• Gaston Burghi, Victoria Metaxa, Peter Pickkers, Marcio Soares, Jordi Rello, Philippe R Bauer, Andry van de Louw, Fabio Silvio Taccone, LoechesIgnacio MartinIMDepartment of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland., Peter Schellongowski, Katerina Rusinova, Massimo Antonelli, Achille Kouatchet, Andreas Barratt-Due, Miia Valkonen, Frédéric Pène, Djamel Mokart, Samir Jaber, Elie Azoulay, Audrey De Jong, and Efraim investigators and the Nine-I study group.
• Terapia Intensiva, Hospital Maciel - Montevideo, Uruguay.
• J Crit Care. 2022 Dec 1; 72: 154152154152.

PurposeTo identify patient, disease and organizational factors associated with decisions to forgo life-sustaining therapies (DFLSTs) in critically ill immunocompromised patients admitted to the intensive care unit (ICU) for acute respiratory failure.Material And MethodsWe performed a secondary analysis of the international EFRAIM prospective study, which enrolled 1611 immunocompromised patients with acute respiratory failure admitted to 68 ICUs in 16 countries between October 2015 and June 2016. Multivariate logistic analysis was performed to identify independent predictors of DFLSTs.ResultsThe main causes of immunosuppression were hematological malignancies (50%) and solid tumor (38%). Patients had a median age of 63 yo (54-71). A pulmonologist was involved in the patient management in 38% of cases. DFLSTs had been implemented in 28% of the patients. The following variables were independently associated with DFLSTs: 1) patient-related: older age (OR 1.02 per one year increase, 95% confidence interval(CI) 1.01-1.03,P < 0.001), poor performance status (OR 2.79, 95% CI 1.98-3.93, P < 0.001); 2) disease-related: shock (OR 2.00, 95% CI 1.45-2.75, P < 0.001), liver failure (OR 1.59, 95% CI 1.14-2.21, P = 0.006), invasive mechanical ventilation (OR 1.79, 95% CI 1.31-2.46, P < 0.001); 3) organizational: having a pulmonologist involved in patient management (OR 1.85, 95% CI 1.36-2.52, P < 0.001), and the presence of a critical care outreach services (OR 1.63, 95% CI 1.11-2.38, P = 0.012).ConclusionsA DFLST is made in one in four immunocompromised patient admitted to the ICU for acute respiratory failure. Involving a pulmonologist in patient's management is associated with less non beneficial care.Copyright © 2022 Elsevier Inc. All rights reserved.

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