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Escalation of Oxygenation Modalities and Mortality in Critically Ill Immunocompromised Patient With Acute Hypoxemic Respiratory Failure: A Clustering Analysis of a Prospectively Multicenter, Multinational Dataset
E. Yvin, A. Kouatchet, D. Mokart, I. Martin-Loeches, FS. Taccone, F. Pène, PR. Bauer, A. Séguin, A. van de Louw, A. Mabrouki, S. Bredin, V. Metaxa, K. Klouche, L. Montini, S. Mehta, F. Bruneel, T. Lisboa, W. Viana, P. Pickkers, L. Russell, K....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, multicentrická studie, pozorovací studie
- MeSH
- hypoxie * terapie mortalita MeSH
- imunokompromitovaný pacient * MeSH
- jednotky intenzivní péče statistika a číselné údaje MeSH
- kritický stav mortalita terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mortalita v nemocnicích MeSH
- oxygenoterapie * metody MeSH
- prospektivní studie MeSH
- respirační insuficience * terapie mortalita MeSH
- senioři MeSH
- shluková analýza MeSH
- umělé dýchání * metody statistika a číselné údaje MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
OBJECTIVES: Acute hypoxemic respiratory failure in immunocompromised patients remains the leading cause of admission to the ICU, with high case fatality. The response to the initial oxygenation strategy may be predictive of outcome. This study aims to assess the response to the evolutionary profiles of oxygenation strategy and the association with survival. DESIGN: Post hoc analysis of EFRAIM study with a nonparametric longitudinal clustering technique (longitudinal K-mean). SETTING AND PATIENTS: Multinational, observational prospective cohort study performed in critically ill immunocompromised patients admitted for an acute respiratory failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 1547 patients who did not require invasive mechanical ventilation (iMV) at ICU admission were included. Change in ventilatory support was assessed and three clusters of change in oxygenation modality over time were identified. Cluster A: 12.3% iMV requirement and high survival rate, n = 717 patients (46.3%); cluster B: 32.9% need for iMV, 97% ICU mortality, n = 499 patients (32.3%); and cluster C: 37.5% need for iMV, 0.3% ICU mortality, n = 331 patients (21.4%). These clusters demonstrated a high discrimination. After adjustment for confounders, clusters B and C were independently associated with need for iMV (odds ratio [OR], 9.87; 95% CI, 7.26-13.50 and OR, 19.8; 95% CI, 13.7-29.1). CONCLUSIONS: This study identified three distinct highly performing clusters of response to initial oxygenation strategy, which reliably predicted the need for iMV requirement and hospital mortality.
Agostino Gemelli University Hospital Università Cattolica del Sacro Cuore Rome Italy
Anesthesiology Department CHU Nîmes University of Nîmes Montpellier Nimes France
Department of Critical Care King's College Hospital NHS Foundation Trust London United Kingdom
Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
Department of Intensive Care Hôpital Erasme Université Libre de Bruxelles Brussels Belgium
Department of Intensive Care Hospital Copa d'Or Rio de Janeiro Brazil
Department of Intensive Care Hospital Santa Rita Santa Casa de Misericordia Porte Allegre Brazil
Department of Medical Intensive Care Medicine University Hospital of Angers Angers France
Division of Pulmonary and Critical Care Penn State University College of Medicine Hershey PA
Hospital Clinic IDIBAPS Universidad de Barcelona Ciberes Barcelona Spain
Infectious Area Vall d'Hebron Institute of Research Barcelona Spain
Medical ICU Nantes University Hospital Nantes France
Medical Intensive Care Unit Hôpital Cochin APHP Centre and Université de Paris Paris France
Medical Intensive Care Unit La Source Hospital CHR Orléans Orléans France
Medical Intensive Care Unit Montpellier University Hospital Montpellier France
Medical Surgical Intensive Care Unit Andre Mignot Hospital Versailles France
Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN
The Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
Citace poskytuje Crossref.org
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