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Noninvasive Ventilation in Patients With Hematologic Malignancy.

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Noninvasive ventilation (NIV) is often used for hematologic malignancy (HM) patients with respiratory failure. However, two-thirds of these patients fail NIV, requiring intubation and facing high mortality rates.

Keywords:
endotracheal intubationhematologic malignancynoninvasive ventilationrespiratory failurerisk factor

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Area of Science:

  • Critical Care Medicine
  • Hematology
  • Pulmonology

Background:

  • Noninvasive ventilation (NIV) is a common first-line therapy for acute respiratory failure in immunocompromised patients.
  • Failure of NIV and delayed endotracheal intubation (ETI) can increase mortality in this vulnerable population.

Purpose of the Study:

  • To evaluate the outcomes of patients with active hematologic malignancy (HM) treated with NIV for acute respiratory failure.
  • To identify factors associated with NIV failure and subsequent mortality in HM patients.

Main Methods:

  • Retrospective study of 79 patients with HM admitted to the ICU for acute respiratory failure between 2010 and 2015.
  • Patients were initially treated with NIV; characteristics of NIV success and failure groups were compared.

Main Results:

  • 56% of patients failed NIV and required ETI; 35% avoided ETI.
  • NIV failure was associated with acute leukemia, higher Paco2, higher FiO2 requirements, and increased vasopressor use.
  • Overall ICU mortality was 42%, with 3-month mortality significantly lower in NIV success (21%) versus failure (74%) groups.

Conclusions:

  • Two-thirds of HM patients with respiratory failure failed NIV, necessitating ETI and leading to high mortality.
  • Higher Paco2, FiO2, and vasopressor use were associated with NIV failure in this cohort.