Title :

Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial

Author(s) :

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

Journal title :

JAMA

Abbreviated title :

JAMA

Volume number :

314

Pages :

1711-9

Publication date :

2015-10-27

ISSN :

1538-3598

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

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

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Université de Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2019-12-09T16:52:48Z