The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure.
OBJECTIVE
The aim of this study was to assess the impact of the 3 types of initial respiratory support (noninvasive positive pressure ventilation vs invasive positive pressure ventilation vs supplemental oxygen only) in hematological patients with acute hypoxemic respiratory failure (ARF).


METHODS
This study is a retrospective analysis of a cohort of hematological patients admitted to the intensive care unit (ICU) of a tertiary care hospital between January 1, 2002, and June 30, 2006.


RESULTS
One hundred thirty-seven hematological patients were admitted at the ICU with ARF (defined as Pao(2)/Fio(2) <200): within the first 24 hours, 24 and 67 patients received noninvasive positive pressure ventilation and invasive positive pressure ventilation, respectively, and 46 received supplemental oxygen only. Intensive care unit mortality in the 3 patient categories was 71%, 63%, and 32%, respectively (P = .001), and in-hospital mortality was 75%, 80%, and 47%, respectively (P = .001). In multivariate regression analysis, increasing cancer-specific severity-of-illness score upon admission and more organ failure after 24 hours of ICU admission, but not the type of initial respiratory support, were significantly associated with ICU or in-hospital mortality.


CONCLUSIONS
Intensive care unit and in-hospital mortality in our population of hematological patients with hypoxemic ARF was determined by severity of illness and not by the type of initial respiratory support.
Depuydt
Pieter O
PO
Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium. pieter.depuydt@ugent.be
Benoit
Dominique D
DD
Roosens
Carl D
CD
Offner
Fritz C
FC
Noens
Lucien A
LA
Decruyenaere
Johan M
JM
D000208:Acute Disease; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011175:Positive-Pressure Respiration / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D012044:Regression Analysis; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome