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

Abstract

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.

S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

“…Bei der Myasthenia gravis, der häufigsten autoimmunen Muskelerkrankung, kann in fast 50 % der Fälle eine Intubation im Rahmen einer akuten respiratorischen Insuffizienz durch eine NIV-Therapie verhindert werden, was zu einer geringeren Mortalität und deutlich kürzeren Beatmungszeiten führt 93 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 . Hier scheint, ähnlich wie bei der ALS, das Ausmaß der Dysphagie über den Erfolg der NIV-Therapie mitzuentscheiden 93 .…”

Management strategy for hematological malignancy patients with acute respiratory failure

“…Several risk factors that could predict NIV failure have been identified. Barreto et al [35] implemented IMV, NIV and oxygen only to 82 HM with ARF based on PaO2/FiO2 and clinical judgement, 59 (72%) patients received NIV, and 30 of them (58.2%) need intubation. The mortality was 83.3%, 49.2% and 5.9% in IMV, NIV and oxygen only, respectively.…”

“…Depuydt et al appealed to IMV for HM with ARF who were excluded from NIV, especially for those whose admission to ICU was driven by sepsis [44]. Other risk factors of NIV failure were also reported in different investigations, which included need for vasopressor, longer delay between admission and NIV, acute respiratory distress syndrome (ARDS), hepatic failure, hemodialysis, high APACHE II and SAPS II score, et al [4,35,37,39,41,45,[54][55][56].…”

“…In contrast, IMV should be the first option for those consciousness disorder, unstable hemodynamic, PaO 2 /FiO 2 < 200, RR > 35 breaths/min, ARDS and multiple organ dysfunction (Fig. 1) [4,35,37,39,41,45,54,57].…”

“…[3,[32][33][34][35][36][37][38][39][40].Conti et al evaluated the efficacy of BiPAP among 16 HM patients with ARF (87 ± 22 of arterial partial pressure of oxygen to fraction of inspired oxygen, (PaO 2 /FiO 2 )) in a pilot study. 15/16 patients showed improvement in blood gas and respiration.…”