• G Hilbert, D Gruson, F Vargas, R Valentino, G Gbikpi-Benissan, J-P Cardinaud, and H Guenard.
• Département de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
• Rev Mal Respir. 2003 Feb 1;20(1 Pt 1):68-76.

IntroductionIn immunosuppressed patients with acute respiratory insufficiency (ARI) mechanical ventilation is associated with a high mortality. Therefore, in this situation, avoidance of intubation could be an important objective. However, experience of non-invasive ventilation (NIV) in the immunosuppressed remains limited.State Of ArtThe first descriptive studies have shown that NIV could be an alternative to intubation, particularly in patients with malignant haematological disorders. In a prospective randomised controlled study Antonelli et al. showed that the use of NIV significantly improved the prognosis of patients with ARI following organ transplantation. We have carried out a prospective randomised controlled trial in 52 immunosuppressed patients to determine whether NIV improved the prognosis in patients admitted to intensive care with pulmonary infiltrates, fever and ARI. The use of NIV was associated with significant reductions in the intubation rate, serious complications and ICU and hospital mortality.PerspectivesFurther studies are needed in order to better define the patients susceptible to benefit from NIV, and to establish variables predictive of the success or the failure of the method.ConclusionsNIV leads to an improvement in the prognosis of some immunosuppressed patients admitted to intensive care.

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