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Salvadori  M, Bertoni  E.  What’s new in clinical solid organ transplantation by 2013.  World J Transplant. 2014;4(4):243-266.PubMedGoogle ScholarCrossref
Soerjomataram  I, Lortet-Tieulent  J, Parkin  DM,  et al.  Global burden of cancer in 2008: a systematic analysis of disability-adjusted life-years in 12 world regions.  Lancet. 2012;380(9856):1840-1850.PubMedGoogle ScholarCrossref
van Vliet  M, Verburg  IW, van den Boogaard  M,  et al.  Trends in admission prevalence, illness severity and survival of haematological patients treated in Dutch intensive care units.  Intensive Care Med. 2014;40(9):1275-1284.PubMedGoogle ScholarCrossref
Azoulay  E, Lemiale  V, Mokart  D,  et al.  Acute respiratory distress syndrome in patients with malignancies.  Intensive Care Med. 2014;40(8):1106-1114.PubMedGoogle ScholarCrossref
Mokart  D, Pastores  SM, Darmon  M.  Has survival increased in cancer patients admitted to the ICU? yes.  Intensive Care Med. 2014;40(10):1570-1572.PubMedGoogle ScholarCrossref
Azoulay  E, Mokart  D, Pène  F,  et al.  Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique study.  J Clin Oncol. 2013;31(22):2810-2818.PubMedGoogle ScholarCrossref
Hilbert  G, Gruson  D, Vargas  F,  et al.  Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure.  N Engl J Med. 2001;344(7):481-487.PubMedGoogle ScholarCrossref
Keenan  SP, Sinuff  T, Burns  KE,  et al; Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group.  Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting.  CMAJ. 2011;183(3):E195-E214.PubMedGoogle ScholarCrossref
Azoulay  E, Lemiale  V.  Non-invasive mechanical ventilation in hematology patients with hypoxemic acute respiratory failure: a false belief?  Bone Marrow Transplant. 2012;47(4):469-472.PubMedGoogle ScholarCrossref
Azoulay  E, Mokart  D, Lambert  J,  et al.  Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial.  Am J Respir Crit Care Med. 2010;182(8):1038-1046.PubMedGoogle ScholarCrossref
Schellongowski  P, Staudinger  T, Kundi  M,  et al.  Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience.  Haematologica. 2011;96(2):231-237.PubMedGoogle ScholarCrossref
Gristina  GR, Antonelli  M, Conti  G,  et al; GiViTI (Italian Group for the Evaluation of Interventions in Intensive Care Medicine).  Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey.  Crit Care Med. 2011;39(10):2232-2239.PubMedGoogle ScholarCrossref
Lemiale  V, Resche-Rigon  M, Azoulay  E; Study Group for Respiratory Intensive Care in Malignancies Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie.  Early non-invasive ventilation for acute respiratory failure in immunocompromised patients (IVNIctus): study protocol for a multicenter randomized controlled trial.  Trials. 2014;15:372.PubMedGoogle ScholarCrossref
Azoulay  E, Mokart  D, Rabbat  A,  et al.  Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data.  Crit Care Med. 2008;36(1):100-107.PubMedGoogle ScholarCrossref
Guérin  C, Reignier  J, Richard  JC.  Prone positioning in the acute respiratory distress syndrome.  N Engl J Med. 2013;369(10):980-981.PubMedGoogle Scholar
Malhotra  A.  Low-tidal-volume ventilation in the acute respiratory distress syndrome.  N Engl J Med. 2007;357(11):1113-1120.PubMedGoogle ScholarCrossref
Papazian  L, Forel  JM, Gacouin  A,  et al; ACURASYS Study Investigators.  Neuromuscular blockers in early acute respiratory distress syndrome.  N Engl J Med. 2010;363(12):1107-1116.PubMedGoogle ScholarCrossref
Santa Cruz  R, Rojas  JI, Nervi  R, Heredia  R, Ciapponi  A.  High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome.  Cochrane Database Syst Rev. 2013;6:CD009098.PubMedGoogle Scholar
Vincent  JL, Moreno  R, Takala  J,  et al; Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.  The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure.  Intensive Care Med. 1996;22(7):707-710.PubMedGoogle ScholarCrossref
Canet  E, Osman  D, Lambert  J,  et al.  Acute respiratory failure in kidney transplant recipients: a multicenter study.  Crit Care. 2011;15(2):R91.PubMedGoogle ScholarCrossref
Faguer  S, Ciroldi  M, Mariotte  E,  et al.  Prognostic contributions of the underlying inflammatory disease and acute organ dysfunction in critically ill patients with systemic rheumatic diseases.  Eur J Intern Med. 2013;24(3):e40-e44.PubMedGoogle ScholarCrossref
Gray  R.  A class of K-sample tests for comparing the cumulative incidence of a competing risk.  Ann Stat. 1988;16(3):1141-1154. http://www.jstor.org/stable/2241622. Accessed September 21, 2015.Google Scholar
Gail  M, Simon  R.  Testing for qualitative interactions between treatment effects and patient subsets.  Biometrics. 1985;41(2):361-372.PubMedGoogle ScholarCrossref
Mokart  D, Darmon  M, Resche-Rigon  M,  et al.  Prognosis of neutropenic patients admitted to the intensive care unit.  Intensive Care Med. 2015;41(2):296-303.PubMedGoogle ScholarCrossref
Azoulay  E, Kouatchet  A, Jaber  S,  et al.  Noninvasive mechanical ventilation in patients having declined tracheal intubation.  Intensive Care Med. 2013;39(2):292-301.PubMedGoogle ScholarCrossref
Adda  M, Coquet  I, Darmon  M, Thiery  G, Schlemmer  B, Azoulay  E.  Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure.  Crit Care Med. 2008;36(10):2766-2772.PubMedGoogle ScholarCrossref
Depuydt  PO, Benoit  DD, Vandewoude  KH, Decruyenaere  JM, Colardyn  FA.  Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure.  Chest. 2004;126(4):1299-1306.PubMedGoogle ScholarCrossref
Lemiale  V, Lambert  J, Canet  E,  et al; Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study.  Identifying cancer subjects with acute respiratory failure at high risk for intubation and mechanical ventilation.  Respir Care. 2014;59(10):1517-1523.PubMedGoogle ScholarCrossref
Depuydt  PO, Benoit  DD, Roosens  CD, Offner  FC, Noens  LA, Decruyenaere  JM.  The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure.  J Crit Care. 2010;25(1):30-36.PubMedGoogle ScholarCrossref
Frat  JP, Brugiere  B, Ragot  S,  et al.  Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study.  Respir Care. 2015;60(2):170-178.PubMedGoogle ScholarCrossref
Original Investigation
Caring for the Critically Ill Patient
October 27, 2015

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

Author Affiliations
  • 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
JAMA. 2015;314(16):1711-1719. doi:10.1001/jama.2015.12402

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