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Ventilatory support in critically ill hematology patients with respiratory failure

Rosario Molina1, Teresa Bernal2, Marcio Borges3, Rafael Zaragoza4, Juan Bonastre5, Rosa María Granada6, Juan Carlos Rodriguez-Borregán7, Karla Núñez8, Iratxe Seijas9, Ignacio Ayestaran10, Guillermo M Albaiceta11112* and the EMEHU study investigators13

Author Affiliations

1 Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Celestino Villamil, 33006 Oviedo, Spain

2 Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Celestino Villamil, 33006 Oviedo, Spain

3 Servicio de Medicina Intensiva, Hospital Son Llatzer, Ctra Manacor, 07190 Palma de Mallorca, Spain

4 Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Av de Gaspar Aguilar 90, 46017 Valencia, Spain

5 Servicio de Medicina Intensiva, Hospital Universitario La Fe, Bulevar Sur, 46026 Valencia, Spain

6 Servicio de Medicina Intensiva, Hospital de Bellvitge, Feixa Larga, 08907 Barcelona, Spain

7 Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Av de Valdecilla 25, 39008 Santander, Spain

8 Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, UAB, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain

9 Servicio de Medicina Intensiva, Hospital de Cruces, Plaza de Cruces, 48903 Barakaldo, Bizkaia, Spain

10 Servicio de Medicina Intensiva, Hospital Universitario Son Espases, Ctra de Valldemossa 79, 07010 Palma de Mallorca, Spain

11 Departamento de Biología Funcional, Universidad de Oviedo, IUOPA, Julian Clavería, 33006 Oviedo, Spain

12 CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain

13 Grupo de Trabajo de Enfermedades Infecciosas, Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), Spain

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Critical Care 2012, 16:R133  doi:10.1186/cc11438

Published: 24 July 2012

Abstract

Introduction

Hematology patients admitted to the ICU frequently experience respiratory failure and require mechanical ventilation. Noninvasive mechanical ventilation (NIMV) may decrease the risk of intubation, but NIMV failure poses its own risks.

Methods

To establish the impact of ventilatory management and NIMV failure on outcome, data from a prospective, multicenter, observational study were analyzed. All hematology patients admitted to one of the 34 participating ICUs in a 17-month period were followed up. Data on demographics, diagnosis, severity, organ failure, and supportive therapies were recorded. A logistic regression analysis was done to evaluate the risk factors associated with death and NIVM failure.

Results

Of 450 patients, 300 required ventilatory support. A diagnosis of congestive heart failure and the initial use of NIMV significantly improved survival, whereas APACHE II score, allogeneic transplantation, and NIMV failure increased the risk of death. The risk factors associated with NIMV success were age, congestive heart failure, and bacteremia. Patients with NIMV failure experienced a more severe respiratory impairment than did those electively intubated.

Conclusions

NIMV improves the outcome of hematology patients with respiratory insufficiency, but NIMV failure may have the opposite effect. A careful selection of patients with rapidly reversible causes of respiratory failure may increase NIMV success.