{
    "abstract": "Acute hypoxemic respiratory failure (ARF) is a major challenge in immunocompromised patients, often complicated by severe respiratory distress and organ dysfunction. High-flow nasal oxygen (HFNO) therapy is the standard of care, but data on its effectiveness and outcomes are limited. This study evaluated the outcomes of HFNO in this population, predictors of invasive mechanical ventilation (IMV), and factors associated with 28-day mortality.\nWe analyzed data from a multicenter cohort of 986 immunocompromised patients with ARF treated with HFNO. Predictive factors for IMV and mortality were assessed using multivariable survival models, and the predictive value of the respiratory rate\u2011oxygenation (ROX) index for IMV was evaluated.\nPatients had a median age of 63\u00a0years [IQR 54-70], and 66% were male. Primary causes of immunosuppression included hematologic malignancies (55%), solid tumors (30%), and solid-organ transplantation (10%). Bacterial pneumonia (40%) and opportunistic infections (15%) were the most common ARF etiologies. IMV was required in 46% of patients. Day 28 mortality was 33%, with better outcomes for solid-organ transplant recipients compared to hematologic malignancy or solid tumor (70% vs. 48% vs. 51% mortality, respectively). Predictors of IMV included a lower ROX index, higher respiratory rates, and lower PaO\nHFNO outcomes in immunocompromised patients with ARF vary widely, influenced by immunosuppression type, ARF etiology, and clinical factors. Optimizing treatment and identifying high-risk patients could improve outcomes. Prospective studies are needed to enhance HFNO strategies.",
    "authors": [
        {
            "affiliation": "Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Paris-Cit\u00e9 University, INSERM UMR1342 Institut de Recherche Saint-Louis, Paris, France. elie.azoulay@aphp.fr.",
            "firstname": "Elie",
            "initials": "E",
            "lastname": "Azoulay"
        },
        {
            "affiliation": "Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Paris-Cit\u00e9 University, INSERM UMR1342 Institut de Recherche Saint-Louis, Paris, France.",
            "firstname": "M\u00e9lanie",
            "initials": "M",
            "lastname": "M\u00e9tais"
        },
        {
            "affiliation": "Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Paris-Cit\u00e9 University, INSERM UMR1342 Institut de Recherche Saint-Louis, Paris, France.",
            "firstname": "Virginie",
            "initials": "V",
            "lastname": "Lemiale"
        },
        {
            "affiliation": "Institut Paoli-Calmettes, Marseille, France.",
            "firstname": "Djamel",
            "initials": "D",
            "lastname": "Mokart"
        },
        {
            "affiliation": "M\u00e9decine Intensive et R\u00e9animation, Centre Hospitalier Universitaire de Lille, Lille, France.",
            "firstname": "Anne-Sophie",
            "initials": "AS",
            "lastname": "Moreau"
        },
        {
            "affiliation": "Centre Hospitalier Universitaire de Nantes, Nantes Universit\u00e9, Nantes, France.",
            "firstname": "Emmanuel",
            "initials": "E",
            "lastname": "Canet"
        },
        {
            "affiliation": "Centre Hospitalier Universitaire d'Angers, Angers, France.",
            "firstname": "Achille",
            "initials": "A",
            "lastname": "Kouatchet"
        },
        {
            "affiliation": "Centre Hospitalier Universitaire de Lyon, H\u00f4pital Edouard Herriot, Lyon, France.",
            "firstname": "Laurent",
            "initials": "L",
            "lastname": "Argaud"
        },
        {
            "affiliation": "Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.",
            "firstname": "Peter",
            "initials": "P",
            "lastname": "Pickkers"
        },
        {
            "affiliation": "Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA.",
            "firstname": "Philippe R",
            "initials": "PR",
            "lastname": "Bauer"
        },
        {
            "affiliation": "Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, USA.",
            "firstname": "Andry",
            "initials": "A",
            "lastname": "van de Louw"
        },
        {
            "affiliation": "Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, (MICRO), St. James' Hospital, Dublin, Ireland.",
