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Topic: Retrospective or Prospective Cohort Study
Noninvasive ventilation in patients with hematologic malignancy: a retrospective review
Jiajia Liu, C. Bell, V. Campbell, J. DeBacker, E. Tamberg, S. Mehta
Internal Medicine, University of Toronto, Toronto, Canada | Medicine, National University of Ireland- Galway, Galway, Ireland | Respiratory Therapy, Mount Sinai Hospital, Toronto, Canada | Research office, Intensive care unit, Mount Sinai Hospital, Toronto, Canada | Research office, Intensive care unit, Mount Sinai Hospital, Toronto, Canada | Intensive care unit, Mount Sinai Hospital, Toronto, Canada
Introduction: Non-invasive ventilation (NIV) is commonly used as a first line therapy for immunocompromised patients with acute respiratory failure. There is evidence that it may not be appropriate for every patient as failure of NIV is an independent predictor of mortality and delayed endotracheal intubation may worsen the prognosis.
Objectives: We report our center’s experience and outcomes for patients with active hematologic malignancy treated with NIV.
Methods: We conducted a retrospective chart review of consecutive patients with hematologic malignancy who were admitted to the Mount Sinai Hospital ICU for acute respiratory failure between January 1, 2010 and May 31, 2015, and were initially treated with NIV (BiPAP or CPAP). We compared characteristics of patients who were successfully treated with NIV and avoided endotracheal intubation (ETI), and those who failed NIV.
Results:
During the study period, 79 patients with hematologic malignancy were treated with NIV for acute respiratory failure. Their mean age was 56.4±14.1 years, APACHE II 27.6 ± 4.6, and 32 (40%) were female. Etiology of respiratory failure was multifactorial in 31 (39%) patients, with features of pneumonia in 61 (77%) patients, severe sepsis or septic shock in 33 (42%), and pulmonary edema in 24 (30%) patients. Of the 79 patients, 60 (76%) were admitted with acute leukemia, 8 (10%) with lymphoma, and 11 (14%) with chronic leukemia, multiple myeloma, or myelodysplastic syndrome. Twelve (15%) patients had received an allogenic stem cell transplant (SCT), and 6 (8%) an autologous SCT. Most (N=75, 94%) patients were treated with BiPAP, and 4 (6%) with CPAP. Of the 79 patients treated with NIV, 44 (56%) failed NIV and required ETI, 7 (9%) had a do-not-intubate (DNI) order and died, and 28 (35%) avoided ETI. Compared with patients who avoided intubation, those who failed NIV were more likely to have acute leukemia (84% vs 61%, p=0.019); and at baseline had higher PaCO2 (39 vs 30, p=0.038), higher FIO2 (0.6 vs 0.4, p=0.002), and more vasopressor use (31% vs 11%, p=0.059). APACHE II scores at baseline (28 vs 27, p=0.32) and daily SOFA scores were not significantly different between patients in the NIV failure and success groups. Only one patient had a diagnostic bronchoscopy while treated with NIV; and 25 had bronchoscopy within 1 day following ETI. Of the 44 patients who failed NIV and required ETI, 30 (68%) died in the ICU. Overall ICU mortality was 41% (32/79) and 3 -month mortality was 57% (45/79 patients).
Conclusion:
Two thirds of patients with hematologic malignancy and respiratory failure fail NIV and require ETI, with a high subsequent mortality. Patients who fail NIV have higher PaCO2, higher FiO2 and more vasopressor use. Use of NIV may be associated with delayed diagnostic bronchoscopy.
References:
1. Hill NS, Brennan J, Garpestad E, Nava S. Noninvasive ventilation in acute respiratory failure. Critical care medicine. 2007 Oct;35(10):2402-7. PubMed PMID: 17717495.
2. Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009 Jul 18;374(9685):250-9. PubMed PMID: 19616722.
3. Bello G, De Pascale G, Antonelli M. Noninvasive ventilation for the immunocompromised patient: always appropriate? Current opinion in critical care. 2012 Feb;18(1):54-60. PubMed PMID: 22143051.
4. Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA : the journal of the American Medical Association. 2000 Jan 12;283(2):235-41. PubMed PMID: 10634340.
5. Squadrone V, Massaia M, Bruno B, Marmont F, Falda M, Bagna C, et al. Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy. Intensive care medicine. 2010 Oct;36(10):1666-74. PubMed PMID: 20533022.
6. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. The New England journal of medicine. 2001 Feb 15;344(7):481-7. PubMed PMID: 11172189.
7. Adda M, Coquet I, Darmon M, Thiery G, Schlemmer B, Azoulay E. Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure. Critical care medicine. 2008 Oct;36(10):2766-72. PubMed PMID: 18766110.
8. Depuydt PO, Benoit DD, Roosens CD, Offner FC, Noens LA, Decruyenaere JM. The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure. Journal of critical care. 2010 Mar;25(1):30-6. PubMed PMID: 19682849.
9. Depuydt PO, Benoit DD, Vandewoude KH, Decruyenaere JM, Colardyn FA. Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest. 2004 Oct;126(4):1299-306. PubMed PMID: 15486396.
10. Gristina GR, Antonelli M, Conti G, Ciarlone A, Rogante S, Rossi C, et al. Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. Critical care medicine. 2011 Oct;39(10):2232-9. PubMed PMID: 21666446.
11. Azevedo LC, Caruso P, Silva UV, Torelly AP, Silva E, Rezende E, et al. Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest. 2014 Aug;146(2):257-66. PubMed PMID: 24480886.
12. Wermke M, Schiemanck S, Hoffken G, Ehninger G, Bornhauser M, Illmer T. Respiratory failure in patients undergoing allogeneic hematopoietic SCT--a randomized trial on early non-invasive ventilation based on standard care hematology wards. Bone marrow transplantation. 2012 Apr;47(4):574-80. PubMed PMID: 21927036.
13. Lemiale V, Lambert J, Canet E, Mokart D, Pene F, Rabbat A, et al. Identifying cancer subjects with acute respiratory failure at high risk for intubation and mechanical ventilation. Respiratory care. 2014 Oct;59(10):1517-23. PubMed PMID: 25233383.
14. de Montmollin E, Tandjaoui-Lambiotte Y, Legrand M, Lambert J, Mokart D, Kouatchet A, et al. Outcomes in critically ill cancer patients with septic shock of pulmonary origin. Shock. 2013 Mar;39(3):250-4. PubMed PMID: 23364436.
15. Grgic Medic M, Gornik I, Gasparovic V. Hematologic malignancies in the medical intensive care unit--Outcomes and prognostic factors. Hematology. 2015 Jun;20(5):247-53. PubMed PMID: 25310461.
Topic: Retrospective or Prospective Cohort Study
Noninvasive ventilation in patients with hematologic malignancy: a retrospective review
Jiajia Liu, C. Bell, V. Campbell, J. DeBacker, E. Tamberg, S. Mehta
Internal Medicine, University of Toronto, Toronto, Canada | Medicine, National University of Ireland- Galway, Galway, Ireland | Respiratory Therapy, Mount Sinai Hospital, Toronto, Canada | Research office, Intensive care unit, Mount Sinai Hospital, Toronto, Canada | Research office, Intensive care unit, Mount Sinai Hospital, Toronto, Canada | Intensive care unit, Mount Sinai Hospital, Toronto, Canada
Introduction: Non-invasive ventilation (NIV) is commonly used as a first line therapy for immunocompromised patients with acute respiratory failure. There is evidence that it may not be appropriate for every patient as failure of NIV is an independent predictor of mortality and delayed endotracheal intubation may worsen the prognosis.
Objectives: We report our center’s experience and outcomes for patients with active hematologic malignancy treated with NIV.
Methods: We conducted a retrospective chart review of consecutive patients with hematologic malignancy who were admitted to the Mount Sinai Hospital ICU for acute respiratory failure between January 1, 2010 and May 31, 2015, and were initially treated with NIV (BiPAP or CPAP). We compared characteristics of patients who were successfully treated with NIV and avoided endotracheal intubation (ETI), and those who failed NIV.
