Non-invasive ventilation in immunosuppressed patients with pneumonia and extrapulmonary sepsis

Peter Razlaf, Dirk Pabst, Michael Mohr, Torsten Kessler, Rainer Wiewrodt, Matthias Stelljes, Holger Reinecke, Johannes Waltenberger, Wolfgang E. Berdel, Pia Lebiedz

Research output: Contribution to journalArticle

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Abstract

Purpose: International guidelines recommend the use of noninvasive ventilation in immunocompromised patients with acute respiratory failure (ARF). We analyzed failure rates and risk factors for NIV failure in immunocompromised patients. Methods: We retrospectively analyzed 120 immunodeficient patients treated with NIV in our medical ICU from 2005 to 2011. We compared the clinical course and NIV failure rates. Furthermore, we compared patients with secondary respiratory failure due to those with Systemic Inflammatory Response Syndrome (SIRS) of other than pulmonary origin to those with primary pulmonary infiltrations. Results: Regression analyses revealed high APACHE II score (p < 0.01), need for catecholamines (p < 0.05) and low paO 2/FIO2 ratio (p < 0.05) as risk factors for NIV failure. Regarding the underlying diseases, we could not find differences in NIV duration (p = 0.07) and outcome (p = 0.44). 59.2% suffered from ARF due to lung infiltrations whereas 40.8% had secondary ARF caused by sepsis of extrapulmonary origin. Patients with lung infiltrations had a longer stay on ICU (16.3 vs 13.2 days; p = 0.047) and showed a trend toward longer NIV duration (87 ± 102 h vs 65.6 ± 97.8 h; p = 0.056). The SIRS patients compared to pneumonia patients showed a trend toward higher serum creatinine (1.63 mg/dL to 1.51 mg/dL; p = 0.059), a higher rate of renal failure (p < 0.01), higher APACHE II score (30.6-25.7, p < 0.01) and more frequently needed catecholamines (p < 0.01). NIV failure rate (overall 55%) was not different. Conclusions: Almost 50% of the immunocompromised patients treated with NIV did not require intubation independent of the etiology of ARF. High APACHE II scores and severity of oxygenation failure were associated with NIV failure.

Original languageEnglish (US)
Pages (from-to)1509-1516
Number of pages8
JournalRespiratory Medicine
Volume106
Issue number11
DOIs
StatePublished - Nov 1 2012

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Noninvasive Ventilation
Respiratory Insufficiency
Sepsis
Pneumonia
APACHE
Immunocompromised Host
Systemic Inflammatory Response Syndrome
Lung
Catecholamines
Intubation
Renal Insufficiency
Creatinine
Regression Analysis
Guidelines
Serum

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

Cite this

Razlaf, Peter ; Pabst, Dirk ; Mohr, Michael ; Kessler, Torsten ; Wiewrodt, Rainer ; Stelljes, Matthias ; Reinecke, Holger ; Waltenberger, Johannes ; Berdel, Wolfgang E. ; Lebiedz, Pia. / Non-invasive ventilation in immunosuppressed patients with pneumonia and extrapulmonary sepsis. In: Respiratory Medicine. 2012 ; Vol. 106, No. 11. pp. 1509-1516.
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title = "Non-invasive ventilation in immunosuppressed patients with pneumonia and extrapulmonary sepsis",
abstract = "Purpose: International guidelines recommend the use of noninvasive ventilation in immunocompromised patients with acute respiratory failure (ARF). We analyzed failure rates and risk factors for NIV failure in immunocompromised patients. Methods: We retrospectively analyzed 120 immunodeficient patients treated with NIV in our medical ICU from 2005 to 2011. We compared the clinical course and NIV failure rates. Furthermore, we compared patients with secondary respiratory failure due to those with Systemic Inflammatory Response Syndrome (SIRS) of other than pulmonary origin to those with primary pulmonary infiltrations. Results: Regression analyses revealed high APACHE II score (p < 0.01), need for catecholamines (p < 0.05) and low paO 2/FIO2 ratio (p < 0.05) as risk factors for NIV failure. Regarding the underlying diseases, we could not find differences in NIV duration (p = 0.07) and outcome (p = 0.44). 59.2{\%} suffered from ARF due to lung infiltrations whereas 40.8{\%} had secondary ARF caused by sepsis of extrapulmonary origin. Patients with lung infiltrations had a longer stay on ICU (16.3 vs 13.2 days; p = 0.047) and showed a trend toward longer NIV duration (87 ± 102 h vs 65.6 ± 97.8 h; p = 0.056). The SIRS patients compared to pneumonia patients showed a trend toward higher serum creatinine (1.63 mg/dL to 1.51 mg/dL; p = 0.059), a higher rate of renal failure (p < 0.01), higher APACHE II score (30.6-25.7, p < 0.01) and more frequently needed catecholamines (p < 0.01). NIV failure rate (overall 55{\%}) was not different. Conclusions: Almost 50{\%} of the immunocompromised patients treated with NIV did not require intubation independent of the etiology of ARF. High APACHE II scores and severity of oxygenation failure were associated with NIV failure.",
author = "Peter Razlaf and Dirk Pabst and Michael Mohr and Torsten Kessler and Rainer Wiewrodt and Matthias Stelljes and Holger Reinecke and Johannes Waltenberger and Berdel, {Wolfgang E.} and Pia Lebiedz",
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Razlaf, P, Pabst, D, Mohr, M, Kessler, T, Wiewrodt, R, Stelljes, M, Reinecke, H, Waltenberger, J, Berdel, WE & Lebiedz, P 2012, 'Non-invasive ventilation in immunosuppressed patients with pneumonia and extrapulmonary sepsis', Respiratory Medicine, vol. 106, no. 11, pp. 1509-1516. https://doi.org/10.1016/j.rmed.2012.08.007

