Risk factors of non-invasive ventilation failure in hematopoietic stem-cell transplantation patients with acute respiratory distress syndrome

Abstract

Background: Non-invasive ventilation (NIV) was one of the first-line ventilation supports for hematopoietic stem-cell transplantation (HSCT) patients with acute respiratory distress syndrome (ARDS). Successful NIV may avoid need for intubation. However, the influence NIV failure had on patients’ outcome and its risk factors were hardly known. Methods: In this retrospective observational study, we reported risk factors and incidence of NIV failure in HSCT patients who were admitted to the Intensive Care Unit (ICU) with a diagnosis of ARDS and supported with mechanical ventilation, in a 5-year period. Patient outcomes, such as ventilator-free days, ICU-free days, and ICU mortality were also reported. Results: Of all the 94 patients included, 70 patients were initially supported with NIV. NIV failure occurred in 44 (63%) patients. Male sex, elevated serum galactomannan (GM) test, (1-3)- β- D-glucan (BG) assay, or elevated serum creatinine level were risk factors for NIV failure. When compared with the NIV success group, failure of NIV was associated with much fewer ICU-free days (22 versus 0, p < 0.001, Cohen’s d = 0.62) and higher ICU mortality (9.5% versus 75.5%, p < 0.001, Pearson’s r = 0.75). There was no difference in ICU-free days, ventilator-free days and ICU mortality between NIV failure and initial invasive mechanical ventilation (IMV) groups. Patients who failed in NIV support had a higher ICU mortality (75.5%) than those who succeeded (9.5%). Conclusion: In a small cohort of HSCT patients with mainly moderate severity of ARDS, male patients with elevated serum GM/BG test or serum creatinine level had a higher risk of NIV failure. Both NIV failure and initial IMV groups were characterized by high mortality rate and extremely low ICU-free days and ventilator-free days; failure of NIV support may further aggravate patient prognosis. The reviews of this paper are available via the supplemental material section.

Non-invasive ventilation for acute hypoxaemic respiratory failure: a propensity-matched cohort study

“…Compared with those who avoided intubation, those who failed NIV had significantly higher APACHE II scores and serum creatinine and higher proportion of bacterial pneumonia diagnosis. A study of similar size assessing the risk factors for NIV failure in haematopoietic stem cell transplantation patients with ARDS showed elevated creatinine as a risk factor for NIV failure 18. Our study is also consistent with other previous studies showing community-acquired pneumonia, illness severity and extrapulmonary organ dysfunction to be associated with NIV failure 19…”

Phenotypes, Lung Microbiota and Cytokine Responses in Pneumonia After Hematopoietic Stem Cell Transplantation

“…The reported 30-day mortality for HSCT patients with respiratory failure was 50–75%. 10 , 30 To present the estimated mortality rate in the study cohort (62.5% as a mean value), we set the allowable error rate as 6.25% (62.5% × 0.1), confidence interval as 0.9, a sample size of 65 is estimated. All statistical analyses were performed on R (v4.0.4).…”

“…For example, in HSCT patients with influenza pneumonia, the reported mortality ranged from 6.3% to 25%, 5 , 6 mortality of Respiratory Syncytial virus pneumonia was 29% to 88%. 7–9 For those who need respiratory supports, their response to mechanical ventilation 10 and extracorporeal membrane oxygenation 11 also differs between patients with different characteristics. Recently, Calfee et al and Bos et al have identified phenotypes of acute respiratory distress syndrome (ARDS) based on clinical and biological data (including serum cytokine levels), patients of different phenotypes have distinct presentations of cytokine levels, other inflammation presentations, clinical outcomes and response to specific treatments.…”

Genome-wide analysis of RNA-binding protein co-expression with alternative splicing events in acute respiratory distress syndrome following hematopoietic stem cell transplantation

“…[4] Recent studies have shown that HSCT patients with secondary ARDS have a poor prognosis and an intensive care unit mortality rate of 76%. [4][5][6] RNA-binding protein (RBP) is a general term for a group of proteins that can bind to RNA to assist the regulatory and metabolic processes of RNA. RBPs use RNA-binding domains to recognize target RNAs and participate in various posttranscriptional regulatory processes such as RNA splicing, translocation, polyadenylation, intracellular localization, translation and degradation.…”