Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00843989%3A_____%2F18%3AE0107121" target="_blank" >RIV/00843989:_____/18:E0107121 - isvavai.cz</a>

Result on the web

<a href="https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-018-2079-9" target="_blank" >https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-018-2079-9</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1186/s13054-018-2079-9" target="_blank" >10.1186/s13054-018-2079-9</a>

Result language

angličtina

Original language name

Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Original language description

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.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30221 - Critical care medicine and Emergency medicine

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2018

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Critical care

ISSN

1364-8535

e-ISSN

1466-609X

Volume of the periodical

22

Issue of the periodical within the volume

157

Country of publishing house

GB - UNITED KINGDOM

Number of pages

15

Pages from-to

1-15

UT code for WoS article

000435422000002

EID of the result in the Scopus database

2-s2.0-85048497595