title: Effect of Noninvasive Ventilation vs Oxygen Therapy on Mortality Among Immunocompromised Patients With Acute Respiratory Failure: A Randomized Clinical Trial.
abstract: 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.
authors.affiliation: Saint-Louis University Hospital, Paris, France.
authors.forename: Virginie
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authors.lastname: Lemiale
authors.affiliation: IPC, Lyon, France.
authors.forename: Djamel
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authors.lastname: Mokart
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authors.affiliation: APHP, Paris, France.
authors.forename: Frédéric
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authors.affiliation: Service de Pneumologie Et Réanimation Médicale, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.
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authors.lastname: Mayaux
authors.affiliation: Hospices Civils de Lyon, Lyon, France.
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authors.affiliation: Roubaix, Roubaix, France.
authors.forename: Martine
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authors.affiliation: Medical Intensive Care Unit, Charles Nicolle University Hospital-Rouen University, Rouen, France.
authors.forename: Christophe
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authors.affiliation: Centre Hospitalier Universitaire-Nancy, Nancy, France.
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authors.affiliation: University Hospital of Nantes, Nantes, France.
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authors.affiliation: The Institut Gustave-Roussy (IGR), France.
authors.forename: Kenneth
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authors.affiliation: Intensive Care Unit, CHRU Angers, Angers, France.
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authors.affiliation: APHP, Paris, France.
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authors.lastname: Théodose
authors.affiliation: Intensive Care Medicine, Ghent, Gent, Belgium.
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authors.forename: Kada
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authors.affiliation: Centre Hospitalier Universitaire-Amiens, Amiens, France.
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authors.affiliation: APHP, Paris, France.
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authors.affiliation: APHP, Paris, France.
authors.forename: Lila
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authors.lastname: Bouadma
authors.affiliation: Centre de Réanimation, CHRU Lille, Lille, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Moreau
authors.affiliation: Centre Hospitalier Universitaire-Caen, Caen, France.
authors.forename: Amélie
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authors.lastname: Seguin
authors.affiliation: Institut Jules Bordet, Brussels, Belgium.
authors.forename: Anne-Pascale
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authors.lastname: Meert
authors.affiliation: Réanimation Médicale, Centre Hospitalier Universitaire-Nantes, Nantes, France.
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authors.lastname: Reignier
authors.affiliation: Réanimation DRIS, Hopital Nord, Marseille, France.
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authors.affiliation: Centre Hospitalier Sud Francilien (CHSF), France.
authors.forename: Ilham
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authors.lastname: Mehzari
authors.affiliation: Hôpital d'Avicenne, APHP, Bobigny, France.
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authors.affiliation: The Hôpital civil de Strasbourg, Strasbourg, France.
authors.forename: Maleka
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authors.lastname: Schenck
authors.affiliation: The Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
authors.forename: Rebecca
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authors.lastname: Hamidfar
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authors.forename: Michael
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authors.lastname: Darmon
authors.affiliation: APHP, Paris, France.
authors.forename: Alexandre
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authors.lastname: Demoule
authors.affiliation: Saint-Louis University Hospital, Paris, France.
authors.forename: Sylvie
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mesh_terms: D000208:Acute Disease; D000368:Aged; D001530:Belgium; D002423:Cause of Death; D003428:Cross Infection; D005260:Female; D005602:France; D006801:Humans; D000860:Hypoxia / Q000401:mortality / Q000628:therapy; D016867:Immunocompromised Host; D007362:Intensive Care Units; D007440:Intubation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000401:mortality*; D010102:Oxygen Inhalation Therapy / Q000401:mortality*; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy; D013997:Time Factors