Abstract
Acute respiratory failure is the main reason for admission to ICU in critically ill immunocompromised patients. Due to special pathophysiology in these patients, the mortality is very high. Oxygen is one of the main interventions to improve survival. As oxygen strategies in these patients have been significantly improved in recent years, we performed a review to summarize the current evidences on noninvasive ventilation (NIV) in critically ill immunocompromised patients. Since high flow nasal cannula (HFNC) is a special NIV, we also included in this review.
We searched the PubMed on the topic of NIV or HFNC in immunocompromised patients published from Jan first, 2017 to Mar 31st, 2019. All the original articles, systemic review, meta-analysis, and guidelines were enrolled. Finally, we enrolled 12 original articles, 3 systemic reviews and meta-analysis, and a guideline in this review.
Based on the evidences published in the last 2 years, we concluded that NIV reduced short-term mortality and intubation rate compared to standard oxygen therapy. HFNC may reduce intubation rate concluded from low-quality studies. However, both NIV failure and HFNC failure were associated with increased mortality. Assessment of heart rate, acidosis, consciousness, oxygenation and respiratory rate (HACOR score) has the potential to identify early NIV failure.
NIV and HFNC is a promising strategy to manage critically ill immunocompromised patients. As the low-quality evidences in current studies, high-quality studies are needed, particularly the randomized controlled trials.
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Duan, J., Bai, L., Han, X., Zhou, L. (2020). Noninvasive Ventilation in Immunocompromised Patients. In: Esquinas, A.M., et al. Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-42998-0_45
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DOI: https://doi.org/10.1007/978-3-030-42998-0_45
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