The challenge of avoiding intubation in immunocompromised patients with acute respiratory failure.

The challenge of avoiding intubation in immunocompromised patients with acute respiratory failure. Expert Rev Respir Med. 2018 Aug 12;: Authors: de Jong A, Calvet L, Lemiale V, Demoule A, Mokart D, Darmon M, Jaber S, Azoulay E Abstract INTRODUCTION: A growing number of immunocompromised (IC) patients with acute hypoxemic respiratory failure (ARF) is admitted to the intensive care unit (ICU) worldwide. Initial management of these patients aims primarily to avoid invasive mechanical ventilation (IMV), while adequately managing hypoxemia. Areas covered: This review provides an overview of the current knowledge of the ways to prevent intubation in IC patients with ARF, including discussion about optimal timing of ICU admission, available respiratory support therapies and the best ways to identify ARF etiology. Expert commentary: Striking differences oppose ARF incidence, characteristics, aetiologies and management between IC and non-IC patients. Survival benefits have been reported with early admission to ICU in IC patients. Then, while managing hypoxemia and associated organ dysfunction, the identification of the cause of ARF will be guided by a rigorous clinical assessment at the bedside, further assisted by an invasive or noninvasive diagnostic strategy based on clinical probability for each etiology. Finally, the initial respiratory support aims to avoid mechanical ventilation for the many yet recognizing those patients for whom dela...
Source: Expert Review of Respiratory Medicine - Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research