Details

Autor(en) / Beteiligte

• Lemiale, Virginie
• Mokart, Djamel
• Resche-Rigon, Matthieu
• Pène, Frédéric
• Mayaux, Julien
• Faucher, Etienne
• Nyunga, Martine
• Girault, Christophe
• Perez, Pierre
• Guitton, Christophe
• Ekpe, Kenneth
• Kouatchet, Achille
• Théodose, Igor
• Benoit, Dominique
• Canet, Emmanuel
• Barbier, François
• Rabbat, Antoine
• Bruneel, Fabrice
• Vincent, Francois
• Klouche, Kada
• Loay, Kontar
• Mariotte, Eric
• Bouadma, Lila
• Moreau, Anne-Sophie
• Seguin, Amélie
• Meert, Anne-Pascale
• Reignier, Jean
• Papazian, Laurent
• Mehzari, Ilham
• Cohen, Yves
• Schenck, Maleka
• Hamidfar, Rebecca
• Darmon, Michael
• Demoule, Alexandre
• Chevret, Sylvie
• Azoulay, Elie

Titel

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

Ist Teil von

• JAMA : the journal of the American Medical Association, 2015-10, Vol.314 (16), p.1711

Ort / Verlag

United States

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure. However, its effectiveness for this indication remains unclear. To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acute hypoxemic respiratory failure. 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. Patients were randomly assigned to early noninvasive ventilation (n = 191) or oxygen therapy alone (n = 183). 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. 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. 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. clinicaltrials.gov Identifier: NCT01915719.