Ten-year evolution of mechanical ventilation in acute respiratory failure in the hematogical patient admitted to the intensive care unit

Abstract

ObjectiveA comparison was made between invasive mechanical ventilation (IMV) and noninvasive positive pressure ventilation (NPPV) in hematological patients with acute respiratory failure. DesignA retrospective observational study was made from 2001 to December 2011. SettingA clinical–surgical intensive care unit (ICU) in a tertiary hospital. PatientsPatients with hematological malignancies suffering acute respiratory failure (ARF) and requiring mechanical ventilation in the form of either IMV or NPPV. Variables of interestAnalysis of infection and organ failure rates, duration of mechanical ventilation and ICU and hospital stays, as well as ICU, hospital and mortality after 90 days. The same variables were analyzed in the comparison between NPPV success and failure. ResultsForty-one patients were included, of which 35 required IMV and 6 NPPV. ICU mortality was higher in the IMV group (100% vs 37% in NPPV, p=.006). The intubation rate in NPPV was 40%. Compared with successful NPPV, failure in the NPPV group involved more complications, a longer duration of mechanical ventilation and ICU stay, and greater ICU and hospital mortality. Multivariate analysis of mortality in the NPPV group identified NPPV failure (OR 13 [95% CI 1.33–77.96], p=.008) and progression to acute respiratory distress syndrome (OR 10 [95% CI 1.95–89.22], p=.03) as prognostic factors. ConclusionThe use of NPPV reduced mortality compared with IMV. NPPV failure was associated with more complications.