![]() ĪRF was defined as a need for oxygen greater than 6L/min to maintain peripheral capillary oxygen saturation >95% or symptoms of respiratory distress (tachypnea >30/min, intercostal recession, labored breathing, and/or dyspnea at rest). Severity of illness was assessed using Simplified Acute Physiology Score (SAPS 2) and Sepsis-related Organ Failure Assessment (SOFA) score. We recorded the following baseline data at ICU admission and during ICU stay: age, gender, underlying malignancy, allogenic or autologous hematopoietic stem cell transplantation (HSCT), disease status, neutropenia, Charlson comorbidities index. The objective of our study was to assess prognostic factors of mortality in ICU cancer patients with ARF requiring MV after HFNC failure, and to identify predictive factors of intubation.ĭemographical, clinical, biological and outcome data were retrospectively collected from the patient’s charts using our ICU management software (MetavisionTM, Dusseldorf, Germany). HFNC failure in immunocompromised patients has been rarely investigated. įor patients who fail to improve with HFNC, intubation should be strongly considered. The absence of diagnosis and mechanical ventilation requirement are the main prognostic factors. Recent data did not find any significant survival or clinical benefit compared with standard oxygen, whereas other publications demonstrated that HFNC may decrease intubation requirement and/or mortality. Uncertainty remains about HFNC effects in immunocompromised patients, studies providing conflicting results. In two recent meta-analyses, HFNC may decrease the need for tracheal intubation without impacting mortality. In unselected patients with ARF, HFNC was associated with increased ventilator-free days and decreased day-90 mortality. High-flow nasal cannula (HFNC) oxygen therapy delivers warm and humidified oxygen through a nasal cannula, allowing for airflows as high as 50 liters/minute to achieve inspired oxygen fractions (FiO2) as high as 100%. Non-invasive ventilation (NIV) was first investigated with significant reduction in intubation and mortality rates, but challenged by larger and multicenter data. Considering the mortality rates in patients requiring MV, non-invasive ventilation strategies have been recently widely evaluated, priority has been given to avoid intubation. The optimal ventilation strategy in cancer patients with ARF remains controversial. Initial management of ARF consists of optimizing oxygenation, identifying ARF etiology guided by a standardized diagnostic approach and supporting associated organ dysfunction at the same time. Mortality can reach 50%, depending on underlying condition, etiology, severity and course of ARF, delayed ICU admission, need for mechanical ventilation (MV), and associated organ dysfunctions at ICU admission It occurs in up to half of patients with hematological malignancies and 15% of patients with solid tumors and represents the first cause for intensive care (ICU) admission in cancer patients. Data are available from the Internal Review Board (IRB) of Institut Paoli Calmettes (contact via S.Maick, for researchers who meet the criteria for access to confidential data.įunding: The authors received no specific funding for this work.Ĭompeting interests: The authors have declared that no competing interests exist.Īcute respiratory failure (ARF) is a frequent and life-threatening complication in immunocompromised patients, raising major diagnostic and therapeutic challenges. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: Data cannot be shared publicly because consent for publication of raw data was not obtained from study participants. ![]() Received: DecemAccepted: JPublished: June 29, 2022Ĭopyright: © 2022 Saillard et al. PLoS ONE 17(6):Įditor: Alessandro Marchioni, University Hospital of Modena (Italy), Respiratory Diseases Unit, ITALY ![]() ![]() (2022) High-flow nasal cannula failure in critically ill cancer patients with acute respiratory failure: Moving from avoiding intubation to avoiding delayed intubation. Multivariate analysis identified 4 prognostic factors of hospital mortality after HFNC failure: complete/partial remission (OR = 0.2, 95%CI = 0.04–0.98, p60% at HFNC initiation (sHR = 3.12, 95%CI = 2.06–4.74, p<0.001) and SAPSII at ICU admission (sHR = 1.03, 95%CI = 1.02–1.05, p<0.01).Ĭitation: Saillard C, Lambert J, Tramier M, Chow-Chine L, Bisbal M, Servan L, et al. ICU and hospital mortality rates were 26.2% (n = 53) and 42.1% (n = 85) respectively, and 53.1% (n = 52) and 68.4% (n = 67) in patients requiring MV. 202 patients were included, 104 successfully treated with HFNC and 98 requiring intubation. ![]()
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