Survival in Immunocompromised Patients Ultimately Requiring Invasive Mechanical Ventilation: A Pooled Individual Patient Data Analysis

Dumas, Guillaume; Lemiale, Virginie; Rathi, Nisha; Cortegiani, Andrea; Pène, Frédéric; Bonny, Vincent; Salluh, Jorge I.; Albaiceta, Guillermo M.; Soares, Márcio; Soubani, Ayman O.; Canet, Emmanuel; Hanane, Tarik; Kouatchet, Achille; Mokart, Djamel; Lebiedz, Pia; Türkoğlu, Melda; Coudroy, Rémi; Jeon, Kyeongman; Demoule, Alexandre; Mehta, Sangeeta; Caruso, Pedro; Frat, Jean Pierre; Yang, Kuang Yao; Roca, Oriol; Laffey, John G.; Timsit, Jean François; Azoulay, Élie; Darmon, Michaël

doi:10.1164/rccm.202009-3575oc

Cited by 38 publications

(39 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The outcomes of critically ill patients have improved in the past decades [1,2]. Higher survival rates were observed in elective surgical admission, sepsis, cancer, and immunocompromised patients, among other intensive care patients [1][2][3][4][5]. Reasons for better outcomes include the improvement in available treatments for the underlying diseases (such as cancer and other chronic illnesses) and advances in the management of organ dysfunctions and intensive care unit (ICU) acquired complications.…”

Section: Introductionmentioning

confidence: 99%

The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs

et al. 2021

Self Cite

View full text Add to dashboard Cite

Purpose To assess whether intensive care unit (ICU) outcomes for patients not affected by coronavirus disease 2019 (COVID-19) worsened during the COVID-19 pandemic. Methods Retrospective cohort study including prospectively collected information of patients admitted to 165 ICUs in a hospital network in Brazil between 2011 and 2020. Association between admission in 2020 and worse hospital outcomes was performed using different techniques, including assessment of changes in illness severity of admitted patients, a variable life-adjusted display of mortality during 2020, a multivariate mixed regression model with admission year as both fixed effect and random slope adjusted for SAPS 3 score, an analysis of trends in performance using standardized mortality ratio (SMR) and standardized resource use (SRU), and perturbation analysis. Results A total of 644,644 admissions were considered. After excluding readmissions and patients with COVID-19, 514,219 patients were available for analysis. Non-COVID-19 patients admitted in 2020 had slightly lower age and SAPS 3 score but a higher mortality (6.4%) when compared with previous years (2019: 5.6%; 2018: 6.1%). Variable-adjusted life display (VLAD) in 2020 increased but started to decrease as the number of COVID-19 cases increased; this trend reversed as number of COVID cases reduced but recurred on the second wave. After logistic regression, being admitted in 2020 was associated with higher mortality when compared to previous years from 2016 and 2019. Individual ICUs standardized mortality ratio also increased during 2020 (higher SMR) while resource use remained constant, suggesting worsening performance. A perturbation analysis further confirmed changes in ICU outcomes for non-COVID-19 patients. Conclusion Hospital outcomes of non-COVID-19 critically ill patients worsened during the pandemic in 2020, possibly resulting in an increased number of deaths in critically ill non-COVID patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06528-6.

show abstract

Section: Introductionmentioning

confidence: 99%

The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The recent study by Dumas and colleagues makes a valuable contribution to the descriptive epidemiology of invasive ventilation in immunocompromised patients ( 1 ). However, the study results must be interpreted in the context of methodological bias, which may substantially interfere with inferences about the timing of invasive ventilation.…”

mentioning

confidence: 99%

Always Say Never: Why Studies of Timing of Invasive Ventilation Should Compare “Early versus Late/Never” as Opposed to “Early versus Late”

Sklar

Yarnell

2021

Am J Respir Crit Care Med

View full text Add to dashboard Cite

“…We read with great interest the recent report in the Journal of Dumas and colleagues summarizing extensive data on ventilation strategies in immunocompromised patients with acute respiratory failure (ARF) ( 1 ). The authors concluded that delayed intubation might be independently associated with increased mortality in immunocompromised patients.…”

mentioning

confidence: 99%

“…We agree with our colleagues that this introduces a strong selection bias, as patients who will eventually fail noninvasive ventilation (NIV) might differ in many characteristics from those that might be successfully bridged with an NIV strategy. Bearing in mind the exceedingly high mortality rate of immunocompromised patients requiring invasive mechanical ventilation ( 1 ), we believe it would be premature to advise toward a general rule of early intubation in all of these patients.…”

mentioning

confidence: 99%

Staying Awake in Severe Acute Respiratory Distress Syndrome: A Perspective on Immunocompromised Patients

Stahl

Schenk

Seeliger

et al. 2021

Am J Respir Crit Care Med

View full text Add to dashboard Cite

Survival in Immunocompromised Patients Ultimately Requiring Invasive Mechanical Ventilation: A Pooled Individual Patient Data Analysis

Cited by 38 publications

References 54 publications

The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs

The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs

Always Say Never: Why Studies of Timing of Invasive Ventilation Should Compare “Early versus Late/Never” as Opposed to “Early versus Late”

Staying Awake in Severe Acute Respiratory Distress Syndrome: A Perspective on Immunocompromised Patients

Contact Info

Product

Resources

About