Abstract
BackgroundThe usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate.AimTo analyze the rate of noninvasive ventilation failure and the main characteristics associated with this endpoint in oncohematological patients with acute respiratory failure (ARF).MethodsA ventilatory support protocol was developed and implemented before the onset of the study. According to the PaO2/FiO2 (P/F) ratio and clinical judgment, patients received supplementary oxygen therapy, NIMV, or invasive mechanical ventilation (IMV).ResultsEighty-two patients were included, average age between 52.1 ± 16 years old; 44 (53.6%) were male. The tested protocol was followed in 95.1% of cases. Six patients (7.3%) received IMV, 59 (89.7%) received NIMV, and 17 (20.7%) received oxygen therapy. ICU mortality rates were significantly higher in the IMV (83.3%) than in the NIMV (49.2%) and oxygen therapy (5.9%) groups (P < 0.001). Among the 59 patients who initially received NIMV, 30 (50.8%) had to eventually be intubated. Higher SOFA score at baseline (1.35 [95% CI = 1.12–2.10], P = 0.007), higher respiratory rate (RR) (1.10 [95% CI = 1.00–1.22], P = 0.048), and sepsis on admission (16.9 [95% CI = 1.93–149.26], P = 0.011) were independently associated with the need of orotracheal intubation among patients initially treated with NIMV. Moreover, NIMV failure was independently associated with ICU (P < 0.001) and hospital mortality (P = 0.049), and mortality between 6 months and 1 year (P < 0.001).ConclusionThe implementation of a NIMV protocol is feasible in patients with hematological neoplasia admitted to the ICU, even though its benefits still remain to be demonstrated. NIMV failure was associated with higher SOFA and RR and more frequent sepsis, and it was also related to poor prognosis.
Highlights
Patients with hematological neoplasms hospitalized in intensive care units (ICU) present high mortality rates— 50 to 70%—making the need of invasive mechanical ventilation (IMV) one of the main determining factors of this outcome
Critically ill patients treated with non-invasive mechanical ventilation (NIMV) that eventually get intubated apparently have a greater rate of complications, such as longer IMV duration, longer ICU stay, and higher mortality rate [8]
NIMV failure was independently associated with ICU mortality (OR = 1.62 [95% CI 1.29–2.03]; P < 0.001) and hospital mortality (OR = 1.29; [95% CI 1.01–1.64]; P = 0.049); the latter, even after adjustment for lactate, P/F ratio and respiratory rate upon ICU admission
Summary
Patients with hematological neoplasms hospitalized in intensive care units (ICU) present high mortality rates— 50 to 70%—making the need of invasive mechanical ventilation (IMV) one of the main determining factors of this outcome. Use of noninvasive mechanical ventilation (NIMV) in patients with hematological neoplasms has been associated in some studies with a reduction in mortality and IMV requirement [1, 6,7,8]. The aim of this study was to analyze factors associated with the transition from noninvasive to IMV (i.e., NIMV failure) in oncohematological patients with acute respiratory failure using a dedicated protocol. The usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate
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