Intensive Care Medicine

, Volume 44, Issue 12, pp 2225–2228 | Cite as

My paper 20 years later: NIV in immunocompromized patients

  • Gilles HilbertEmail author
  • Frédéric Vargas
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Introduction, historical background

Twenty years ago we designed a trial, the first patients were included in May 1998, and in 2001 we published in the New England Journal of Medicine the study entitled ‘Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure’ [1].

Pulmonary complications were an important cause of illness in immunocompromised patients and invasive mechanical ventilation (MV) was associated with a significant risk of death [2, 3]. Thus, avoiding intubation should be an important objective in the management of hypoxemic acute respiratory failure (ARF) in immunosuppressed patients.

There were only limited data on the efficacy of NIV in high-risk immunocompromized patients [4, 5].

Summary of original study

In a prospective, randomized, controlled study, we compared the efficacy of NIV delivered intermittently through a mask with that of standard medical treatment with supplemental oxygen and no ventilatory...



The original research was conducted in the medical intensive care unit of Pellegrin hospital, Bordeaux, France, by a group of enthusiastic colleagues who co-authored the original paper. To them (Valentino R, Gbikpi-Benissan G, Dupon M, Gruson D with Reiffers J and Cardinaud JP in memoriam) goes our gratitude.

Compliance with ethical standards

Conflicts of interest

The authors do not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.


  1. 1.
    Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation for treatment of acute respiratory failure in immunosuppressed patients with pulmonary infiltrates and fever, a randomized trial. N Engl J Med 344:481–487CrossRefPubMedGoogle Scholar
  2. 2.
    Masur H, Shelhamer J, Parrillo JE (1985) The management of pulmonary infiltrates and fevers in immunocompromised patients. JAMA 253:1769–1773CrossRefPubMedGoogle Scholar
  3. 3.
    Ewig S, Torres A, Riquelme R, El-Ebiary M, Rovira M, Carreras E, Raño A, Xaubet A (1998) Pulmonary complications in patients with haematological malignancies treated at a respiratory intensive care unit. Eur Respir J 12:116–122CrossRefPubMedGoogle Scholar
  4. 4.
    Evans TW (2001) International Consensus Conferences in Intensive Care Medicine: non-invasive positive pressure ventilation in acute respiratory failure. Organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Société de Réanimation de Langue Française, and approved by the ATS Board of Directors. Intensive Care Med 27(1):166–178CrossRefPubMedGoogle Scholar
  5. 5.
    Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, Gasparetto A, Meduri GU (2000) Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation. A randomized trial. JAMA 283:235–241CrossRefPubMedGoogle Scholar
  6. 6.
    Mokart D, Darmon M, Resche-Rigon M, Lemiale V, Pène F, Mayaux J, Rabbat A, Kouatchet A, Vincent F, Nyunga M, Bruneel F, Lebert C, Perez P, Renault A, Hamidfar R, Jourdain M, Meert AP, Benoit D, Chevret S, Azoulay E (2015) Prognosis of neutropenic patients admitted to the intensive care unit. Intensive Care Med 41(2):296–303CrossRefGoogle Scholar
  7. 7.
    Azoulay E, Afessa B (2006) The intensive care support of patients with malignancy: do everything that can be done. Intensive Care Med 32(1):3–5CrossRefPubMedGoogle Scholar
  8. 8.
    Azoulay E, Pickkers P, Soares M, Perner A, Rello J, Bauer PR, van de Louw A, Hemelaar P, Lemiale V, Taccone FS, Martin Loeches I, Meyhoff TS, Salluh J, Schellongowski P, Rusinova K, Terzi N, Mehta S, Antonelli M, Kouatchet A, Barratt-Due A, Valkonen M, Landburg PP, Bruneel F, Bukan RB, Pène F, Metaxa V, Moreau AS, Souppart V, Burghi G, Girault C, Silva UVA, Montini L, Barbier F, Nielsen LB, Gaborit B, Mokart D, Chevret S, Efraim investigators and the Nine-I study group (2017) Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study. Intensive Care Med 43(12):1808–1819CrossRefPubMedGoogle Scholar
  9. 9.
    Conférences de Consensus en Réanimation et Médecine d’Urgence (2006) Ventilation Non Invasive au cours de l’insuffisance respiratoire aiguë (nouveau-né exclu). Texte court:
  10. 10.
    American Thoracic Society (2005) Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416CrossRefGoogle Scholar
  11. 11.
    Lemiale V, Mokart D, Resche-Rigon M, Pène F, Mayaux J, Faucher E, Nyunga M, Girault C, Perez P, Guitton C, Ekpe K, Kouatchet A, Théodose I, Benoit D, Canet E, Barbier F, Rabbat A, Bruneel F, Vincent F, Klouche K, Loay K, Mariotte E, Bouadma L, Moreau AS, Seguin A, Meert AP, Reignier J, Papazian L, Mehzari I, Cohen Y, Schenck M, Hamidfar R, Darmon M, Demoule A, Chevret S, Azoulay E, Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH) (2015) Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial. JAMA 314(16):1711–1719CrossRefPubMedGoogle Scholar
  12. 12.
    Patel BK, Kress JP (2015) The changing landscape of noninvasive ventilation in the intensive care unit. JAMA 314(16):1697–1699CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Frat JP, Ragot S, Girault C, Perbet S, Prat G, Boulain T, Demoule A, Ricard JD, Coudroy R, Robert R, Mercat A, Brochard L, Thille AW (2016) Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post hoc analysis of a randomised trial. Lancet Respir Med 8:646–652CrossRefGoogle Scholar
  14. 14.
    Hilbert G (2012) Optimizing noninvasive ventilation in hematological patients with acute respiratory failure. In: Azoulay E (ed) Pulmonary involvement in patients with hematological malignancies. Springer, BerlinGoogle Scholar
  15. 15.
    Lemiale V, Resche-Rigon M, Mokart D, Pène F, Argaud L, Mayaux J, Guitton C, Rabbat A, Girault C, Kouatchet A, Vincent F, Bruneel F, Nyunga M, Seguin A, Klouche K, Colin G, Kontar L, Perez P, Meert AP, Benoit DD, Papazian L, Demoule A, Chevret S, Azoulay E (2017) High-flow nasal cannula oxygenation in immunocompromised patients with acute hypoxemic respiratory failure: a groupe de recherche respiratoire en réanimation onco-hématologique study. Crit Care Med 45(3):e274–e280CrossRefPubMedGoogle Scholar
  16. 16.
    Mokart D, Geay C, Chow-Chine L, Brun JP, Faucher M, Blache JL, Bisbal M, Sannini A (2015) High-flow oxygen therapy in cancer patients with acute respiratory failure. Intensive Care Med 41:2008–2010CrossRefPubMedGoogle Scholar
  17. 17.
    Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Members of the steering committee, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S, Members of the task force (2017) Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 50(2):1602426. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Chef de Service de Médecine Intensive RéanimationHôpital Pellegrin-Tripode 1° étage, Centre Hospitalier Universitaire de BordeauxBordeauxFrance
  2. 2.Centre de Recherche Cardio-Thoracique, INSERM 1045, CIC 0005Université de BordeauxBordeauxFrance

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