• Virginie Lemiale, Audrey De Jong, Guillaume Dumas, Alexandre Demoule, Djamel Mokart, Frederic Pène, Achille Kouatchet, Magali Bisbal, Fabrice Bruneel, Christine Lebert, Isabelle Vinatier, Dominique Benoit, Anne-Pascale Meert, Samir Jaber, Michael Darmon, Elie Azoulay, and Groupe de Recherche en Reanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH).
• ICU, Saint Louis Teaching Hospital, Paris, France.
• Crit. Care Med. 2020 Sep 1; 48 (9): e768-e775.

ObjectivesTo assess the response to initial oxygenation strategy according to clinical variables available at admission.DesignMulticenter cohort study.SettingThirty French and Belgium medical ICU.SubjectsImmunocompromised patients with hypoxemic acute respiratory failure.InterventionsNone.Measurements And Main ResultsData were extracted from the Groupe de Recherche en Reanimation Respiratoire du patient d'Onco-Hématologie database. Need for invasive mechanical ventilation was the primary endpoint. Secondary endpoint was day-28 mortality. Six-hundred forty-nine patients were included. First oxygenation strategies included standard oxygen (n = 245, 38%), noninvasive ventilation (n = 285; 44%), high-flow nasal cannula oxygen (n = 55; 8%), and noninvasive ventilation + high-flow nasal cannula oxygen (n = 64; 10%). Bilateral alveolar pattern (odds ratio = 1.67 [1.03-2.69]; p = 0.04), bacterial (odds ratio = 1.98 [1.07-3.65]; p = 0.03) or opportunistic infection (odds ratio = 4.75 [2.23-10.1]; p < 0.001), noninvasive ventilation use (odds ratio = 2.85 [1.73-4.70]; p < 0.001), Sequential Organ Failure Assessment score (odds ratio = 1.19 [1.10-1.28]; p < 0.001), and ratio of PaO2 and FIO2 less than 100 at ICU admission (odds ratio = 1.96 [1.27-3.02]; p = 0.0002) were independently associated with intubation rate. Day-28 mortality was independently associated with bacterial (odds ratio = 2.34 [1.10-4.97]; p = 0.03) or opportunistic infection (odds ratio = 4.96 [2.11-11.6]; p < 0.001), noninvasive ventilation use (odds ratio = 2.35 [1.35-4.09]; p = 0.003), Sequential Organ Failure Assessment score (odds ratio = 1.19 [1.10-1.28]; p < 0.001), and ratio of PaO2 and FIO2 less than 100 at ICU admission (odds ratio = 1.97 [1.26-3.09]; p = 0.003). High-flow nasal cannula oxygen use was neither associated with intubation nor mortality rates.ConclusionsSome clinical characteristics at ICU admission including etiology and severity of acute respiratory failure enable to identify patients at high risk for intubation.

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