title: Respiratory failure after stem cell transplantation: improved outcome with non-invasive ventilation.
abstract: We retrospectively analyzed the efficacy of non-invasive ventilation in 35 patients with acute hypoxemic respiratory failure after autologous or allogeneic stem cell transplantation (SCT). Non-invasive ventilation was delivered by a standard face mask or helmet. Decisions to intubate were made according to standard criteria. Between 1993 and 2003, 836 patients underwent an autologous or allogeneic bone marrow or SCT. Eighty-two patients developed respiratory failure. Of these, 47 patients were initially intubated and mechanically ventilated. None of these patients survived. Thirty-five patients initially underwent non-invasive ventilation at the bone marrow transplant unit. Seven of these patients survived and were discharged from the hospital (20%). Eleven of the 35 (31%) patients improved within the first 4 h of non-invasive ventilation with respect to oxygenation and were regarded as responders. Seven of these patients survived to hospital discharge (64%), while all non-responders died (P<0.001). In all survivors, the partial pressure of arterial oxygen (PaO2) improved after the initiation of non-invasive ventilation. In non-survivors, PaO2 improved in only 4 of 28 patients (17%) (P<0.0001). Non-invasive ventilation in patients with acute respiratory failure after SCT could improve prognosis in a carefully selected group of patients.
authors.affiliation: Bone Marrow Transplantation Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria. werner.rabitsch@meduniwein.ac.at
authors.forename: Werner
authors.initials: W
authors.lastname: Rabitsch
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
authors.forename: Gottfried J
authors.initials: GJ
authors.lastname: Locker
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Köstler
authors.forename: Klaus
authors.initials: K
authors.lastname: Laczika
authors.forename: Michael
authors.initials: M
authors.lastname: Frass
authors.forename: Paul
authors.initials: P
authors.lastname: Knoebl
authors.forename: Hildegard T
authors.initials: HT
authors.lastname: Greinix
authors.forename: Peter
authors.initials: P
authors.lastname: Kalhs
authors.forename: Felix
authors.initials: F
authors.lastname: Keil
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011379:Prognosis; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D010100:Oxygen