title: High-flow nasal cannula oxygen therapy versus noninvasive ventilation in immunocompromised patients with acute respiratory failure: an observational cohort study.
abstract: BACKGROUND
  Acute respiratory failure is the main cause of admission to intensive care unit in immunocompromised patients. In this subset of patients, the beneficial effects of noninvasive ventilation (NIV) as compared to standard oxygen remain debated. High-flow nasal cannula oxygen therapy (HFNC) is an alternative to standard oxygen or NIV, and its use in hypoxemic patients has been growing. Therefore, we aimed to compare outcomes of immunocompromised patients treated using HFNC alone or NIV as a first-line therapy for acute respiratory failure in an observational cohort study over an 8-year period. Patients with acute-on-chronic respiratory failure, those treated with standard oxygen alone or needing immediate intubation, and those with a do-not-intubate order were excluded.
  
  
  RESULTS
  Among the 115 patients analyzed, 60 (52 %) were treated with HFNC alone and 55 (48 %) with NIV as first-line therapy with 30 patients (55 %) receiving HFNC and 25 patients (45 %) standard oxygen between NIV sessions. The rates of intubation and 28-day mortality were higher in patients treated with NIV than with HFNC (55 vs. 35 %, p = 0.04, and 40 vs. 20 %, p = 0.02 log-rank test, respectively). Using propensity score-matched analysis, NIV was associated with mortality. Using multivariate analysis, NIV was independently associated with intubation and mortality.
  
  
  CONCLUSIONS
  Based on this observational cohort study including immunocompromised patients admitted to intensive care unit for acute respiratory failure, intubation and mortality rates could be lower in patients treated with HFNC alone than with NIV. The use of NIV remained independently associated with poor outcomes.
authors.affiliation: Service de Réanimation Médicale, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers, France. remi.coudroy@chu-poitiers.fr.|INSERM CIC 1402 (ALIVE Group), Université de Poitiers, Poitiers, France. remi.coudroy@chu-poitiers.fr.
authors.forename: Rémi
authors.initials: R
authors.lastname: Coudroy
authors.affiliation: Service de Réanimation Médicale, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers, France.
authors.forename: Angéline
authors.initials: A
authors.lastname: Jamet
authors.affiliation: Service de Réanimation Médicale, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Petua
authors.affiliation: Service de Réanimation Médicale, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers, France.|INSERM CIC 1402 (ALIVE Group), Université de Poitiers, Poitiers, France.
authors.forename: René
authors.initials: R
authors.lastname: Robert
authors.affiliation: Service de Réanimation Médicale, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers, France.|INSERM CIC 1402 (ALIVE Group), Université de Poitiers, Poitiers, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Frat
authors.affiliation: Service de Réanimation Médicale, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers, France.|INSERM CIC 1402 (ALIVE Group), Université de Poitiers, Poitiers, France.
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
keywords: Acute lung injury; Acute respiratory failure; High-flow oxygen therapy; Immunosuppression; Mechanical ventilation; Noninvasive positive pressure ventilation