Mechanical Ventilation in Critically Ill Cancer Patients by Antonio M. Esquinas S. Egbert Pravinkumar & AYMAN O. SOUBANI

Author:Antonio M. Esquinas, S. Egbert Pravinkumar & AYMAN O. SOUBANI
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

18.4 CPAP for Immunosuppressed Patients

With the increased number of immunosuppressed patients, respiratory complications are the main contributor to mortality [25] and often require invasive mechanical ventilation which is associated with significant risk of death [26].

Immunocompromised often suffer from acute respiratory failure that signal a serious underline phase of the disease, with decreased survival rate and increased costs to the ICU admission [27]. Early use of NIV could lead to better help as shown by ICU randomized studies that compared NIV therapy with standard therapy. Patients with a received solid-organ transplant and who suffered with hypoxemic acute respiratory failure, NIV had reduced intubation rate, complications, mortality rate, and ICU duration of stay [28]. In view of the risk of ICU admitting patients with immunosuppressed, at current, NIV is used in some institutions at early phase in hematology wards, either via a helmet or face mask, to prevent transfer to intensive care [29].

NIV benefit in immunocompromised patients has been evaluated in two randomized control trials (RCTs) who also had acute respiratory failure or distress [23, 28]. The first RCT evaluated 40 patients who received NIV or oxygen therapy with solid-organ transplantation and suffered hypoxemic respiratory failure [28]. Patients treated with NIV had improved oxygenation and less rate of endotracheal intubation and mortality. The second RCT evaluated 52 immunosuppressed with hypoxemic respiratory failure and pneumonia who received NIV or oxygen therapy [23]. Patients with NIV showed lower rate of endotracheal intubation, mortality when compared with the other therapy.

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