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[Acute respiratory insufficiency in hemoblastoses: evaluation of treatment effectiveness by survival rate]
Abstract:
Acute respiratory failure (ARF) is a typical complication of chemotherapy for hematologic malignancies. Despite the effective correction of gas exchange by mechanical ventilation, the mortality in this population is expected to be extremely high due to unavoidable fatal infection of immunocompromised host and the poor prognosis of primary malignancy. However, modern specific treatment of leukemia and lymphoma has made these conditions curable in many cases, and even severe myelotoxic neutropenia does not always lead to uniformly fatal outcome. We studied survival in 113 cases of ARF retrospectively selected according to the uniform criteria of this syndrome. No selection was made as to the diagnosis, stage, and response to the treatment of the underlying disease. The group consisted of 51% male and 49% female patients aged 34, on an average; 69% of these with acute leukemia, 22% with malignant lymphoma, and 9% with other conditions. Sixty-five (58%) patients were subjected to mechanical ventilation (MV). Forty-two were treated after a Protocol on intensive care of ARF which contained standard requirements to management of patients. Another group of 71 patients admitted to intensive care units before this Protocol was introduced were historical controls. Total survival was 19.5%. In the MV group survival was 15% with 10 cases of cure, ARF developing during severe neutropenia in 3 out of these 10 cases. The results became evidently better after the Protocol was introduced, improving from 16 to 27%. The primary disease dramatically influenced the results: long-term survival was significantly poorer in patients with relapses and resistant to chemotherapy, with 100% mortality within 8 months after discharge. A conclusion is drawn that intensive care of ARF including MV is justified in patients with hematologic malignancies, except cases when primary malignancy is not properly treated or resistant to specific chemotherapy.