Current knowledge and perspectives in respiratory management for immunocompromised patients with acute respiratory failure.

PURPOSE: One of the most common causes of intensive care unit admission in the immunocompromised population is acute respiratory failure. This population has many unique characteristics that render their respiratory failure risk factors, etiologies, and management different from the general nonimmunocompromised population. While mortality rates have improved in the setting of invasive mechanical ventilation, it remains higher than the general population, making prevention of intubation a key area of interest.

RECENT FINDINGS: Acute respiratory failure in immunocompromised patients is common, complex, and associated with a high case-fatality rate. Ventilatory strategies should be tailored to the clinical context and to the prognosis of the underlying condition. In eligible patients, early ICU admission, a thorough work up to identify the etiology and invasive mechanical ventilation should not be delayed once criteria for intubation are met, despite attempts at noninvasive oxygenation. Future research should aim move beyond a binary definition of immunosuppression and account for its complexities to identify sub-phenotypes most likely to benefit from specific therapeutic strategies, thereby advancing the personalization of care.

SUMMARY: This review explores the literature on noninvasive respiratory support, invasive mechanical ventilation, and extracorporeal life support and the unique considerations in the immunocompromised population.