Is Non-Invasive Ventilation Dangerous for Immunocompromised Patients?

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?”

Welcome … and a bit about us

Todd, Dave, and Matt are three intensivist colleagues who have at some time practiced together.  All three of us trained extensively under Dr. Arthur Wheeler, and therefore have been engrained with many of the principles he instilled in the practice and study of critical care medicine. Namely, we are dedicated to improving the care of critically ill patients and have interest in the practicality of critical care.  The three of us conduct clinical research in critically ill patients, with one focus being the conduct of pragmatic clinical trials within the routine care of patients (i.e. the learning healthcare environment)

In this blog, we hope to entertain (and maybe even educate) by discussing all aspects of critical care, from the nuances of taking care of patients, to interpretation of new and emerging literature.  In doing so, we are also paying tribute to Dr. Wheeler, our mentor and colleague, whose dedication to critical care not only saved innumerable patient lives, but also educated so many healthcare professionals and changed the lives of so many people.

In the obligatory disclosure, the views expressed in this blog are solely the opinions of the authors and in no way represent the view of our employers, societies that we hold memberships in, funders, partners, or colleagues.

Dr. Todd Rice Dr. Rice treated Jason Martin, an ICU patient who was seriously ill with H1N1. (Vanderbilt University / Daniel Dubois)
Todd Rice, MD, MSc
david janz
David Janz, MD, MSc
Semler
Matt Semler, MD, MSc