Non invasive ventilation in immunocompromised patients.

In the last thirty years, the rapid evolution of surgical techniques, together with the use of innovative immunosuppressive strategies and optimal chemoprofilaxis, has dramatically extended the applicability of solid organs transplantation. However, despite the increase of post-transplantation survival rate, respiratory complications remain the main cause of morbidity and one of the main causes of mortality. Accordingly, the use of aggressive treatments has also increased the survival rates in patients with hematologic malignancies, but at price of an increased susceptibility to infections. Many immunocompromised patients develop acute respiratory failure (ARF). In this situation, the early application of positive pressure ventilation is aimed at restoring the decreased lung volume, increasing oxygenation, and reducing both the work of breathing and the respiratory drive; moreover to re-establish patient's equilibrium allows to buy time for an effective etiologic treatment. According to the results of several prospective randomized and non-randomized trials, the application of NIV seems able both to decrease the rate of nosocomial infectious complications, and to improve gas exchange with optimal patients tolerance. The aim of this review will be to shortly analyze the fields of application and the clinical results obtained with NIV in patients with immunosuppression of various origin.