ObjectiveTo evaluate the clinical characteristics of patients with hematological disease
admitted to the intensive care unit and the use of noninvasive mechanical
ventilation in a subgroup with respiratory dysfunction.MethodsA retrospective observational study from September 2011 to January 2014.ResultsOverall, 157 patients were included. The mean age was 45.13 (± 17.2) years
and 46.5% of the patients were female. Sixty-seven (48.4%) patients had sepsis,
and 90 (57.3%) patients required vasoactive vasopressors. The main cause for
admission to the intensive care unit was acute respiratory failure (94.3%). Among
the 157 studied patients, 47 (29.9%) were intubated within the first 24 hours, and
38 (24.2%) underwent noninvasive mechanical ventilation. Among the 38 patients who
initially received noninvasive mechanical ventilation, 26 (68.4%) were
subsequently intubated, and 12 (31.6%) responded to this mode of ventilation.
Patients who failed to respond to noninvasive mechanical ventilation had higher
intensive care unit mortality (66.7% versus 16.7%; p = 0.004) and a longer stay in
the intensive care unit (9.6 days versus 4.6 days, p = 0.02) compared with the
successful cases. Baseline severity scores (SOFA and SAPS 3) and the total
leukocyte count were not significantly different between these two subgroups. In a
multivariate logistic regression model including the 157 patients, intubation at
any time during the stay in the intensive care unit and SAPS 3 were independently
associated with intensive care unit mortality, while using noninvasive mechanical
ventilation was not.ConclusionIn this retrospective study with severely ill hematologic patients, those who
underwent noninvasive mechanical ventilation at admission and failed to respond to
it presented elevated intensive care unit mortality. However, only intubation
during the intensive care unit stay was independently associated with a poor
outcome. Further studies are needed to define predictors of noninvasive mechanical
ventilation failure.
Background
The usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate.
Aim
To analyze the rate of noninvasive ventilation failure and the main characteristics associated with this endpoint in oncohematological patients with acute respiratory failure (ARF).
Methods
A 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).
Results
Eighty-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).
Conclusion
The 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.
Aims: This pilot study aimed to evaluate the usefulness of a sequential lung ultrasound score (LUS) in immunosuppressed patients with oncohematologic diseases and acute respiratory dysfunction hospitalized in an intensive care unit (ICU).Materials and methods: LUS was calculated at ICU admission, after 24 h, 48 h and at discharge. A score ranging from 0 to 26 was attributed according to the number of B lines, presence of lung consolidation and pleural effusion.Results: Twenty-six patients were included. The median age was 50 years [interquartile range (IQR) 21] and 14 (54%) were male. LUS on the day of ICU admission was significantly higher in non-survivors compared to survivors (13 [5] vs 9 [9], respectively; p=0.047). The median delta LUS (LUS_D2 – LUS_D1) did not show difference between survivors and non-survivors (2 [0-7.5] vs 1 [-1.5 – 5], p=0.33). Among patients initially submitted to noninvasive mechanical ventilation (NIMV), no difference in LUS at inclusion or after 24 h was found between those who succeeded or failed on this support.Conclusion: The use of LUS to quantify lung aeration loss in oncohematologic patients hospitalized in an ICU due to acute respiratory dysfunction might be a helpful tool to predict the severity of the illness.
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