BiPAP should not be used in Immunocompromised patients

This was a post-hoc analysis of the FLORALI trial that I have reviewed before on this medium. In that study they compared patients who had hypoxemic respiratory failure by putting them on 1:1:1 on high flow nasal cannula (HFNC), standard oxygen therapy, and non-invasive ventilation (NIV aka BiPAP). They found that BiPAP was not beneficial in immunocompromised patients.

My interest was piqued in trying to find out what they defined as immunocompromised patients. They looked at patient with hematologic and solid malignancies, AIDS, drug induced, and steroid related. The etiology for the respiratory failure in these patients was mostly for pneumonia, whether opportunistic etiology or not.

To make it simple, they found that patients treated wit HFNC did better than patients who received NIV regarding rates of intubation as well as mortality. Therefore, BiPAP might not be the right option in the immunocompromised. 

Frat J-P, Ragot S, Girault C, et al. 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 2016;4:646–52.

Link to Abstract

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