Supporting respiratory function in the immunocompromised critically ill patient: new perspectives for an old paradigm

Delivering care to patients suffering from a severe depression of the immune system is a challenge for the intensivist. Such patients pose relevant issues in terms of choice of the appropriate treatment and resource allocation, as well as relevant ethical issues in both clinical practice and research. Especially in the past, the poor prognosis improvement achieved with intensive treatment among these patients lead critical care givers to be reluctant in admitting them to the intensive care unit (ICU) for two main reasons: the willingness to avoid relentless treatment and the perception of ICU as a high-risk setting for contracting multiresistant microorganisms (1). Acute respiratory failure (ARF) is a common complication in these patients, and the leading reason requiring admission to the ICU (1-3). For many caregivers the idea that immunocompromised patients are unlikely to benefit from ICU admission has been a paradigm for long time.