@article{6f20ceb227244732ac7df81b87c9a846,
title = "Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database",
abstract = "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. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013.",
keywords = "Acute respiratory failure, ARDS, Immunocompromised patients, Mechanical ventilation, Noninvasive ventilation",
author = "Andrea Cortegiani and Fabiana Madotto and Cesare Gregoretti and Giacomo Bellani and Laffey, {John G.} and Tai Pham and {Van Haren}, Frank and Antonino Giarratano and Massimo Antonelli and Antonio Pesenti and Giacomo Grasselli and {LUNG SAFE Investigators} and {ESICM Trials Group} and Hektor Sula and Lordian Nunci and Alma Cani and Alan Zazu and Christian Dellera and Insaurralde, {Carolina S.} and Alejandro, {Risso V.} and Julio Daldin and Mauricio Vinzio and Fernandez, {Ruben O.} and Cardonnet, {Luis P.} and Bettini, {Lisandro R.} and Bisso, {Mariano Carboni} and Osman, {Emilio M.} and Setten, {Mariano G.} and Pablo Lovazzano and Javier Alvarez and Veronica Villar and Pozo, {Norberto C.} and Nicolas Grubissich and Plotnikow, {Gustavo A.} and Vasquez, {Daniela N.} and Santiago Ilutovich and Norberto Tiribelli and Ariel Chena and Pellegrini, {Carlos A.} and Saenz, {Mar{\'i}a G.} and Elisa Estenssoro and Matias Brizuela and Hernan Gianinetto and Gomez, {Pablo E.} and Cerrato, {Valeria I.} and Bezzi, {Marco G.} and Borello, {Silvina A.} and Loiacono, {Flavia A.} and Fernandez, {Adriana M.} and Serena Knowles and Claire Reynolds and Inskip, {Deborah M.} and Miller, {Jennene J.} and Jing Kong and Christina Whitehead and Shailesh Bihari and Aylin Seven and Amanda Krstevski and Rodgers, {Helen J.} and Millar, {Rebecca T.} and Mckenna, {Toni E.} and Bailey, {Irene M.} and Hanlon, {Gabrielle C.} and Anders Aneman and Lynch, {Joan M.} and Raman Azad and John Neal and Woods, {Paul W.} and Roberts, {Brigit L.} and Kol, {Mark R.} and Wong, {Helen S.} and Riss, {Katharina C.} and Thomas Staudinger and Xavier Wittebole and Caroline Berghe and Bulpa, {Pierre A.} and Dive, {Alain M.} and Rik Verstraete and Herve Lebbinck and Pieter Depuydt and Joris Vermassen and Philippe Meersseman and Helga Ceunen and Rosa, {Jonas I.} and Beraldo, {Daniel O.} and Claudio Piras and Rampinelli, {Adenilton M.} and Nassar, {Antonio P.} and Sergio Mataloun and Marcelo Moock and Thompson, {Marlus M.} and Gon{\c c}alves, {Claudio H.} and Ant{\^o}nio, {Ana Carolina P.} and Aline Ascoli and Biondi, {Rodrigo S.} and Fontenele, {Danielle C.} and Danielle Nobrega and {Sales Brunei}, {Vanessa M.} and Suresh Shindhe and {Binti Pengiran Haji Ismail}, {Dayangku Hajah Maizatul Aiman} and Francois Beloncle and Davies, {Kyle G.} and Rob Cirone and Venika Manoharan and Mehvish Ismail and Goligher, {Ewan C.} and Mandeep Jassal and Erin Nishikawa and Areej Javeed and Gerard Curley and Nuttapol Rittayamai and Matteo Parotto and Ferguson, {Niall D.