Noninvasive ventilation in patients with hematologic malignancy: a retrospective review
CCCF ePoster library. Liu J. Oct 27, 2015; 117386; P77
Dr. Jiajia Liu
Dr. Jiajia Liu
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Abstract
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P77


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.



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