Focus on immunocompromised patients

Azoulay, Élie; Soares, Márcio; Benoît, Dominique

doi:10.1007/s00134-016-4224-8

Cited by 13 publications

(14 citation statements)

References 20 publications

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“…The actual advantage of ICU admission of immunocompromised patients remains debated [ 3 , 4 , 10 , 29 , 30 ]. Our results demonstrate that almost 50% of immunocompromised patients with ARDS survive to hospital discharge, and this may support the decision to offer them at least an “ICU trial” [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent decades, significant advances in the management of immunocompromised patients have led to improved survival rates [ 1 – 3 ]. Hence, intensive care unit (ICU) admission and invasive life-sustaining treatments are offered with increasing frequency to these patients [ 3 , 4 ]. However, several studies show that the prognosis of critically ill patients with active malignancies or immunodeficiency remains poor, especially when the cause of ICU admission is acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation (IMV) [ 5 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

et al. 2018

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BackgroundThe aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients.MethodsWe performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents.ResultsOf 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio.ConclusionsImmunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge.Trial registrationClinicalTrials.gov, NCT02010073. Registered on 12 December 2013.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2079-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

et al. 2018

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“…To date, few clinical studies on the immune status of ARDS patients have focused on aetiology, treatment and prognosis [11]. Immunocompromised individuals represent a significant proportion of ARDS patients [11,12], these patients do not have the ability to respond normally to an infection due to an impaired or weakened immune system. Some studies have shown that ARDS occurs in patients with previous immunodeficiencies, such as haematologic malignancies, active solid tumours, solid organ transplantation, and acquired immunodeficiency syndrome, as well as in patients taking long-term or high-dose corticosteroids or immunosuppressants, and those who use extra-corporeal membrane oxygenation (ECMO) may have a better prognosis [13].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

Song

Liu

et al. 2020

BMC Pulm Med

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Background: Risk factors affecting the prognosis of acute respiratory distress syndrome (ARDS) in adults were investigated. The aim was to identify new predictors for ARDS patient prognosis, including those with clinical, pathophysiological, and atypical immunodeficiency. Methods: ARDS patients were retrospectively included. The patients were grouped and analysed according to different oxygenation index grades and prognosis, and factors influencing prognosis and survival were examined. Adolescent patients, patients with typical immunodeficiency and patients who died within 24 h after being diagnosed with ARDS were excluded. The predictive value for mortality was determined by Cox proportional hazard analysis. Results: In total, 201 patients who fulfilled the Berlin definition of ARDS were included. The severity of critical illness on the day of enrolment, as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score (P = 0.016), Sequential Organ Failure Assessment (SOFA) score (P = 0.027), and PaO 2 /FiO 2 (P = 0.000), worsened from mild to severe ARDS cases. Compared with survivors, non-survivors were significantly older and had higher APACHE II and SOFA scores. Moreover, significantly lower lymphocyte/neutrophil ratios and leukocyte counts were found among non-survivors than survivors (P = 0.008, P = 0.012). A moderate positive correlation between the lymphocyte/ neutrophil and PaO 2 /FiO 2 ratios (P = 0.023) was observed. In predicting 100-day survival in patients with ARDS, the area under the curve (AUC) for the lymphocyte/neutrophil ratio was significantly higher than those for the PaO 2 / FiO 2 ratio alone, body mass index (BMI) alone, and the lymphocyte count alone (P = 0.0062, 0.0001, and 0.0154). Age (per log 10 years), BMI < 24, SOFA score, leukocyte count, and the lymphocyte/neutrophil ratio were independent predictors of 28-day mortality in ARDS patients. Additionally, ARDS patients with a lymphocyte/ neutrophil ratio < 0.0537 had increased 28-day mortality rates (P = 0.0283). Old age affected both 28-day and 100day mortality rates (P = 0.0064,0.0057).

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“… Failure to adhere to minimum infection control standards, including the proper cleaning and disinfection of the ultrasound equipment, increases the risk of pathogen transmission to patients and staff and has led to infection arising from ultrasound examinations 2–6 The requirements in these guidelines have been based on the standards of AS/NZS4187:2014 and AS/NZS4185:2006 Low‐level instrument grade disinfection (LLD): disinfectant that kills vegetative bacteria, some fungi and few viruses. High‐level instrument grade disinfection (HLD): disinfectant that kills all microorganisms except for high numbers of bacterial endospores. Low‐level instrument grade disinfection (LLD): disinfectant that kills vegetative bacteria, some fungi and few viruses. The ASUM/ACIPC guidelines do not mention intermediate‐level disinfection (ILD) as it was unavailable at the time of publication.…”

Section: Overview Of the Asum/acipc 2017 Guidelines For Reprocessing mentioning

confidence: 99%

Prevention of pathogen transmission during ultrasound use in the Intensive Care Unit: Recommendations from the College of Intensive Care Medicine Ultrasound Special Interest Group (USIG)

Costello

Basseal

Yang

et al. 2020

Australas J Ultrason Med

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ICU ultrasonography constitutes important part of modern car patient care. Current standards and practice of infection control and prevention are inadequate. This purpose of this document is to adapt and expand the 2017 Australasian Society for Ultrasound in Medicine (ASUM) and the Australasian College for Infection Prevention Control (ACIPC) guidelines on minimum standards for reprocessing/cleaning of ultrasound transducers to the specifics of intensive care medicine and provide advice to the ICU practitioners and health care administrators. It considers the medical, administrative, financial and practical controversies surrounding implementation, and addresses emerging issues of care for patients with confirmed or suspected Corona Virus Disease 2019 .

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Focus on immunocompromised patients

Cited by 13 publications

References 20 publications

Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

Prevention of pathogen transmission during ultrasound use in the Intensive Care Unit: Recommendations from the College of Intensive Care Medicine Ultrasound Special Interest Group (USIG)

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