} and Sangeeta Mehta and Jenny Knoll and Antoine Pronovost and Sergio Canestrini and Bruhn, {Alejandro R.} and Garcia, {Patricio H.} and Aliaga, {Felipe A.} and Far{\'i}as, {Pamela A.} and Yumha, {Jacob S.} and Ortiz, {Claudia A.} and Salas, {Javier E.} and Saez, {Alejandro A.} and Vega, {Luis D.} and Labarca, {Eduardo F.} and Martinez, {Felipe T.} and Carre{\~n}o, {Nicol{\'a}s G.} and Pilar Lora and Haitao Liu and Haibo Qiu and Ling Liu and Rui Tang and Xiaoming Luo and Youzhong An and Huiying Zhao and Yan Gao and Zhe Zhai and Ye, {Zheng L.} and Wei Wang and Wenwen Li and Qingdong Li and Ruiqiang Zheng and Wenkui Yu and Juanhong Shen and Xinyu Li and Tao Yu and Weihua Lu and Wu, {Ya Q.} and Huang, {Xiao B.} and Zhenyang He and Yuanhua Lu and Hui Han and Fan Zhang and Renhua Sun and Wang, {Hua X.} and Qin, {Shu H.} and Zhu, {Bao H.} and Jun Zhao and Jian Liu and Bin Li and Liu, {Jing L.} and Zhou, {Fa C.} and Li, {Qiong J.} and Zhang, {Xing Y.} and Zhou Li-Xin and Qiang Xin-Hua and Liangyan Jiang and Gao, {Yuan N.} and Zhao, {Xian Y.} and Li, {Yuan Y.} and Li, {Xiao L.} and Chunting Wang and Qingchun Yao and Rongguo Yu and Kai Chen and Huanzhang Shao and Bingyu Qin and Huang, {Qing Q.} and Zhu, {Wei H.} and Hang, {Ai Y.} and Hua, {Ma X.} and Yimin Li and Yonghao Xu and Di, {Yu D.} and Ling, {Long L.} and Qin, {Tie H.} and Wang, {Shou H.} and Junping Qin and Yi Han and Suming Zhou and Vargas, {Monica P.} and {Silesky Jimenez}, {Juan I.} and Rojas, {Manuel A.Gonz{\'a}lez} and Solis-Quesada, {Jaime E.} and Ramirez-Alfaro, {Christian M.} and Jan M{\'a}ca and Peter Sklienka and Jakob Gjedsted and Aage Christiansen and Jonas Nielsen and Villamagua, {Boris G.} and Miguel Llano and Philippe Burtin and Gautier Buzancais and Pascal Beuret and Nicolas Pelletier and Satar Mortaza and Alain Mercat and Jonathan Chelly and S{\'e}bastien Jochmans and Nicolas Terzi and C{\'e}dric Daubin and Guillaume Carteaux and {de Prost}, Nicolas and Chiche, {Jean Daniel} and Fabrice Daviaud and Pham Tai and Muriel Fartoukh and Guillaume Barberet and Jerome Biehler and Jean Dellamonica and Denis Doyen and Arnal, {Jean Michel} and Anais Briquet and Sami Hraiech and Laurent Papazian and Arnaud Follin and Damien Roux and Jonathan Messika and Evangelos Kalaitzis and Laurence Dangers and Alain Combes and Au, {Siu Ming} and Gaetan B{\'e}duneau and Doroth{\'e}e Carpentier and Zogheib, {Elie H.} and Herve Dupont and Sylvie Ricome and Santoli, {Francesco L.} and Besset, {Sebastien L.} and Philippe Michel and Bruno Gel{\'e}e and Danin, {Pierre Eric} and Bernard Goubaux and Crova, {Philippe J.} and Phan, {Nga T.} and Frantz Berkelmans and Badie, {Julio C.} and Romain Tapponnier and Josette Gally and Samy Khebbeb",
note = "Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.",
year = "2018",
month = jun,
day = "12",
doi = "10.1186/s13054-018-2079-9",
language = "English",
volume = "22",
journal = "Critical Care",
issn = "1364-8535",
publisher = "BioMed Central Ltd.",
number = "1",
}