• Yang Xu, Yi-Fan Wang, Yi-Wei Liu, Run Dong, Yan Chen, Yi Wang, Li Weng, Bin Du, and China Critical Care Clinical Trials Group (CCCCTG) and China National Critical Care Quality Control Center Group.
• Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
• Crit. Care Med. 2024 Nov 1; 52 (11): 173917491739-1749.

ObjectiveTo determine whether mortality differed between initial invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV) followed by delayed IMV in immunocompromised patients with sepsis.DesignRetrospective analysis using the National Data Center for Medical Service claims data in China from 2017 to 2019.SettingA total of 3530 hospitals across China.PatientsA total of 36,187 adult immunocompromised patients with sepsis requiring ventilation.InterventionsNone.Measurements And Main ResultsThe primary outcome was hospital mortality. Patients were categorized into NIV initiation or IMV initiation groups based on first ventilation. NIV patients were further divided by time to IMV transition: no transition, immediate (≤ 1 d), early (2-3 d), delayed (4-7 d), or late (≥ 8 d). Mortality was compared between groups using weighted Cox models. Over the median 9-day follow-up, mortality was similar for initial NIV versus IMV (adjusted hazard ratio [HR] 1.006; 95% CI, 0.959-1.055). However, among NIV patients, a longer time to IMV transition is associated with stepwise increases in mortality, from immediate transition (HR 1.65) to late transition (HR 2.51), compared with initial IMV. This dose-response relationship persisted across subgroups and sensitivity analyses.ConclusionsProlonged NIV trial before delayed IMV transition is associated with higher mortality in immunocompromised sepsis patients ultimately intubated.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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