            "firstname": "Ignacio",
            "initials": "I",
            "lastname": "Martin-Loeches"
        },
        {
            "affiliation": "Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, University of Toronto, Toronto, Canada.",
            "firstname": "Sangeeta",
            "initials": "S",
            "lastname": "Mehta"
        },
        {
            "affiliation": "CHU Rouen, Medical Intensive Care Unit, Universit\u00e9 de Rouen Normandie, Normandie Universit\u00e9, GRHVN UR 3830, Rouen, France.",
            "firstname": "Christophe",
            "initials": "C",
            "lastname": "Girault"
        },
        {
            "affiliation": "Centre Hospitalier Lyon Sud Hospices Civils de Lyon, Pierre-B\u00e9nite, France.",
            "firstname": "Florent",
            "initials": "F",
            "lastname": "Wallet"
        },
        {
            "affiliation": "Assistance Publique - H\u00f4pitaux de Paris, H\u00f4pital Cochin, Service de M\u00e9decine Intensive R\u00e9animation, Institut Cochin, Universit\u00e9 Paris Cit\u00e9, INSERM U1016, CNRS UMR8104, Paris, France.",
            "firstname": "Fr\u00e9d\u00e9ric",
            "initials": "F",
            "lastname": "P\u00e8ne"
        },
        {
            "affiliation": "D\u00e9partement R3S, Service de M\u00e9decine Intensive - R\u00e9animation, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Universit\u00e9, Site Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France.",
            "firstname": "Alexandre",
            "initials": "A",
            "lastname": "Demoule"
        },
        {
            "affiliation": "Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Paris-Cit\u00e9 University, INSERM UMR1342 Institut de Recherche Saint-Louis, Paris, France.",
            "firstname": "Alexis",
            "initials": "A",
            "lastname": "Maillard"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2025. Springer-Verlag GmbH Germany, part of Springer Nature.",
    "doi": "10.1007/s00134-025-07890-5\n10.1016/S2213-2600(18)30345-X\n10.1164/rccm.202009-3575OC\n10.1007/s00134-017-4947-1\n10.1001/jama.2016.0692\n10.1016/S2213-2600(22)00096-0\n10.1001/jama.2018.14282\n10.1007/s00134-023-07050-7\n10.1164/rccm.201605-0916OC\n10.1007/s00134-017-4890-1\n10.1056/NEJMoa1503326\n10.1007/s00134-019-05590-5\n10.1001/jama.2022.15613\n10.1183/13993003.01574-2021\n10.1164/rccm.201001-0018OC\n10.1007/s00134-019-05906-5\n10.1001/jama.2019.2064\n10.1186/s13054-015-1097-0\n10.1186/s13613-016-0202-0\n10.1186/s13613-021-00801-z\n10.1164/rccm.201803-0589OC\n10.1016/j.chest.2020.05.598\n10.2147/JIR.S453123\n10.1055/s-0043-1778137\n10.1016/S2213-2600(14)70097-9\n10.1182/blood.2023021414\n10.1007/s00134-012-2687-9\n10.1183/13993003.02442-2018\n10.1080/17476348.2018.1511430\n10.1016/j.chest.2023.07.4222\n10.1016/j.jcrc.2022.154152\n10.1007/s00134-018-5339-x\n10.1007/s00134-022-06729-7\n10.1002/14651858.CD010172.pub2",
    "journal": "Intensive care medicine",
    "keywords": [
        "ARDS",
        "Hematology",
        "Neutropenia",
        "Oncology",
        "Respiratory distress",
        "Transplantation"
    ],
    "methods": null,
    "publication_date": "2025-04-22",
    "pubmed_id": "40261380\n30529232\n33751920\n28948369\n27139067\n35325620\n30357270\n37326646\n27997805\n28762180\n25981908\n30888444\n36166027\n34649974\n20581167\n32034433\n31087018\n27783381\n33501590\n30576221\n32561442\n38444638\n38266998\n24853585\n38232056\n23070123\n31831677\n30101630\n37567412\n36137351\n30136140\n35577992\n28555461",
    "results": "Patients had a median age of 63\u00a0years [IQR 54-70], and 66% were male. Primary causes of immunosuppression included hematologic malignancies (55%), solid tumors (30%), and solid-organ transplantation (10%). Bacterial pneumonia (40%) and opportunistic infections (15%) were the most common ARF etiologies. IMV was required in 46% of patients. Day 28 mortality was 33%, with better outcomes for solid-organ transplant recipients compared to hematologic malignancy or solid tumor (70% vs. 48% vs. 51% mortality, respectively). Predictors of IMV included a lower ROX index, higher respiratory rates, and lower PaO",
    "title": "Outcomes in immunocompromised patients with acute hypoxemic respiratory failure treated by high-flow nasal oxygen.",
    "xml": "<Element 'PubmedArticle' at 0x788506f78db0>"
}