Treatment of immunocompromised patients who develop respiratory failure often requires intubation and mechanical ventilatory assistance. As mechanical ventilation is associated with a significant risk of death, noninvasive ventilation (NIV) could be particularly beneficial in these high-risk patients. Nevertheless, in patients with hypoxemic acute respiratory failure, experience is less extensive than in COPD patients. The mechanisms of improvement with NIV, the equipment and techniques, and the main studies on NIV in immunocompromised patients with hypoxemic acute respiratory failure are discussed.
To date, 2 randomized controlled studies have been performed. In a recent prospective, randomized trial, Antonelli et al showed the advantage of NIV in significantly improving the outcome of patients undergoing solid organ transplantation who developed acute respiratory failure. Hilbert et al recently demonstrated in a prospective randomized controlled study conducted in immunosuppressed patients with pneumonitis and hypoxemic acute respiratory failure, that early application of NIV was effective in avoiding endotracheal intubation in comparison with standard treatment. Patients randomized to NIV had significantly lower rates of endotracheal intubation, major or fatal complications, and intensive care unit and hospital mortality.
Further studies are needed. Nevertheless, avoiding intubation should be an important objective in the management of respiratory failure in immunocompromised patients, and NIV may help achieve that goal.