Mortality of immunocompromised patients who need mechanical ventilation has reduced dramatically but remain relatively high (40-60%)
NIV does reduce intubation rates in these patients in older trials (but at that time, mortality for intubation was 80% rather than the lower values found in modern practice)
Multicentre, RCT comparing NIV to O2 on all-cause D28 mortality in immunocompromised patients with hypoxaemic respiratory failure
- Haematological/solid tumour OR
- Solid organ transplant OR
- Long-tern steroids OR
- + Respiratory failure
Excluded other organ failures or likely to need ETT / lots of O2
191 received early NIV, 183 O2. No loss to follow-up.
No difference in mortality at 28 days
Didn’t matter what diagnosis was (i.e. solid organ or haematological malignancy). However, was powered for mortality of 35% in oxygen group and was much less than this.
7% of patients only received one session of NIV – either due to need for intubation or poor tolerance (who were in the main subsequently intubated)
No difference in intubation rates, length of ICU stay, 6/12 mortality
1/3 of patients across the two groups received HFNO2 but mortality wasn’t any different
Conclusion: Early NIV did not reduce mortality compared with O2 but study underpowered as mortality much less than was predicted.