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Background: The clinical indications of extracorporeal membrane oxygenation (ECMO) in immunosuppressed patients are not clear. This study aimed to analyse the effectiveness of ECMO and to identify the risk factors for the mortality of ECMO in immunocompromised patients with acute respiratory failure. Methods: This retrospective, cohort study included 46 confirmed immunocompromised patients with acute hypoxemic respiratory failure treated with ECMO between July 2014 and August 2020. The clinical features and outcomes of the survival group and the non‐survival group were statistically analysed. Results: The mean age of the enrolled patients was 60.0 (50.0, 66.0) years; male patients accounted for 60.9% of patients, and the mean CD4 level was 213 cells/μL (150.3, 325.3). The hospital mortality rate of the cohort was 67.4% (31/46 patients). Patients in the survival group showed a higher rate of receiving awake ECMO (11/15 vs. 4/31; p = 0.006), a lower rate of acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT) (1/15 vs. 12/31; p = 0.035), fewer platelet transfusion units (0/15 vs. 2/31 units; p = 0.039) and a lower rate of ventilator‐associated pneumonia (2/15 vs. 19/31; p = 0.006). In a multivariate Cox regression analysis model, intubated ECMO (hazard ratio = 1.77, 95% confidence interval: 1.34–2.32, p < 0.001) and AKI requiring CRRT (1.37, 95% confidence interval: 1.14–1.61, p = 0.003) were identified as independent risk factors for mortality. Conclusions: In‐hospital mortality has remained high in ECMO‐treated immunocompromised patients with acute respiratory failure. Intubated ECMO and AKI receiving CRRT during ECMO treatment may predict ECMO failure in immunocompromised patients with ARF. A primarily awake ECMO strategy seems feasible in some selected immunocompromised patients. [ABSTRACT FROM AUTHOR]

Background: The incidence of Pneumocystis pneumonia (PCP) among patients without human immunodeficiency virus (HIV) infection continues to increase. Here, we identified potential risk factors for in‐hospital mortality among HIV‐negative patients with PCP admitted to the intensive care unit (ICU). Methods: We retrospectively analyzed medical records of 154 non‐HIV‐infected PCP patients admitted to the ICU at Peking Union Medical College Hospital (PUMCH) and China‐Japan Friendship Hospital (CJFH) from October 2012 to July 2020. Clinical characteristics were examined, and factors related to in‐hospital mortality were analyzed. Results: A total of 154 patients were enrolled in our study. Overall, the in‐hospital mortality rate was 65.6%. The univariate analysis indicated that nonsurvivors were older (58 vs. 52 years, P = 0.021), were more likely to use high‐dose steroids (≥1 mg/kg/day prednisone equivalent, 39.62% vs. 55.34%, P = 0.047), receive caspofungin during hospitalization (44.6% vs. 28.3%, P = 0.049), require invasive ventilation (83.2% vs. 47.2%, P < 0.001), develop shock during hospitalization (61.4% vs. 20.8%, P < 0.001), and develop pneumomediastinum (21.8% vs. 47.2%, P = 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores on ICU admission (20.32 vs. 17.39, P = 0.003), lower lymphocyte counts (430 vs. 570 cells/μl, P = 0.014), and lower PaO2/FiO2 values (mmHg) on admission (108 vs. 147, P = 0.001). Multivariate analysis showed that age (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.00–1.06; P = 0.024), use of high‐dose steroids (≥1 mg/kg/day prednisone equivalent) during hospitalization (OR 2.29; 95% CI 1.07–4.90; P = 0.034), and a low oxygenation index on admission (OR 0.99; 95% CI 0.99–1.00; P = 0.014) were associated with in‐hospital mortality. Conclusions: The mortality rate of non‐HIV‐infected patients with PCP was high, and predictive factors of a poor prognosis were advanced age, use of high‐dose steroids (≥1 mg/kg/day prednisone equivalent) during hospitalization, and a low oxygenation index on admission. The use of caspofungin during hospitalization might have no contribution to the prognosis of non‐HIV‐infected patients with PCP in the ICU. [ABSTRACT FROM AUTHOR]

