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Survival of acute myelogenous leukemia patients requiring intubation/ventilatory support
L N Tremblay1, R H Hyland, B D Schouten
1Department of Medicine, Wellesley Hospital, University of Toronto, Ontario.
Abstract:
A 5-y (1987-1992) retrospective chart review assessed the survival of patients with acute myelogenous leukemia (AML) who required intubation/ventilatory support in the intensive care unit (ICU). Thirty-two patients were identified, average age 52 +/- 19 (range 14-82) y. Seven patients had undergone bone marrow transplantation for AML 2 weeks to 4 months prior to admission. Of the remaining 25 patients, 16 received chemotherapy prior to admission, 6 started or continued chemotherapy in the ICU, and 3 patients did not receive any chemotherapy. The Apache II score, which quantifies illness severity, on admission to the ICU was 32.5 +/- 8.8. The average length of stay was 7.4 d. Twenty-nine patients had diffuse pulmonary infiltrates on admission, 2 patients had large pleural effusions, and 1 patient had severe bronchospasm with a clear chest X-ray. The average PaO2/FiO2, when first stabilized on mechanical ventilation, was 204 +/- 83. Of the 32 patients, 28 died in the ICU, and 3 died shortly after withdrawal of aggressive therapy and discharge to the ward. A single patient survived the hospital admission but died 4 months later at home. The observed vs. the predicted ICU mortality determined by Knaus' method, was significantly greater even for those with lower Apache II scores. Acute myelogenous leukemia patients had a greater mortality than 2 other intubated patient populations in our ICU admitted during the same time period, a group of 126 consecutive admissions and 53 patients with connective tissue disease. The latter 2 control groups only included patients requiring mechanical ventilation. We conclude that AML patients who require ventilatory support for acute respiratory failure rarely survive their ICU admission.
Insights
Patients with acute myelogenous leukemia (AML) requiring mechanical ventilation in the ICU have a very high mortality rate. Survival is rare, with most patients dying during their ICU stay, even with lower illness severity scores.
Area of Science:
- Hematology
- Critical Care Medicine
- Oncology
Background:
- Acute myelogenous leukemia (AML) is a hematologic malignancy with significant morbidity.
- Patients with severe AML may require intensive care unit (ICU) admission for acute respiratory failure.
- The prognosis for critically ill AML patients requiring mechanical ventilation is often poor.
Purpose of the Study:
- To assess the survival outcomes of patients with acute myelogenous leukemia (AML) requiring intubation and ventilatory support in the ICU.
- To compare the mortality of AML patients in the ICU with other patient populations requiring mechanical ventilation.
Main Methods:
- Retrospective chart review of patients admitted to the ICU between 1987 and 1992.
- Identification of 32 patients with AML who required intubation/ventilatory support.
- Analysis of patient demographics, treatments (chemotherapy, bone marrow transplant), illness severity (Apache II score), respiratory parameters (PaO2/FiO2), and survival outcomes.
Main Results:
- Thirty-two AML patients requiring mechanical ventilation were identified, with an average age of 52 years.
- The majority of patients (29/32) presented with diffuse pulmonary infiltrates.
- Observed ICU mortality was extremely high (28/32 died in ICU), significantly exceeding predicted mortality.
- AML patients had a higher mortality rate compared to other ICU patient groups requiring mechanical ventilation.
Conclusions:
- Acute myelogenous leukemia patients who require ventilatory support for acute respiratory failure have a very low survival rate.
- The high mortality underscores the critical condition of AML patients necessitating ICU admission for respiratory failure.
- Further research may be needed to identify potential interventions to improve outcomes for this vulnerable patient group.