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

Cortegiani, Andrea, Madotto, Fabiana, Gregoretti, Cesare, Bellani, Giacomo, Laffey, John G., Pham, Tai, Van Haren, Frank, Giarratano, Antonino, Antonelli, Massimo, Pesenti, Antonio, Grasselli, Giacomo and Szakmany, Tamas ORCID: https://orcid.org/0000-0003-3632-8844 2018. Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database. Critical Care 22 (157) 10.1186/s13054-018-2079-9

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: BioMed Central
ISSN: 1364-8535
Date of First Compliant Deposit: 23 September 2018
Date of Acceptance: 22 May 2018
Last Modified: 05 May 2023 07:07
URI: https://orca.cardiff.ac.uk/id/eprint/115183

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