Noninvasive ventilation for the immunocompromised patient: always appropriate?

Over the last few decades, the survival rate in critically ill immunocompromised patients has substantially improved, mainly because of advances in oncohematological treatments and management of organ dysfunctions in the ICU. As a result, the number of patients admitted to the ICU has rapidly grown. Immunocompromised patients in whom acute respiratory failure (ARF) develops often require mechanical ventilatory support. In these patients, noninvasive ventilation (NIV) has the potential of avoiding endotracheal intubation and its complications. This review will discuss the recent findings on the role of NIV in immunocompromised patients with ARF.

In recent studies, NIV success was associated with shorter periods of ventilatory assistance and ICU stays, less infectious complications, and lower ICU and hospital mortality, compared with invasive mechanical ventilation. Failure of NIV occurred in half of the hematological patients with ARF. Major risk factors for NIV failure in these patients were illness severity at baseline and the presence of acute respiratory distress syndrome on admission.

Use of NIV may not be appropriate for all immunocompromised patients. However, current evidence supports the use of NIV as the first-line approach for managing mild/moderate ARF in selected patients with immunosuppression of various origin.