Acute respiratory distress syndrome in patients with malignancies

Azoulay, Élie; Lemiale, Virginie; Mokart, Djamel; Pène, Frédéric; Kouatchet, Achille; Perez, Pierre; Vincent, François; Mayaux, Julien; Benoît, Dominique; Bruneel, Fabrice; Meert, Anne-Pascale; Nyunga, Martine; Rabbat, Antoine; Darmon, Michaël

doi:10.1007/s00134-014-3354-0

Cited by 225 publications

(204 citation statements)

References 47 publications

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“…In contrast, the ICU is an environment in which IMV can be applied by intensive care doctors accustomed to providing mechanical ventilation and who can monitor the patient continuously with the support of adequate nursing resources. Although NPPV also appears to be useful in the initial stage of acute respiratory failure, treatment with NPPV alone was unsuccessful in the majority of cases, and the failure of the initial NPPV treatment may be associated with a prognosis (14). The above results appear to indicate a need for stringent monitoring to ensure that there is no delay in the progression from NPPV to IMV, and that an ICU is a preferable treatment environment to a sterile ward (17).…”

Section: Discussionmentioning

confidence: 99%

“…However, there are conflicting reports which state that NPPV is not superior to IMV as an initial treatment for acute respiratory failure in hematological malignancy patients (12,13). In hematological malignancy patients, acute respiratory failure is often accompanied by other forms of organ failure, thus NPPV alone is often insufficient and IMV treatment will eventually become necessary (14). Furthermore, it has been reported that in many of the cases in which the initial treatment with NPPV fails, it is difficult to wean the patient from mechanical ventilation and that the prognosis of such patients is poor; thus the decision to use NPPV as the initial treatment should not be taken lightly (15).…”

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confidence: 99%

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The Therapeutic Outcomes of Mechanical Ventilation in Hematological Malignancy Patients with Respiratory Failure

et al. 2016

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Objective In hematological malignancy patients, the complication of acute respiratory failure often reaches a degree of severity that necessitates mechanical ventilation. The objective of the present study was to investigate the therapeutic outcomes of mechanical ventilation in hematological malignancy patients with respiratory failure and to analyze the factors that are associated with successful treatment in order to identify the issues that should be addressed in the future. Methods The present study was a retrospective analysis of 71 hematological malignancy patients with noncardiogenic acute respiratory failure who were treated with mechanical ventilation at Nippon Medical School Hospital between 2003 and 2014. Results Twenty-six patients (36.6%) were treated with mechanical ventilation in an intensive care unit (ICU). Non-invasive positive pressure ventilation (NPPV) was applied in 29 cases (40.8%). The rate of successful mechanical ventilation treatment with NPPV alone was 13.8%. The rate of endotracheal extubation was 17.7%. A univariate analysis revealed that the following factors were associated with the successful extubation of patients who received invasive mechanical ventilation: respiratory management in an ICU (p= 0.012); remission of the hematological disease (p=0.011); female gender (p=0.048); low levels of accompanying non-respiratory organ failure (p=0.041); and the non-use of extracorporeal circulation (p=0.005). A subsequent multivariate analysis revealed that respiratory management in an ICU was the only variable associated with successful extubation (p=0.030). Conclusion The outcomes of hematological malignancy patients who receive mechanical ventilation treatment for respiratory failure are very poor. Respiratory management in an ICU environment may be useful in improving the therapeutic outcomes of such patients.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The Therapeutic Outcomes of Mechanical Ventilation in Hematological Malignancy Patients with Respiratory Failure

et al. 2016

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“…In order to avoid intubation and invasive mechanical ventilation, NIV is traditionally used as first-line treatment in this group of patients, although NIV failure has also been associated with increased mortality [66][67][68].…”

Section: Acute Hypoxaemic Respiratory Failure In Immunocompromised Pamentioning

confidence: 99%

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre-and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with "do not intubate" status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

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“…The mortality associated with ARDS remains unacceptably high, reaching 46 % in patients with severe disease [16,17]. The burgeoning outcomes literature on complex and high-risk ARDS patients has evolved to increasingly embrace patient-and family-centered outcome measures.…”

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confidence: 99%

Focus on veno-venous ECMO in adults with severe ARDS

Papazian

Herridge

2016

Intensive Care Med

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Veno-venous extracorporeal membrane oxygenation (vvECMO) improves oxygenation and promotes carbon dioxide (CO 2 ) removal [1,2]. In the most severe form of ARDS, ECMO rapidly facilitates the correction of severe derangement in gas exchange and saves time, which allows one to treat the cause of lung injury. Recent advances in ECMO technology have improved safety and promoted its use [3][4][5].Knowledge of the gas exchange performance of membrane oxygenators is important to help choose the optimal system for patients suffering from acute respiratory failure. In an in vivo study of 317 vvECMO patients supported with four different ECMO systems, Lehle et al. [6] showed that CO 2 transfer was dependent on sweep gas flow and blood flow, while O 2 transfer was only dependent on blood flow when it was above 3 L/min.The association between ECMO use and the development of thrombocytopenia secondary to circuit-induced platelet activation and aggregation has been suggested, although never carefully evaluated. In a retrospective cohort study of 100 adults who received vvECMO for acute respiratory failure, Abrams et al. [7] demonstrated that the severity of critical illness and platelet count at the time of cannulation were independently associated with the development of severe thrombocytopenia, while the duration of ECMO support was not.A position paper [8] from an international group of experts described the optimal approach to organizing programs and delivering safe and proficient ECMO for acute respiratory failure. They encouraged restraint in the widespread use of ECMO until a better appreciation of both the potential clinical applications and the optimal techniques for performing ECMO are available. They also underlined the need for further randomized controlled trials assessing this technique.Using hospital ECMO volumes from 290 international centers, a retrospective study of more than 55,000 ECMO patients [9] found an association between higher adult ECMO hospital volume and lower ECMO mortality rates. Patients receiving ECMO at hospitals with more than 30 adult annual ECMO cases had significantly lower odds of mortality (adjusted odds ratio, 0.61; 95 % confidence interval 0.46-0.80) compared with those receiving ECMO at hospitals with fewer than six cases annually.In a review paper, Levy et al.[10] proposed a multistep therapeutic approach with optimization of ECMO blood flow, red blood cell transfusion, moderate hypothermia, and short-action beta-blockers for the management of persistent severe hypoxemia under vvECMO. Important technical considerations for the care of ECMO patients by nurses [11] and physicians were also detailed in a review.The optimal ventilatory strategy for ARDS patients under ECMO remains unclear. Controlled mechanical ventilation is recommended in the first few days [12]. While the ventilator settings should be as low as possible to reduce ventilator-induced lung injury (VILI), there is an increased risk of derecruitment. In a recent international study [13] it was suggested that higher PEEP ...

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Acute respiratory distress syndrome in patients with malignancies

Cited by 225 publications

References 47 publications

The Therapeutic Outcomes of Mechanical Ventilation in Hematological Malignancy Patients with Respiratory Failure

The Therapeutic Outcomes of Mechanical Ventilation in Hematological Malignancy Patients with Respiratory Failure

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

Focus on veno-venous ECMO in adults with severe ARDS

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