Guillaume Dumas1,2, Virginie Lemiale1,2, Nisha Rathi3, Andrea Cortegiani4, Frédéric Pène5, Vincent Bonny1,2, Jorge Salluh6, Guillermo M Albaiceta7,8, Marcio Soares6, Ayman O Soubani9, Emmanuel Canet10, Tarik Hanane11, Achille Kouatchet12, Djamel Mokart13, Pia Lebiedz14, Melda Türkoğlu15, Rémi Coudroy16,17, Kyeongman Jeon18,19, Alexandre Demoule20, Sangeeta Mehta21, Pedro Caruso22, Jean-Pierre Frat16,17, Kuang-Yao Yang23,24, Oriol Roca8,25,26, John Laffey27,28, Jean-François Timsit29, Elie Azoulay1,2, Michael Darmon1,2. 1. Medical ICU, Saint-Louis Teaching Hospital, Paris, France. 2. ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France. 3. Department of Critical Care, MD Anderson Cancer Center, Houston, Texas. 4. Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy. 5. Medical ICU, Cochin Teaching Hospital, Paris, France. 6. The Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil. 7. Instituto de Investigación Sanitaria del Principado de Asturias, Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain. 8. CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 9. Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan. 10. Medical ICU, Nantes Teaching Hospital, Nantes, France. 11. Department of Critical Care, Cleveland Clinic, Cleveland, Ohio. 12. Medical ICU, Angers Teaching Hospital, Angers, France. 13. ICU, Institut Paoli Calmettes, Marseille, France. 14. ICU, Evangelisches Krankenhaus, Oldenburg, Germany. 15. Medical ICU, Gazi University School of Medicine, Ankara, Turkey. 16. CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France. 17. INSERM CIC1402, groupe ALIVE, Université de Poitiers, Poitiers, France. 18. Department of Critical Care Medicine and. 19. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro, Gangnam-gu, Seoul, Korea. 20. APHP Sorbonne Université site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S) and INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France. 21. Medical Surgical ICU, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. 22. Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil. 23. Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 24. School of Medicine, National Yang-Ming University, Taipei, Taiwan. 25. Servei de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Barcelona, Spain. 26. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. 27. Department of Anesthesia and. 28. Department of Intensive Care Medicine, NUI Galway, Ireland; and. 29. Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, UMR 1137 Inserm, Université de Paris, IAME, Paris, France.
Abstract
Rationale: Acute respiratory failure (ARF) is associated with high mortality in immunocompromised patients, particularly when invasive mechanical ventilation is needed. Therefore, noninvasive oxygenation/ventilation strategies have been developed to avoid intubation, with uncertain impact on mortality, especially when intubation is delayed. Objectives: We sought to report trends of survival over time in immunocompromised patients receiving invasive mechanical ventilation. The impact of delayed intubation after failure of noninvasive strategies was also assessed. Methods: Systematic review and meta-analysis using individual patient data of studies that focused on immunocompromised adult patients with ARF requiring invasive mechanical ventilation. Studies published in English were identified through PubMed, Web of Science, and Cochrane Central (2008-2018). Individual patient data were requested from corresponding authors for all identified studies. We used mixed-effect models to estimate the effect of delayed intubation on hospital mortality and described mortality rates over time. Measurements and Main Results: A total of 11,087 patients were included (24 studies, three controlled trials, and 21 cohorts), of whom 7,736 (74%) were intubated within 24 hours of ICU admission (early intubation). The crude mortality rate was 53.2%. Adjusted survivals improved over time (from 1995 to 2017, odds ratio [OR] for hospital mortality per year, 0.96 [0.95-0.97]). For each elapsed day between ICU admission and intubation, mortality was higher (OR, 1.38 [1.26-1.52]; P < 0.001). Early intubation was significantly associated with lower mortality (OR, 0.83 [0.72-0.96]), regardless of initial oxygenation strategy. These results persisted after propensity score analysis (matched OR associated with delayed intubation, 1.56 [1.44-1.70]). Conclusions: In immunocompromised intubated patients, survival has improved over time. Time between ICU admission and intubation is a strong predictor of mortality, suggesting a detrimental effect of late initial oxygenation failure.
Rationale: Acute respiratory failure (ARF) is associated with high mortality in immunocompromised patients, particularly when invasive mechanical ventilation is needed. Therefore, noninvasive oxygenation/ventilation strategies have been developed to avoid intubation, with uncertain impact on mortality, especially when intubation is delayed. Objectives: We sought to report trends of survival over time in immunocompromised patients receiving invasive mechanical ventilation. The impact of delayed intubation after failure of noninvasive strategies was also assessed. Methods: Systematic review and meta-analysis using individual patient data of studies that focused on immunocompromised adult patients with ARF requiring invasive mechanical ventilation. Studies published in English were identified through PubMed, Web of Science, and Cochrane Central (2008-2018). Individual patient data were requested from corresponding authors for all identified studies. We used mixed-effect models to estimate the effect of delayed intubation on hospital mortality and described mortality rates over time. Measurements and Main Results: A total of 11,087 patients were included (24 studies, three controlled trials, and 21 cohorts), of whom 7,736 (74%) were intubated within 24 hours of ICU admission (early intubation). The crude mortality rate was 53.2%. Adjusted survivals improved over time (from 1995 to 2017, odds ratio [OR] for hospital mortality per year, 0.96 [0.95-0.97]). For each elapsed day between ICU admission and intubation, mortality was higher (OR, 1.38 [1.26-1.52]; P < 0.001). Early intubation was significantly associated with lower mortality (OR, 0.83 [0.72-0.96]), regardless of initial oxygenation strategy. These results persisted after propensity score analysis (matched OR associated with delayed intubation, 1.56 [1.44-1.70]). Conclusions: In immunocompromised intubated patients, survival has improved over time. Time between ICU admission and intubation is a strong predictor of mortality, suggesting a detrimental effect of late initial oxygenation failure.
Authors: Matthias Kochanek; Jan Kochanek; Boris Böll; Dennis A Eichenauer; Gernot Beutel; Hendrik Bracht; Stephan Braune; Florian Eisner; Sigrun Friesecke; Ulf Günther; Gottfried Heinz; Michael Hallek; Christian Karagiannidis; Stefan Kluge; Klaus Kogelmann; Pia Lebiedz; Philipp M Lepper; Tobias Liebregts; Catherina Lueck; Ralf M Muellenbach; Matthias Hansen; Christian Putensen; Peter Schellongowski; Jens-Christian Schewe; Kathrin Schumann-Stoiber; Frederik Seiler; Peter Spieth; Steffen Weber-Carstens; Daniel Brodie; Elie Azoulay; Alexander Shimabukuro-Vornhagen Journal: Intensive Care Med Date: 2022-02-10 Impact factor: 17.440
Authors: Fernando G Zampieri; Leonardo S L Bastos; Marcio Soares; Jorge I Salluh; Fernando A Bozza Journal: Intensive Care Med Date: 2021-09-13 Impact factor: 17.440