Non-invasive ventilation in immunosuppressed patients with pneumonia and extrapulmonary sepsis. / Razlaf, Peter; Pabst, Dirk; Mohr, Michael; Kessler, Torsten; Wiewrodt, Rainer; Stelljes, Matthias; Reinecke, Holger; Waltenberger, Johannes; Berdel, Wolfgang E.; Lebiedz, Pia.

In: Respiratory Medicine, Vol. 106, No. 11, 01.11.2012, p. 1509-1516.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Non-invasive ventilation in immunosuppressed patients with pneumonia and extrapulmonary sepsis

AU - Razlaf, Peter

AU - Pabst, Dirk

AU - Mohr, Michael

AU - Kessler, Torsten

AU - Wiewrodt, Rainer

AU - Stelljes, Matthias

AU - Reinecke, Holger

AU - Waltenberger, Johannes

AU - Berdel, Wolfgang E.

AU - Lebiedz, Pia

PY - 2012/11/1

Y1 - 2012/11/1

N2 - Purpose: International guidelines recommend the use of noninvasive ventilation in immunocompromised patients with acute respiratory failure (ARF). We analyzed failure rates and risk factors for NIV failure in immunocompromised patients. Methods: We retrospectively analyzed 120 immunodeficient patients treated with NIV in our medical ICU from 2005 to 2011. We compared the clinical course and NIV failure rates. Furthermore, we compared patients with secondary respiratory failure due to those with Systemic Inflammatory Response Syndrome (SIRS) of other than pulmonary origin to those with primary pulmonary infiltrations. Results: Regression analyses revealed high APACHE II score (p < 0.01), need for catecholamines (p < 0.05) and low paO 2/FIO2 ratio (p < 0.05) as risk factors for NIV failure. Regarding the underlying diseases, we could not find differences in NIV duration (p = 0.07) and outcome (p = 0.44). 59.2% suffered from ARF due to lung infiltrations whereas 40.8% had secondary ARF caused by sepsis of extrapulmonary origin. Patients with lung infiltrations had a longer stay on ICU (16.3 vs 13.2 days; p = 0.047) and showed a trend toward longer NIV duration (87 ± 102 h vs 65.6 ± 97.8 h; p = 0.056). The SIRS patients compared to pneumonia patients showed a trend toward higher serum creatinine (1.63 mg/dL to 1.51 mg/dL; p = 0.059), a higher rate of renal failure (p < 0.01), higher APACHE II score (30.6-25.7, p < 0.01) and more frequently needed catecholamines (p < 0.01). NIV failure rate (overall 55%) was not different. Conclusions: Almost 50% of the immunocompromised patients treated with NIV did not require intubation independent of the etiology of ARF. High APACHE II scores and severity of oxygenation failure were associated with NIV failure.

AB - Purpose: International guidelines recommend the use of noninvasive ventilation in immunocompromised patients with acute respiratory failure (ARF). We analyzed failure rates and risk factors for NIV failure in immunocompromised patients. Methods: We retrospectively analyzed 120 immunodeficient patients treated with NIV in our medical ICU from 2005 to 2011. We compared the clinical course and NIV failure rates. Furthermore, we compared patients with secondary respiratory failure due to those with Systemic Inflammatory Response Syndrome (SIRS) of other than pulmonary origin to those with primary pulmonary infiltrations. Results: Regression analyses revealed high APACHE II score (p < 0.01), need for catecholamines (p < 0.05) and low paO 2/FIO2 ratio (p < 0.05) as risk factors for NIV failure. Regarding the underlying diseases, we could not find differences in NIV duration (p = 0.07) and outcome (p = 0.44). 59.2% suffered from ARF due to lung infiltrations whereas 40.8% had secondary ARF caused by sepsis of extrapulmonary origin. Patients with lung infiltrations had a longer stay on ICU (16.3 vs 13.2 days; p = 0.047) and showed a trend toward longer NIV duration (87 ± 102 h vs 65.6 ± 97.8 h; p = 0.056). The SIRS patients compared to pneumonia patients showed a trend toward higher serum creatinine (1.63 mg/dL to 1.51 mg/dL; p = 0.059), a higher rate of renal failure (p < 0.01), higher APACHE II score (30.6-25.7, p < 0.01) and more frequently needed catecholamines (p < 0.01). NIV failure rate (overall 55%) was not different. Conclusions: Almost 50% of the immunocompromised patients treated with NIV did not require intubation independent of the etiology of ARF. High APACHE II scores and severity of oxygenation failure were associated with NIV failure.

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