Noninvasive ventilation in patients with malignancies and hypoxemic acute respiratory failure: A still pending question

Abstract

Acute respiratory failure (ARF) is a severe complication and a leading reason for admission to intensive care units (ICUs) of patients with malignancies [1]. For decades, ARF developing in these patients was considered a consequence of refractory pulmonary diseases hence associated with very high mortality rates. For the last years, improved survival rates were reported in different specialized centers [2-6]. In addition to oncological and hematologic advances and to intensive care improvements, investigators have attributed the increased survival to the use of noninvasive ventilation (NIV) [3,6]. In 2001, a randomized control trial from Hilbert et al [7] reported several benefits of NIV including improvements in oxygenation parameters and reduced need for endotracheal intubation and its related complications in immunosuppressed patients with ARF. Although only 30 patients with malignancies were included in that study, the improved survival rates placed NIV as the initial method of choice for ventilatory support for hypoxemic ARF in these patients. However, concerns were raised about patient's outcomes in the control group in whom intubation was associated with up to 94%mortality. Moreover, later studies demonstrated that NIV failure (as defined by