Noninvasive ventilation for the treatment of acute respiratory failure in patients with hematologic malignancies: a pilot study.
OBJECTIVE
To evaluate treatment with noninvasive ventilation (NIV) by nasal mask as an alternative to endotracheal intubation and conventional mechanical ventilation in patients with hematologic malignancies complicated by acute respiratory failure to decrease the risk of hemorrhagic complications and increase clinical tolerance.


METHODS
Prospective clinical study.


METHODS
Hematologic and general intensive care unit (ICU), University of Rome "La Sapienza".


METHODS
16 consecutive patients with acute respiratory failure complicating hematologic malignancies.


METHODS
NIV was delivered via nasal mask by means of a BiPAP ventilator (Respironics, USA); we evaluated the effects on blood gases, respiratory rate, and hemodynamics along with tolerance, complications, and outcome.


RESULTS
15 of the 16 patients showed a significant improvement in blood gases and respiratory rate within the first 24 h of treatment. Arterial oxygen tension (PaO2), PaO2/FIO2 (fractional inspired oxygen) ratio, and arterial oxygen saturation significantly improved after 1 h of treatment (43+/-10 vs 88+/-37 mmHg; 87+/-22 vs 175+/-64; 81+/-9 vs 95+/-4%, respectively) and continued to improve in the following 24 h (p < 0.01). Five patients died in the ICU following complications independent of the respiratory failure, while 11 were discharged from the ICU in stable condition after a mean stay of 4.3+/-2.4 days and were discharged in good condition from the hospital.


CONCLUSIONS
NIV by nasal mask proved to be feasible and appropriate for the treatment of respiratory failure in hematologic patients who were at high risk of intubation-related complications.
Conti
G
G
Institute of Anaesthesia and Intensive Care, University of Rome La Sapienza, Italy. contigio@uniroma1.it
Marino
P
P
Cogliati
A
A
Dell'Utri
D
D
Lappa
A
A
Rosa
G
G
Gasparetto
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007938:Leukemia / Q000150:complications*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications; D008297:Male; D008397:Masks; D008875:Middle Aged; D010865:Pilot Projects; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome