The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure

Cancer patients with ARDS: survival gains and unanswered questions

“…Moreover, overall NIV failure rates exceeded 70 %, particularly in more severely ill patients. In previous studies in cancer patients, ARDS was associated with NIV failure [6][7][8]. Therefore, the present study provides additional evidence that NIV should not be standard first-line support for the oncological/hematological patient with ARDS.…”

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

“…Thus there are reports which assert that acute respiratory failure in hematological malignancy patients should initially be treated with NPPV (11). 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).…”

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

“…Even though major advances have been achieved in the care of the critically ill hematological patient over the last 2 decades, acute respiratory failure requiring intubation and mechanical ventilation still has an associated mortality of 50-70% [1][2][3][4][5]. As such, strategies aiming to avoid intubation may have more potential to positively impact survival here than further improvements or refinements of the care of the invasively ventilated patient.…”

“…Two small interventional trials [6,7] randomizing immunocompromized patients (including hematological patients in one study [7]) with hypoxemia and diffuse pulmonary infiltrates between therapy with NIV and supportive oxygen only found reduced rates of intubation and better survival in the NIV-treated arm, and thus founded the main scientific rationale for the use of NIV in hematological patients with ARF. Observational studies provided more conflicting results, as some of these found an association between better survival and the use of NIV as compared with invasive ventilation [2], while others identified no such protective effect of NIV [4,5]. While these observational data could not prove a beneficial effect of NIV (or a lack thereof), they provided additional insights into the relationships among the ventilator mode used, the etiology underlying ARF, and the patient outcome, which are more complex in hematological patients than for instance in COPD patients.…”

“…While these observational data could not prove a beneficial effect of NIV (or a lack thereof), they provided additional insights into the relationships among the ventilator mode used, the etiology underlying ARF, and the patient outcome, which are more complex in hematological patients than for instance in COPD patients. First, the disease process leading to ARF, and more precisely the reversibility of it, has a major impact on mortality, and may act as an important confounder in the association between ventilator mode and outcome, as not all of these underlying etiologies may be appropriate for NIV [3][4][5]. Second, the optimal timing of starting NIV as well as aborting a trial of NIV is likely critical to its potential to improve outcome: delaying NIV has been identified as an important risk factor for NIV failure [8], and conversion of NIV to invasive ventilation itself has been shown to be associated with very high rates of mortality [3][4][5]8].…”