Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study

Azoulay, Élie; Pickkers, Peter; Soares, Márcio; Perner, Anders; Rello, Jordi; Bauer, Philippe R.; Louw, Andry Van de; Hemelaar, Pleun; Lemiale, Virginie; Taccone, Fabio Silvio; Martín‐Loeches, Ignacio; Meyhoff, Tine Sylvest; Salluh, Jorge I.; Schellongowski, Peter; Rusínová, Kateřina; Terzi, Nicolas; Mehta, Sangeeta; Antonelli, Massimo; Kouatchet, Achille; Barratt‐Due, Andreas; Valkonen, Miia; Landburg, Precious Pearl; Bruneel, Fabrice; Bukan, Ramin Brandt; Pène, Frédéric; Metaxa, Victoria; Moreau, Anne; Souppart, Virginie; Burghi, Gastón; Girault, Christophe; Silva, Ulysses V. A.; Montini, Luca; Barbier, François; Nielsen, Lene; Gaborit, Benjamin; Mokart, Djamel; Chevret, Sylvie; investigators, Efraim

doi:10.1007/s00134-017-4947-1

Cited by 184 publications

(190 citation statements)

References 32 publications

(51 reference statements)

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“…Azouley et al quote an in‐hospital mortality rate of 52.5% for patients intubated instantly at ICU admission. But they also point out that mortality was significantly higher, when IMV became necessary during ICU stay after failure of non‐invasive ventilation with an increment of the odds ratio for mortality from 2.55 to 5.54 . Failure of NIV with the need of secondary intubation is reported to be associated with increased mortality also by other authors .…”

Section: Discussionsupporting

confidence: 63%

Interaction of increasing ICU survival and admittance policies in patients with hematologic neoplasms: A single center experience with 304 patients

Kondakci

Reinbach

Germing

et al. 2019

European J of Haematology

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Objective We evaluated the development of ICU survival of patients with hematopoietic malignancies and discussed changes in admittance policies. Method We compared 166 patients treated between 2009 and 2012 with 138 patients treated between 2013 and 2016. Patient characteristics and outcome were analyzed. Results ICU survival was 45.2% in the first group and 66.7% in the second (P < 0.0005). Infection (P = 0.033), invasive ventilation (IMV) (P = 0.014) and SOFA score at day 3 (SOFA‐48h) (P = 0.007) independently indicated worse ICU survival in the first group, IMV (P = 0.013) and SOFA‐48h (P = 0.019) in the second group. The second group showed lower frequencies of infection (P = 0.003), IMV (P < 0.0005), need for vasopressors (P < 0.0005) and RRT (P = 0.021) at ICU admittance than the first. Further, the accumulation of hyperkaliemia, acidosis, low bicarbonate, high lactate and hypotension showed worse ICU survival in both groups and was lower in second group. Conclusion ICU survival increased distinctly between 2009 and 2016. At ICU admittance, parameters showing severity of illness were less frequent in the second group. Our findings indicate general treatment improvements especially of infections and changes of admittance policies toward early ICU admittance during time.

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Section: Discussionsupporting

confidence: 63%

Interaction of increasing ICU survival and admittance policies in patients with hematologic neoplasms: A single center experience with 304 patients

Kondakci

Reinbach

Germing

et al. 2019

European J of Haematology

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“…ARF in an immunocompromised patient may be due to infection by more than one viral, bacterial, fungal, or parasitic agent [7]. In addition, non-infectious factors may contribute to cause ARF and should be sought routinely.…”

Section: General Considerationsmentioning

confidence: 99%

“…Bacterial pneumonia accounts for about 30% of ICU admissions in cancer patients [7]. Depending on the type of immunosuppression, the incidence rate varies from 5% after chemotherapy for lung cancer to 30% after remission-induction chemotherapy for acute leukemia [17,18].…”

Section: Bacterial Pneumoniamentioning

confidence: 99%

Diagnosis of severe respiratory infections in immunocompromised patients

et al. 2020

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An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.

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“…10 Thus, for patients that require 6 L/min of standard oxygen or more, need for intubation throughout the ICU stay and mortality before hospital discharge are up to 40%. [9][10][11][12][13][14][15][16] Delayed ICU admission has been associated with increased mortality. 13,14,17 Immunocompromised patients with acute respiratory failure can be encountered by all clinicians in their daily practice.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16] Delayed ICU admission has been associated with increased mortality. 13,14,17 Immunocompromised patients with acute respiratory failure can be encountered by all clinicians in their daily practice. In this Review, we look at the epidemiology, outcomes, and diagnostic investigations in immunocompromised patients with acute respiratory failure, with emphasis on the broad range of causes that must be considered.…”

Section: Introductionmentioning

confidence: 99%

Acute respiratory failure in immunocompromised adults

Azoulay

Mokart

Kouatchet

et al. 2019

The Lancet Respiratory Medicine

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108

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Acute respiratory failure occurs in up to half of patients with haematological malignancies and 15% of those with solid tumours or solid organ transplantation. Mortality remains high. Factors associated with mortality include a need for invasive mechanical ventilation, organ dysfunction, older age, frailty or poor performance status, delayed intensive care unit admission, and acute respiratory failure due to an invasive fungal infection or unknown cause. In addition to appropriate antibacterial therapy, initial clinical management aims to restore oxygenation and predict the most probable cause based on variables related to the underlying disease, acute respiratory failure characteristics, and radiographic findings. The cause of acute respiratory failure must then be confirmed using the most efficient, least invasive, and safest diagnostic tests. In patients with acute respiratory failure of undeter mined cause, a standardised diagnostic investi gation should be done immediately at admission before deciding whether to perform more invasive diagnostic procedures or to start empirical treatments. Collaborative and multidisciplinary clinical and research networks are crucial to improve our understanding of disease pathogenesis and causation and to develop less invasive diagnostic strategies and more targeted treatment options.www.thelancet.com/respiratory Vol

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Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study

Cited by 184 publications

References 32 publications

Interaction of increasing ICU survival and admittance policies in patients with hematologic neoplasms: A single center experience with 304 patients

Interaction of increasing ICU survival and admittance policies in patients with hematologic neoplasms: A single center experience with 304 patients

Diagnosis of severe respiratory infections in immunocompromised patients

Acute respiratory failure in immunocompromised adults

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