Improving survival in immunocompromised patients with hypoxemic acute respiratory failure

Guillaume Dumas, Virginie Lemiale, Alexandre Demoule, Elie Azoulay


Over the last two decades, the number of patients living with immune deficiency has steadily increased (1). Even though a greater life expectancy could be achieved (2), immunocompromised patients still experience life- threatening complications warranting admission to the intensive care unit (ICU), chiefly for hypoxemic acute respiratory failure (ARF). Case fatality is high in ARF patients, especially when endotracheal intubation (ETI) is needed (3). Hence, oxygenation and ventilation strategies to avoid invasive mechanical ventilation have been widely evaluated in this setting. The single center trial from Hilbert et al. (4) which reported a significant reduction in intubation and mortality rates associated with noninvasive ventilation (NIV) has been challenged by larger and multicenter data (5,6).