Introduction: Limited information exists about the relationship between body mass index (BMI) and the outcome of acute respiratory distress syndrome (ARDS). Objective: To evaluate the hospital mortality of patients with ARDS in relation to BMI. Materials and methods: We conducted a retrospective, multicenter study including patients with ARDS. ARDS was defined according to the Berlin criteria. Body weight and height were obtained to calculate BMI. The primary outcome was in‐hospital mortality. Secondary outcomes were intensive care unit (ICU) mortality, invasive positive pressure ventilation (IPPV) free days within 28 days and length of stays in the ICU and hospital. Results: Among 523 patients, 28 (5%) were underweight (BMI <18.5 kg/m2), 299 (57%) were normal weight (BMI 18.5‐24.9 kg/m2), 159 (30%) were overweight (BMI 25‐29.9 kg/m2) and 37 (7%) were obese (BMI ≥30 kg/m2). Increasing BMI was associated with younger age (P = 0.017), hypertension (P = 0.003) and diabetes (P = 0.02). Compared with normal weight, being overweight and obese resulted in lower mortality regardless of whether in the hospital (P = 0.019) or ICU (P = 0.044). However, after risk adjustment, only obesity was associated with lower hospital mortality (OR 0.393, 95% CI 0.169‐0.914, P = 0.030). With the increase of BMI, the in‐hospital mortality and ICU mortality of ARDS dropped gradually (from 57.1% to 24.3%, P = 0.021, and from 53.6% to 24.3%, P = 0.035). Conclusions: Obesity is associated with lower mortality in patients with ARDS. With the increase of BMI, the mortality of ARDS drops gradually. [ABSTRACT FROM AUTHOR]

Introduction: Standard bi‐level non‐invasive ventilation with fixed‐level pressure support (PS) delivery may not maintain ventilation during the changes in pulmonary mechanics that occur throughout day and night, so average volume‐assured pressure support (AVAPS) modes that target a preset volume by adjustment of PS may be effective. Objective: Our meta‐analysis wants to compare AVAPS and pressure support non‐invasive ventilation (PS‐NIV) regarding arterial blood gases (ABGs), sleep efficiency and compliance. Method: Relevant publications indexed in PubMed, Cochrane Library, Embase, Web of Science, Wanfang Data, China National Knowledge Infrastructure and VIPI were identified. Appropriate articles identified from the reference lists of the above searches were also reviewed. We included randomized controlled trials involved the use of AVAPS and PS‐NIV ventilation for chronic respiratory failure. Each included study weighted mean differences, and 95% confidence intervals (CI) were calculated for continuous outcomes. Statistical heterogeneity was assessed using the I2 value ≤ 50% were considered as no statistical heterogeneity and used fixed effects model. Otherwise, a random effects model was used. Results: Eight trials were eligible. No significant difference was observed between AVAPS and PS‐NIV groups to compare PaCO2 (OR −0.97, CI‐2.54‐0.61, P = 0.23) and PaO2 (OR −1.81, CI‐4.29‐0.67, P = 0.15) in ABGs. There was no significant difference between the two groups with sleep efficiency (OR −3.31, CI‐7.58‐0.95, P = 0.13) and visual analog scale (OR 0.32, CI‐6.97‐7.61, P = 0.93). Conclusions: The evidence shows there is no significant difference in clinical outcomes when comparing AVAPS and PS‐NIV used for chronic respiratory failure patients. [ABSTRACT FROM AUTHOR]

Introduction: There has been a rapid increase in the number of influenza and invasive pulmonary aspergillosis (IPA) co‐infection. Objectives: To explore the risk factors and predictors of a poor prognosis in influenza and IPA co‐infection. Methods: We included patients with confirmed influenza during the 2017‐2018 influenza season and cases of influenza and IPA co‐infection in the literature. Results: A total of 64 patients with influenza infection were admitted to ICU. Of these patients, 18 were co‐infected with IPA. Others were assigned to the control group (n = 46). A total of 45 patients from the literature were added to the IPA group (n = 63). A multivariate logistic regression suggested that influenza patients who were given steroids after ICU admission, who had a white blood count (WBC) of more than 10*109/L on ICU admission and whose CT findings manifested as multiple nodules and cavities might have a higher risk of developing IPA. Compared to survivors, non‐survivors had higher sequential organ failure assessment (SOFA) scores (16 ± 4 points vs 8 ± 4 points, P < 0.001), lower CD4+ T cell counts on ICU admission [315 (83‐466) cells/μL vs 152 (50‐220) cells/μL, P = 0.031] and more requirement extracorporeal membrane oxygenation (ECMO) support [13 (50%) vs 7 (18.9%), P = 0.015]. Conclusions: Influenza patients who are given steroids after ICU admission, who have WBCs of greater than 10*109/L on ICU admission, and whose CT imaging shows multiple nodules and cavities might have a high risk of IPA. Higher SOFA scores, CD4+ T cell counts lower than 200 cells/μL on ICU admission and more ECMO requirement might be predictors of a poor prognosis. [ABSTRACT FROM AUTHOR]