Results:
During the study period, 79 patients with hematologic malignancy were treated with NIV for acute respiratory failure. Their mean age was 56.4±14.1 years, APACHE II 27.6 ± 4.6, and 32 (40%) were female. Etiology of respiratory failure was multifactorial in 31 (39%) patients, with features of pneumonia in 61 (77%) patients, severe sepsis or septic shock in 33 (42%), and pulmonary edema in 24 (30%) patients. Of the 79 patients, 60 (76%) were admitted with acute leukemia, 8 (10%) with lymphoma, and 11 (14%) with chronic leukemia, multiple myeloma, or myelodysplastic syndrome. Twelve (15%) patients had received an allogenic stem cell transplant (SCT), and 6 (8%) an autologous SCT. Most (N=75, 94%) patients were treated with BiPAP, and 4 (6%) with CPAP. Of the 79 patients treated with NIV, 44 (56%) failed NIV and required ETI, 7 (9%) had a do-not-intubate (DNI) order and died, and 28 (35%) avoided ETI. Compared with patients who avoided intubation, those who failed NIV were more likely to have acute leukemia (84% vs 61%, p=0.019); and at baseline had higher PaCO2 (39 vs 30, p=0.038), higher FIO2 (0.6 vs 0.4, p=0.002), and more vasopressor use (31% vs 11%, p=0.059). APACHE II scores at baseline (28 vs 27, p=0.32) and daily SOFA scores were not significantly different between patients in the NIV failure and success groups. Only one patient had a diagnostic bronchoscopy while treated with NIV; and 25 had bronchoscopy within 1 day following ETI. Of the 44 patients who failed NIV and required ETI, 30 (68%) died in the ICU. Overall ICU mortality was 41% (32/79) and 3 -month mortality was 57% (45/79 patients).
Conclusion:
Two thirds of patients with hematologic malignancy and respiratory failure fail NIV and require ETI, with a high subsequent mortality. Patients who fail NIV have higher PaCO2, higher FiO2 and more vasopressor use. Use of NIV may be associated with delayed diagnostic bronchoscopy.
References:
1. Hill NS, Brennan J, Garpestad E, Nava S. Noninvasive ventilation in acute respiratory failure. Critical care medicine. 2007 Oct;35(10):2402-7. PubMed PMID: 17717495.
2. Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009 Jul 18;374(9685):250-9. PubMed PMID: 19616722.
3. Bello G, De Pascale G, Antonelli M. Noninvasive ventilation for the immunocompromised patient: always appropriate? Current opinion in critical care. 2012 Feb;18(1):54-60. PubMed PMID: 22143051.
4. Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA : the journal of the American Medical Association. 2000 Jan 12;283(2):235-41. PubMed PMID: 10634340.
5. Squadrone V, Massaia M, Bruno B, Marmont F, Falda M, Bagna C, et al. Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy. Intensive care medicine. 2010 Oct;36(10):1666-74. PubMed PMID: 20533022.
6. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. The New England journal of medicine. 2001 Feb 15;344(7):481-7. PubMed PMID: 11172189.
7. Adda M, Coquet I, Darmon M, Thiery G, Schlemmer B, Azoulay E. Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure. Critical care medicine. 2008 Oct;36(10):2766-72. PubMed PMID: 18766110.
8. Depuydt PO, Benoit DD, Roosens CD, Offner FC, Noens LA, Decruyenaere JM. The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure. Journal of critical care. 2010 Mar;25(1):30-6. PubMed PMID: 19682849.
9. Depuydt PO, Benoit DD, Vandewoude KH, Decruyenaere JM, Colardyn FA. Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest. 2004 Oct;126(4):1299-306. PubMed PMID: 15486396.
10. Gristina GR, Antonelli M, Conti G, Ciarlone A, Rogante S, Rossi C, et al. Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. Critical care medicine. 2011 Oct;39(10):2232-9. PubMed PMID: 21666446.
11. Azevedo LC, Caruso P, Silva UV, Torelly AP, Silva E, Rezende E, et al. Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest. 2014 Aug;146(2):257-66. PubMed PMID: 24480886.
12. Wermke M, Schiemanck S, Hoffken G, Ehninger G, Bornhauser M, Illmer T. Respiratory failure in patients undergoing allogeneic hematopoietic SCT--a randomized trial on early non-invasive ventilation based on standard care hematology wards. Bone marrow transplantation. 2012 Apr;47(4):574-80. PubMed PMID: 21927036.
13. Lemiale V, Lambert J, Canet E, Mokart D, Pene F, Rabbat A, et al. Identifying cancer subjects with acute respiratory failure at high risk for intubation and mechanical ventilation. Respiratory care. 2014 Oct;59(10):1517-23. PubMed PMID: 25233383.
