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

Centro de Investigación Biomédica en Red en enfermedades respiratorias Instituto Salud Carlos 3 Barcelona Spain

Department of Anesthesiology and Intensive Care Medicine and Institute for Medical Humanities 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic

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 Intensive Care Medicine Multidisciplinary Intensive Care Research Organization and Department of Clinical Medicine Trinity College Wellcome Trust HRB Clinical Research Facility St JamesHospital Dublin Ireland

Department of Medical Intensive Care Medicine University Hospital of Angers Angers France

Department of Medicine and Interdepartmental Division of Critical Care Medicine Sinai Health System University of Toronto Toronto ON Canada

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 APHP Hôpital Saint Louis Famirea Study Group ECSTRA Team and Clinical Epidemiology UMR 1153 Center of Epidemiology and Biostatistics Sorbonne Paris Cité CRESS INSERM Paris Diderot Sorbonne University Paris 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

Réanimation Polyvalente et Département d'Anesthésie et de Réanimation Institut Paoli Calmettes Marseille France

The Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands

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