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Effect of Noninvasive Ventilation vs Oxygen Therapy on Mortality Among Immunocompromised Patients With Acute Respiratory Failure: A Randomized Clinical Trial

Lemiale, Virginie, Mokart, Djamel, Resche-Rigon, Matthieu, Pène, Frédéric, Mayaux, Julien, Faucher, Etienne, Nyunga, Martine, Girault, Christophe, Perez, Pierre, Guitton, Christophe, Ekpe, Kenneth, Kouatchet, Achille, Théodose, Igor, Benoit, Dominique, Canet, Emmanuel, Barbier, François, Rabbat, Antoine, Bruneel, Fabrice, Vincent, Francois, Klouche, Kada, Loay, Kontar, Mariotte, Eric, Bouadma, Lila, Moreau, Anne-Sophie, Seguin, Amélie, Meert, Anne-Pascale, Reignier, Jean, Papazian, Laurent, Mehzari, Ilham, Cohen, Yves, Schenck, Maleka, Hamidfar, Rebecca, Darmon, Michael, Demoule, Alexandre, Chevret, Sylvie, Azoulay, Elie·2015·JAMA

Abstract

IMPORTANCE: Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure. However, its effectiveness for this indication remains unclear. OBJECTIVE: To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acute hypoxemic respiratory failure. DESIGN, SETTING, AND PARTICIPANTS: Multicenter randomized trial conducted among 374 critically ill immunocompromised patients, of whom 317 (84.7%) were receiving treatment for hematologic malignancies or solid tumors, at 28 intensive care units (ICUs) in France and Belgium between August 12, 2013, and January 2, 2015. INTERVENTIONS: Patients were randomly assigned to early noninvasive ventilation (n = 191) or oxygen therapy alone (n = 183). MAIN OUTCOMES AND MEASURES: The primary outcome was day-28 mortality. Secondary outcomes were intubation, Sequential Organ Failure Assessment score on day 3, ICU-acquired infections, duration of mechanical ventilation, and ICU length of stay. RESULTS: At randomization, median oxygen flow was 9 L/min (interquartile range, 5-15) in the noninvasive ventilation group and 9 L/min (interquartile range, 6-15) in the oxygen group. All patients in the noninvasive ventilation group received the first noninvasive ventilation session immediately after randomization. On day 28 after randomization, 46 deaths (24.1%) had occurred in the noninvasive ventilation group vs 50 (27.3%) in the oxygen group (absolute difference, -3.2 [95% CI, -12.1 to 5.6]; P = .47). Oxygenation failure occurred in 155 patients overall (41.4%), 73 (38.2%) in the noninvasive ventilation group and 82 (44.8%) in the oxygen group (absolute difference, -6.6 [95% CI, -16.6 to 3.4]; P = .20). There were no significant differences in ICU-acquired infections, duration of mechanical ventilation, or lengths of ICU or hospital stays. CONCLUSIONS AND RELEVANCE: Among immunocompromised patients admitted to the ICU with hypoxemic acute respiratory failure, early noninvasive ventilation compared with oxygen therapy alone did not reduce 28-day mortality. However, study power was limited. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01915719.

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Metadata

Authors
Lemiale, V., Mokart, D., Resche-Rigon, M., Pène, F., Mayaux, J., Faucher, E., Nyunga, M., Girault, C., Perez, P., Guitton, C., Ekpe, K., Kouatchet, A., Théodose, I., Benoit, D., Canet, E., Barbier, F., Rabbat, A., Bruneel, F., Vincent, F., Klouche, K., Loay, K., Mariotte, E., Bouadma, L., Moreau, A.-S., Seguin, A., Meert, A.-P., Reignier, J., Papazian, L., Mehzari, I., Cohen, Y., Schenck, M., Hamidfar, R., Darmon, M., Demoule, A., Chevret, S., & Azoulay, E.
Venue
JAMA
Published
2015-10-27
Volume
314
Issue
16
Pages
1711
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W1922120322
Cited by
378
References
2
FWCI
31.16
Type
journal article
Language
en
Open access
closed

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CoChat. (2026). Citation check: Effect of Noninvasive Ventilation vs Oxygen Therapy on Mortality Among Immunocompromised Patients With Acute Respiratory Failure: A Randomized Clinical Trial. https://app.cochat.ai/papers/10.1001/jama.2015.12402
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Lemiale, V., Mokart, D., Resche-Rigon, M., Pène, F., Mayaux, J., Faucher, E., Nyunga, M., Girault, C., Perez, P., Guitton, C., Ekpe, K., Kouatchet, A., Théodose, I., Benoit, D., Canet, E., Barbier, F., Rabbat, A., Bruneel, F., Vincent, F., . . . Azoulay, E. (2015). Effect of Noninvasive Ventilation vs Oxygen Therapy on Mortality Among Immunocompromised Patients With Acute Respiratory Failure: A Randomized Clinical Trial. JAMA. https://doi.org/10.1001/jama.2015.12402

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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