14. de Montmollin E, Tandjaoui-Lambiotte Y, Legrand M, Lambert J, Mokart D, Kouatchet A, et al. Outcomes in critically ill cancer patients with septic shock of pulmonary origin. Shock. 2013 Mar;39(3):250-4. PubMed PMID: 23364436.
15. Grgic Medic M, Gornik I, Gasparovic V. Hematologic malignancies in the medical intensive care unit--Outcomes and prognostic factors. Hematology. 2015 Jun;20(5):247-53. PubMed PMID: 25310461.
Topic: Retrospective or Prospective Cohort Study
Noninvasive ventilation in patients with hematologic malignancy: a retrospective review
Jiajia Liu, C. Bell, V. Campbell, J. DeBacker, E. Tamberg, S. Mehta
Internal Medicine, University of Toronto, Toronto, Canada | Medicine, National University of Ireland- Galway, Galway, Ireland | Respiratory Therapy, Mount Sinai Hospital, Toronto, Canada | Research office, Intensive care unit, Mount Sinai Hospital, Toronto, Canada | Research office, Intensive care unit, Mount Sinai Hospital, Toronto, Canada | Intensive care unit, Mount Sinai Hospital, Toronto, Canada
Introduction: Non-invasive ventilation (NIV) is commonly used as a first line therapy for immunocompromised patients with acute respiratory failure. There is evidence that it may not be appropriate for every patient as failure of NIV is an independent predictor of mortality and delayed endotracheal intubation may worsen the prognosis.
Objectives: We report our center’s experience and outcomes for patients with active hematologic malignancy treated with NIV.
Methods: We conducted a retrospective chart review of consecutive patients with hematologic malignancy who were admitted to the Mount Sinai Hospital ICU for acute respiratory failure between January 1, 2010 and May 31, 2015, and were initially treated with NIV (BiPAP or CPAP). We compared characteristics of patients who were successfully treated with NIV and avoided endotracheal intubation (ETI), and those who failed NIV.
Results:
During the study period, 79 patients with hematologic malignancy were treated with NIV for acute respiratory failure. Their mean age was 56.4±14.1 years, APACHE II 27.6 ± 4.6, and 32 (40%) were female. Etiology of respiratory failure was multifactorial in 31 (39%) patients, with features of pneumonia in 61 (77%) patients, severe sepsis or septic shock in 33 (42%), and pulmonary edema in 24 (30%) patients. Of the 79 patients, 60 (76%) were admitted with acute leukemia, 8 (10%) with lymphoma, and 11 (14%) with chronic leukemia, multiple myeloma, or myelodysplastic syndrome. Twelve (15%) patients had received an allogenic stem cell transplant (SCT), and 6 (8%) an autologous SCT. Most (N=75, 94%) patients were treated with BiPAP, and 4 (6%) with CPAP. Of the 79 patients treated with NIV, 44 (56%) failed NIV and required ETI, 7 (9%) had a do-not-intubate (DNI) order and died, and 28 (35%) avoided ETI. Compared with patients who avoided intubation, those who failed NIV were more likely to have acute leukemia (84% vs 61%, p=0.019); and at baseline had higher PaCO2 (39 vs 30, p=0.038), higher FIO2 (0.6 vs 0.4, p=0.002), and more vasopressor use (31% vs 11%, p=0.059). APACHE II scores at baseline (28 vs 27, p=0.32) and daily SOFA scores were not significantly different between patients in the NIV failure and success groups. Only one patient had a diagnostic bronchoscopy while treated with NIV; and 25 had bronchoscopy within 1 day following ETI. Of the 44 patients who failed NIV and required ETI, 30 (68%) died in the ICU. Overall ICU mortality was 41% (32/79) and 3 -month mortality was 57% (45/79 patients).
Conclusion:
Two thirds of patients with hematologic malignancy and respiratory failure fail NIV and require ETI, with a high subsequent mortality. Patients who fail NIV have higher PaCO2, higher FiO2 and more vasopressor use. Use of NIV may be associated with delayed diagnostic bronchoscopy.
References:
1. Hill NS, Brennan J, Garpestad E, Nava S. Noninvasive ventilation in acute respiratory failure. Critical care medicine. 2007 Oct;35(10):2402-7. PubMed PMID: 17717495.
2. Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009 Jul 18;374(9685):250-9. PubMed PMID: 19616722.
