Predicting Survival Following Acute Respiratory Failure in Immunocompromised Patients

Mortality among immunocompromised adult patients with acute respiratory failure requiring invasive mechanical ventilation was strongly associated with time to intubation, according to the results of a recent study published in the American Journal of Respiratory and Critical Care Medicine.

Researchers retrospectively reviewed 24 studies for outcome data from immunocompromised adult patients with acute respiratory failure requiring invasive mechanical ventilation. Mixed-effect models were then employed to estimate the effect of delayed intubation on hospital mortality and rates over time.

Among the 11,087 patients with acute respiratory failure requiring invasive mechanical ventilation included in the analysis, 7736 were intubated within 24 hours of intensive care unit (ICU) admission. The mortality rate was 53.2%. However, mortality was strongly associated with time to intubation (survival: 0.51±1.80 days vs death: 0.91±2.84 days; P <.001). In addition, for each elapsed day between ICU admission and intubation, mortality was higher (odds ratio [OR], 1.38; 95% CI, 1.26-1.52; P <.001). Early intubation was significantly associated with lower mortality, regardless of initial oxygenation strategy (OR, 0.83; 95% CI, 0.72-0.96).

“Our results suggest that the prognosis of immunocompromised patients who required invasive mechanical ventilation for [acute respiratory failure] has improved over time,” the study authors wrote. “Time between ICU admission and intubation is a strong predictor of mortality, suggesting a detrimental effect of late initial oxygenation failure.”

Reference

Dumas G, Lemiale V, Rathi N, et al. Survival in immunocompromised patients ultimately requiring invasive mechanical ventilation: a pooled individual patient data analysis. Am J Respir Crit Care Med. Published online March 22, 2021. doi:10.1164/rccm.202009-3575OC