Due to higher survival rates with good quality of life, related to new treatments in the fields of oncology, hematology, and transplantation, the number of immunocompromised patients is increasing. But these patients are at high risk of intensive care unit admission because of numerous complications. Acute respiratory failure due to severe community-acquired pneumonia is one of the leading causes of admission. In this setting, the need for invasive mechanical ventilation is up to 60%, associated with a high hospital mortality rate of around 40 to 50%. A wide range of pathogens according to the reason of immunosuppression is associated with severe pneumonia in those patients: documented bacterial pneumonia represents a third of cases, viral and fungal pneumonia both account for up to 15% of cases. For patients with an undetermined etiology despite comprehensive diagnostic workup, the hospital mortality rate is very high. Thus, a standardized diagnosis strategy should be defined to increase the diagnosis rate and prescribe the appropriate treatment. This review focuses on the benefit-to-risk ratio of invasive or noninvasive strategies, in the era of omics, for the management of critically ill immunocompromised patients with severe pneumonia in terms of diagnosis and oxygenation.

中文翻译：

---

免疫功能低下患者的严重社区获得性肺炎

由于较高的生存率和良好的生活质量，与肿瘤学、血液学和移植领域的新疗法相关，免疫功能低下的患者数量正在增加。但由于许多并发症，这些患者进入重症监护室的风险很高。严重社区获得性肺炎导致的急性呼吸衰竭是入院的主要原因之一。在这种情况下，有创机械通气的需求高达 60%，医院死亡率高达 40% 至 50% 左右。根据免疫抑制的原因，多种病原体与这些患者的重症肺炎相关：记录在案的细菌性肺炎占病例的三分之一，病毒性和真菌性肺炎均占病例的 15%。对于尽管进行了全面诊断检查但病因不明的患者，医院死亡率非常高。因此，应制定标准化的诊断策略，以提高诊断率并制定适当的治疗方案。本综述重点关注组学时代侵入性或非侵入性策略在诊断和氧合方面治疗重症肺炎重症免疫功能低下患者的获益与风险比。