3. Bello G, De Pascale G, Antonelli M. Noninvasive ventilation for the immunocompromised patient: always appropriate? Current opinion in critical care. 2012 Feb;18(1):54-60. PubMed PMID: 22143051.
4. Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA : the journal of the American Medical Association. 2000 Jan 12;283(2):235-41. PubMed PMID: 10634340.
5. Squadrone V, Massaia M, Bruno B, Marmont F, Falda M, Bagna C, et al. Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy. Intensive care medicine. 2010 Oct;36(10):1666-74. PubMed PMID: 20533022.
6. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. The New England journal of medicine. 2001 Feb 15;344(7):481-7. PubMed PMID: 11172189.
7. Adda M, Coquet I, Darmon M, Thiery G, Schlemmer B, Azoulay E. Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure. Critical care medicine. 2008 Oct;36(10):2766-72. PubMed PMID: 18766110.
8. Depuydt PO, Benoit DD, Roosens CD, Offner FC, Noens LA, Decruyenaere JM. The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure. Journal of critical care. 2010 Mar;25(1):30-6. PubMed PMID: 19682849.
9. Depuydt PO, Benoit DD, Vandewoude KH, Decruyenaere JM, Colardyn FA. Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest. 2004 Oct;126(4):1299-306. PubMed PMID: 15486396.
10. Gristina GR, Antonelli M, Conti G, Ciarlone A, Rogante S, Rossi C, et al. Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. Critical care medicine. 2011 Oct;39(10):2232-9. PubMed PMID: 21666446.
11. Azevedo LC, Caruso P, Silva UV, Torelly AP, Silva E, Rezende E, et al. Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest. 2014 Aug;146(2):257-66. PubMed PMID: 24480886.
12. Wermke M, Schiemanck S, Hoffken G, Ehninger G, Bornhauser M, Illmer T. Respiratory failure in patients undergoing allogeneic hematopoietic SCT--a randomized trial on early non-invasive ventilation based on standard care hematology wards. Bone marrow transplantation. 2012 Apr;47(4):574-80. PubMed PMID: 21927036.
13. Lemiale V, Lambert J, Canet E, Mokart D, Pene F, Rabbat A, et al. Identifying cancer subjects with acute respiratory failure at high risk for intubation and mechanical ventilation. Respiratory care. 2014 Oct;59(10):1517-23. PubMed PMID: 25233383.
14. de Montmollin E, Tandjaoui-Lambiotte Y, Legrand M, Lambert J, Mokart D, Kouatchet A, et al. Outcomes in critically ill cancer patients with septic shock of pulmonary origin. Shock. 2013 Mar;39(3):250-4. PubMed PMID: 23364436.
15. Grgic Medic M, Gornik I, Gasparovic V. Hematologic malignancies in the medical intensive care unit--Outcomes and prognostic factors. Hematology. 2015 Jun;20(5):247-53. PubMed PMID: 25310461.
Topic: Retrospective or Prospective Cohort Study
Noninvasive ventilation in patients with hematologic malignancy: a retrospective review
Jiajia Liu, C. Bell, V. Campbell, J. DeBacker, E. Tamberg, S. Mehta
Internal Medicine, University of Toronto, Toronto, Canada | Medicine, National University of Ireland- Galway, Galway, Ireland | Respiratory Therapy, Mount Sinai Hospital, Toronto, Canada | Research office, Intensive care unit, Mount Sinai Hospital, Toronto, Canada | Research office, Intensive care unit, Mount Sinai Hospital, Toronto, Canada | Intensive care unit, Mount Sinai Hospital, Toronto, Canada
Introduction: Non-invasive ventilation (NIV) is commonly used as a first line therapy for immunocompromised patients with acute respiratory failure. There is evidence that it may not be appropriate for every patient as failure of NIV is an independent predictor of mortality and delayed endotracheal intubation may worsen the prognosis.
Objectives: We report our center’s experience and outcomes for patients with active hematologic malignancy treated with NIV.
Methods: We conducted a retrospective chart review of consecutive patients with hematologic malignancy who were admitted to the Mount Sinai Hospital ICU for acute respiratory failure between January 1, 2010 and May 31, 2015, and were initially treated with NIV (BiPAP or CPAP). We compared characteristics of patients who were successfully treated with NIV and avoided endotracheal intubation (ETI), and those who failed NIV.
