Main characteristics observed in patients with hematologic diseases admitted to an intensive care unit of a Brazilian university hospital

Abstract

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.

Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes

“…However, the protocol implementation was not associated with lower NIMV failure rates. Actually, the frequency of poor response and need of intubation after NIMV trial was similar to that found in other studies [ 6 , 9 , 14 , 21 – 25 ], despite being lower than that observed in oncohematological patients admitted to the same unit (50.8% vs. 68.4%) in a previous study of our group [ 9 ]. In addition, patients with poor response to NIMV were apparently more severely ill, with higher median values of SOFA at baseline, and had a diagnosis of sepsis more frequently.…”

“…Finally, the use of vasopressors and the need for IMV were associated with higher rates of ICU mortality. In a historical cohort that was admitted in the same unit of this study, only the use of vasopressors upon inclusion was independently associated with NIMV failure [9,14,21].…”

“…This was a prospective interventional study designed to test a ventilator assistance protocol in patients with hematological neoplasms admitted to an ICU with ARF. The hypothesis in this study was that the use of a protocol based on the best evidence in literature and on previous experience of the research team [9] would improve the suitability of NIMV recommendation in this group of patients. We also evaluated the characteristics associated with NIMV failure.…”

“…The protocol of ventilatory assistance was developed specifically for this study (Fig. 1), based on information supplied by a retrospective [9] survey carried out at the same unit and on data from the literature [1,14,15]. In summary, the modality of ventilatory support was defined according to the P/F ratio observed at the moment of ICU admission.…”

“…To define the impact of the tested protocol in the NIMV failure rate, the sample size was calculated based on the cohort of the prior study conducted by our research group [9]. In that study, we observed NIMV failure rate of 68.4%, resulting in orotracheal intubation.…”