Non-invasive ventilation in patients with hematological malignancies: the saga continues, but where is the finale?

Benoît, Dominique; Depuydt, Pieter

doi:10.1007/s00134-010-1949-7

Cited by 9 publications

(5 citation statements)

References 16 publications

(31 reference statements)

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“…This fact can be explained by the mode of NIMV employed, by the etiology of the respiratory failure, and by the intrinsic complexity of hematological patients with acute respiratory failure, making it difficult to predict whether NIMV will be successful. ( 17 , 18 , 21 ) In general populations admitted to the ICU with acute respiratory failure, some predictors of NIMV failure have been described, such as the use of vasopressors, renal replacement therapy, severe hypoxemic respiratory failure, comorbidities, late transfer to the ICU and delay in administering appropriate ventilatory support. ( 20 , 22 , 23 ) However, there is still no specific consensus regarding onco-hematologic patients.…”

Section: Discussionmentioning

confidence: 99%

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

Barreto¹,

Torga²,

Coelho³

et al. 2015

Revista Brasileira De Terapia Intensiva

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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.

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Section: Discussionmentioning

confidence: 99%

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

Barreto¹,

Torga²,

Coelho³

et al. 2015

Revista Brasileira De Terapia Intensiva

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“…However, more recently, non-randomized studies failed to confirm these results [ 15 ]. Over the last two decades, survival of patients with hematological malignancy admitted to ICU improved, even for patients receiving mechanical ventilation [ 16 – 19 ]. For instance, in a recent study from our GRRROH network, mortality of hematology patients requiring mechanical ventilation and who had at least one additional organ dysfunction was 60 % [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Acute respiratory failure in patients with hematological malignancies: outcomes according to initial ventilation strategy. A groupe de recherche respiratoire en réanimation onco-hématologique (Grrr-OH) study

Lemiale

Resche-Rigon

Mokart

et al. 2015

Ann. Intensive Care

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Background In patients with hematological malignancies and acute respiratory failure (ARF), noninvasive ventilation was associated with a decreased mortality in older studies. However, mortality of intubated patients decreased in the last years. In this study, we assess outcomes in those patients according to the initial ventilation strategy. Methods We performed a post hoc analysis of a prospective multicentre study of critically ill hematology patients, in 17 intensive care units in France and Belgium. Patients with hematological malignancies admitted for ARF in 2010 and 2011 and who were not intubated at admission were included in the study. A propensity score-based approach was used to assess the impact of NIV compared to oxygen only on hospital mortality. Results Among 1011 patients admitted to ICU during the study period, 380 met inclusion criteria. Underlying diseases included lymphoid ( n = 162, 42.6 %) or myeloid ( n = 141, 37.1 %) diseases. ARF etiologies were pulmonary infections ( n = 161, 43 %), malignant infiltration ( n = 65, 17 %) or cardiac pulmonary edema ( n = 40, 10 %). Mechanical ventilation was ultimately needed in 94 (24.7 %) patients, within 3 [2–5] days of ICU admission. Hospital mortality was 32 % (123 deaths). At ICU admission, 142 patients received first-line noninvasive ventilation (NIV), whereas 238 received oxygen only. Fifty-five patients in each group (NIV or oxygen only) were matched according the propensity score. NIV was not associated with decreased hospital mortality [OR 1.5 (0.62–3.65)]. Conclusions In hematology patients with acute respiratory failure, initial treatment with NIV did not improve survival compared to oxygen only. Clinical trial.gov number NCT 01172132

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“…The authors were surprised to observe significant decreases in intubation rates and mortality rates in these patients compared with those determined in former studies (14). The delayed use of NIV was a pivotal predictor of NIV failure (15) and the mortality rate of patients increased dramatically after the failure of NIV (12,13,16). These results signal that it may be useful to move the timing and initiation of NIV ahead.…”

Section: What Causes the Negative Results Of Niv And Hfnc Despite Thementioning

confidence: 79%

Acute Hypoxemic Respiratory Failure in Immunocompromised Patients: Taking Aggressive Measures to Identify Etiology

Liu

2020

Front. Med.

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Immunocompromised patients often experience pulmonary complications especially acute respiratory failure (ARF) (1-3), the main cause of which is infection (4). To avoid increasing the risk of infection, non-invasive mechanical ventilation (NIV) is recommended as a first line treatment for immunocompromised patients (5, 6). However, recent studies have cast some doubts on the protective effects of NIV as a first-line treatment in immunocompromised patients with ARF (7-9). Meanwhile, a high-flow nasal cannula (HFNC) may potentially be a better alternative to NIV or standard oxygenation therapy (SOT) in immunocompromised patients due to its unique functions (4), but the results of studies of the effect of HFNC are also obscure (10-12). It has been determined that the identification of ARF etiology in immunocompromised patients currently contributes extensively to the survival rates of these patients. Recently, Azoulay et al. (13) conducted a large, multinational prospective cohort study named the Efraim study, in which 1,611 critically ill immunocompromised patients with ARF were enrolled. They compared the intubation rate between four groups: standard oxygen only, HFNC only, NIV only, and both HFNC + NIV. Meanwhile, they also included patients who received firstline invasive mechanical ventilation (IMV) and all-cause hospital mortality rates were compared between these groups. The study illustrated that the use of NIV did not impact outcomes. Although HFNC reduced the intubation rate, it did not influence all-cause hospital mortality. However, more importantly, they found that the etiology of ARF had an impact on hospital mortality, acting as a vital confounder in the association between oxygenation strategy and mortality, and the study proved that patients with undetermined ARF have a very high mortality rate.

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Non-invasive ventilation in patients with hematological malignancies: the saga continues, but where is the finale?

Cited by 9 publications

References 16 publications

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

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

Acute respiratory failure in patients with hematological malignancies: outcomes according to initial ventilation strategy. A groupe de recherche respiratoire en réanimation onco-hématologique (Grrr-OH) study

Acute Hypoxemic Respiratory Failure in Immunocompromised Patients: Taking Aggressive Measures to Identify Etiology

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