Results:
During the study period, 79 patients with hematologic malignancy were treated with NIV for acute respiratory failure. Their mean age was 56.4±14.1 years, APACHE II 27.6 ± 4.6, and 32 (40%) were female. Etiology of respiratory failure was multifactorial in 31 (39%) patients, with features of pneumonia in 61 (77%) patients, severe sepsis or septic shock in 33 (42%), and pulmonary edema in 24 (30%) patients. Of the 79 patients, 60 (76%) were admitted with acute leukemia, 8 (10%) with lymphoma, and 11 (14%) with chronic leukemia, multiple myeloma, or myelodysplastic syndrome. Twelve (15%) patients had received an allogenic stem cell transplant (SCT), and 6 (8%) an autologous SCT. Most (N=75, 94%) patients were treated with BiPAP, and 4 (6%) with CPAP. Of the 79 patients treated with NIV, 44 (56%) failed NIV and required ETI, 7 (9%) had a do-not-intubate (DNI) order and died, and 28 (35%) avoided ETI. Compared with patients who avoided intubation, those who failed NIV were more likely to have acute leukemia (84% vs 61%, p=0.019); and at baseline had higher PaCO2 (39 vs 30, p=0.038), higher FIO2 (0.6 vs 0.4, p=0.002), and more vasopressor use (31% vs 11%, p=0.059). APACHE II scores at baseline (28 vs 27, p=0.32) and daily SOFA scores were not significantly different between patients in the NIV failure and success groups. Only one patient had a diagnostic bronchoscopy while treated with NIV; and 25 had bronchoscopy within 1 day following ETI. Of the 44 patients who failed NIV and required ETI, 30 (68%) died in the ICU. Overall ICU mortality was 41% (32/79) and 3 -month mortality was 57% (45/79 patients).
Conclusion:
Two thirds of patients with hematologic malignancy and respiratory failure fail NIV and require ETI, with a high subsequent mortality. Patients who fail NIV have higher PaCO2, higher FiO2 and more vasopressor use. Use of NIV may be associated with delayed diagnostic bronchoscopy.
References:
1. Hill NS, Brennan J, Garpestad E, Nava S. Noninvasive ventilation in acute respiratory failure. Critical care medicine. 2007 Oct;35(10):2402-7. PubMed PMID: 17717495.
2. Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009 Jul 18;374(9685):250-9. PubMed PMID: 19616722.
3. Bello G, De Pascale G, Antonelli M. Noninvasive ventilation for the immunocompromised patient: always appropriate? Current opinion in critical care. 2012 Feb;18(1):54-60. PubMed PMID: 22143051.
4. Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA : the journal of the American Medical Association. 2000 Jan 12;283(2):235-41. PubMed PMID: 10634340.
5. Squadrone V, Massaia M, Bruno B, Marmont F, Falda M, Bagna C, et al. Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy. Intensive care medicine. 2010 Oct;36(10):1666-74. PubMed PMID: 20533022.
6. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. The New England journal of medicine. 2001 Feb 15;344(7):481-7. PubMed PMID: 11172189.
7. Adda M, Coquet I, Darmon M, Thiery G, Schlemmer B, Azoulay E. Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure. Critical care medicine. 2008 Oct;36(10):2766-72. PubMed PMID: 18766110.
8. Depuydt PO, Benoit DD, Roosens CD, Offner FC, Noens LA, Decruyenaere JM. The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure. Journal of critical care. 2010 Mar;25(1):30-6. PubMed PMID: 19682849.
9. Depuydt PO, Benoit DD, Vandewoude KH, Decruyenaere JM, Colardyn FA. Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest. 2004 Oct;126(4):1299-306. PubMed PMID: 15486396.
10. Gristina GR, Antonelli M, Conti G, Ciarlone A, Rogante S, Rossi C, et al. Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. Critical care medicine. 2011 Oct;39(10):2232-9. PubMed PMID: 21666446.
11. Azevedo LC, Caruso P, Silva UV, Torelly AP, Silva E, Rezende E, et al. Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest. 2014 Aug;146(2):257-66. PubMed PMID: 24480886.
12. Wermke M, Schiemanck S, Hoffken G, Ehninger G, Bornhauser M, Illmer T. Respiratory failure in patients undergoing allogeneic hematopoietic SCT--a randomized trial on early non-invasive ventilation based on standard care hematology wards. Bone marrow transplantation. 2012 Apr;47(4):574-80. PubMed PMID: 21927036.
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