Acute respiratory failure in patients with hematological malignancies: outcomes according to initial ventilation strategy. A groupe de recherche respiratoire en ... View Full Text


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Article Info

DATE

2015-09-30

AUTHORS

Virginie Lemiale, Matthieu Resche-Rigon, Djamel Mokart, Frederic Pène, Antoine Rabbat, Achille Kouatchet, François Vincent, Fabrice Bruneel, Martine Nyunga, Christine Lebert, Pierre Perez, Anne-Pascale Meert, Dominique Benoit, Sylvie Chevret, Elie Azoulay

ABSTRACT

BackgroundIn patients with hematological malignancies and acute respiratory failure (ARF), noninvasive ventilation was associated with a decreased mortality in older studies. However, mortality of intubated patients decreased in the last years. In this study, we assess outcomes in those patients according to the initial ventilation strategy.MethodsWe performed a post hoc analysis of a prospective multicentre study of critically ill hematology patients, in 17 intensive care units in France and Belgium. Patients with hematological malignancies admitted for ARF in 2010 and 2011 and who were not intubated at admission were included in the study. A propensity score-based approach was used to assess the impact of NIV compared to oxygen only on hospital mortality.ResultsAmong 1011 patients admitted to ICU during the study period, 380 met inclusion criteria. Underlying diseases included lymphoid (n = 162, 42.6 %) or myeloid (n = 141, 37.1 %) diseases. ARF etiologies were pulmonary infections (n = 161, 43 %), malignant infiltration (n = 65, 17 %) or cardiac pulmonary edema (n = 40, 10 %). Mechanical ventilation was ultimately needed in 94 (24.7 %) patients, within 3 [2–5] days of ICU admission. Hospital mortality was 32 % (123 deaths). At ICU admission, 142 patients received first-line noninvasive ventilation (NIV), whereas 238 received oxygen only. Fifty-five patients in each group (NIV or oxygen only) were matched according the propensity score. NIV was not associated with decreased hospital mortality [OR 1.5 (0.62–3.65)].ConclusionsIn hematology patients with acute respiratory failure, initial treatment with NIV did not improve survival compared to oxygen only.Clinical trial.gov number NCT 01172132 More... »

PAGES

28

References to SciGraph publications

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  • 2014-09-25. Early non-invasive ventilation for acute respiratory failure in immunocompromised patients (IVNIctus): study protocol for a multicenter randomized controlled trial in TRIALS
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    http://scigraph.springernature.com/pub.10.1186/s13613-015-0070-z

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    http://dx.doi.org/10.1186/s13613-015-0070-z

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/26429355


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    18 schema:description BackgroundIn patients with hematological malignancies and acute respiratory failure (ARF), noninvasive ventilation was associated with a decreased mortality in older studies. However, mortality of intubated patients decreased in the last years. In this study, we assess outcomes in those patients according to the initial ventilation strategy.MethodsWe performed a post hoc analysis of a prospective multicentre study of critically ill hematology patients, in 17 intensive care units in France and Belgium. Patients with hematological malignancies admitted for ARF in 2010 and 2011 and who were not intubated at admission were included in the study. A propensity score-based approach was used to assess the impact of NIV compared to oxygen only on hospital mortality.ResultsAmong 1011 patients admitted to ICU during the study period, 380 met inclusion criteria. Underlying diseases included lymphoid (n = 162, 42.6 %) or myeloid (n = 141, 37.1 %) diseases. ARF etiologies were pulmonary infections (n = 161, 43 %), malignant infiltration (n = 65, 17 %) or cardiac pulmonary edema (n = 40, 10 %). Mechanical ventilation was ultimately needed in 94 (24.7 %) patients, within 3 [2–5] days of ICU admission. Hospital mortality was 32 % (123 deaths). At ICU admission, 142 patients received first-line noninvasive ventilation (NIV), whereas 238 received oxygen only. Fifty-five patients in each group (NIV or oxygen only) were matched according the propensity score. NIV was not associated with decreased hospital mortality [OR 1.5 (0.62–3.65)].ConclusionsIn hematology patients with acute respiratory failure, initial treatment with NIV did not improve survival compared to oxygen only.Clinical trial.gov number NCT 01172132
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    26 Belgium
    27 France
    28 Groupe de Recherche Respiratoire
    29 ICU
    30 ICU admission
    31 MethodsWe
    32 acute respiratory failure
    33 admission
    34 analysis
    35 approach
    36 cardiac pulmonary edema
    37 care unit
    38 criteria
    39 days
    40 decreased hospital mortality
    41 decreased mortality
    42 disease
    43 edema
    44 etiology
    45 failure
    46 first-line noninvasive ventilation
    47 group
    48 hematological malignancies
    49 hematology patients
    50 hospital mortality
    51 ill hematology patients
    52 impact
    53 impact of NIV
    54 inclusion criteria
    55 infection
    56 infiltration
    57 initial treatment
    58 initial ventilation strategy
    59 intensive care unit
    60 intubated patients
    61 last years
    62 lymphoid
    63 malignancy
    64 malignant infiltration
    65 mechanical ventilation
    66 mortality
    67 multicentre study
    68 myeloid diseases
    69 noninvasive ventilation
    70 older studies
    71 outcomes
    72 oxygen
    73 patients
    74 period
    75 propensity score
    76 propensity score-based approach
    77 prospective multicentre study
    78 pulmonary edema
    79 pulmonary infection
    80 respiratoires
    81 respiratory failure
    82 score-based approach
    83 scores
    84 strategies
    85 study
    86 study period
    87 survival
    88 treatment
    89 units
    90 ventilation
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    92 years
    93 schema:name Acute respiratory failure in patients with hematological malignancies: outcomes according to initial ventilation strategy. A groupe de recherche respiratoire en réanimation onco-hématologique (Grrr-OH) study
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