Previous data had suggested that non-invasive ventilation (NIV) may be beneficial in immunocompromised patients (http://www.ncbi.nlm.nih.gov/pubmed/11172189; http://www.ncbi.nlm.nih.gov/pubmed/20533022). Due to these provocative studies, combined with the known poor outcomes in immunocompromised patients who undergo intubation and mechanical ventilation, many clinicians began using NIV routinely in immuncompromised patients with acute hypoxemic respiratory failure. However, a multicenter randomized controlled trial (iVNIctus ) conducted by the GRRR-OH group was recently published which failed to confirm the benefits of NIV in similarly immunocompromised patients (http://jama.jamanetwork.com/article.aspx?articleid=2454912). In this trial, NIV did not significantly lower 28 day mortality or the need for intubation. In addition, it resulted in similar duration of mechanical ventilation, incidence of acquiring ICU infections, and ICU and hospital lengths of stay as standard oxygen therapy. This has prompted many to re-evaluate the routine use of NIV in immunocompromised patients.
Now, this month, the Lancet Respiratory Medicine has published an intriguing post-hoc analysis of immunocompromised patients enrolled in the FLORALI trial (http://www.ncbi.nlm.nih.gov/pubmed/27245914). Continue reading “Is Non-Invasive Ventilation Dangerous for Immunocompromised Patients?”