• Guillaume Dumas, Sylvie Chevret, Virginie Lemiale, Frédéric Pène, Alexandre Demoule, Julien Mayaux, Achille Kouatchet, Martine Nyunga, Pierre Perez, Laurent Argaud, François Barbier, François Vincent, Fabrice Bruneel, Kada Klouche, Loay Kontar, Anne-Sophie Moreau, Jean Reignier, Laurent Papazian, Yves Cohen, Djamel Mokart, and Elie Azoulay.
• Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris, France.
• Oncotarget. 2018 Sep 14; 9 (72): 33682-33693.

AbstractWe investigated how the initial ventilation/oxygenation management may influence the need for intubation on the coming day in a cohort of immunocompromised patients with acute hypoxemic respiratory failure (ARF). Data from 847 immunocompromised patients with ARF were used to estimate the probability of intubation at day+1 within the first 3 days of ICU admission, according to oxygenation management. First, noninvasive ventilation (NIV) was compared to oxygen therapy whatever the administration device; then standard oxygen was compared to High Flow Nasal Cannula therapy alone (HFNC), NIV alone or NIV+HFNC. To take into account the oxygenation regimens over time and to handle confounders, propensity score weighting models were used. In the original sample, the probability of intubation at day+1 was higher in the NIV group vs oxygenation therapy (OR = 1.64, 95CI, 1.09-2.48) or vs the standard oxygen group (OR = 2.05, 95CI: 1.29-3.29); it was also increased in the HFNC group compared to standard oxygen (OR = 2.85, 95CI: 1.37-5.67). However, all these differences disappeared by handling confounding-by-indication in the weighted samples, as well as in the pooled model. Note that adjusted OR for day-28 mortality increased with the day of intubation. In this large cohort of immunocompromised patients, ventilation/oxygenation management had no impact on the probability of intubation on the coming day.

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