio A.
AU - Venti, Aaron
PY - 2018/6/12
Y1 - 2018/6/12
N2 - 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.
AB - 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.
KW - Acute respiratory failure
KW - ARDS
KW - Immunocompromised patients
KW - Mechanical ventilation
KW - Noninvasive ventilation
UR - http://www.scopus.com/inward/record.url?scp=85048497595&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048497595&partnerID=8YFLogxK
U2 - 10.1186/s13054-018-2079-9
DO - 10.1186/s13054-018-2079-9
M3 - Article
AN - SCOPUS:85048497595
VL - 22
JO - Critical Care
JF - Critical Care
SN - 1466-609X
IS - 1
M1 - 157
ER -