Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy.
OBJECTIVE
Although chemotherapy and transplantation improve outcome of patients with hematological malignancy, complications of these therapies are responsible for a 20-50% mortality rate that increases when respiratory symptoms evolve into acute lung injury (ALI). The aim of this study is to determine the effectiveness of early continuous positive airway pressure (CPAP) delivered in the ward to prevent occurrence of ALI requiring intensive care unit (ICU) admission for mechanical ventilation.


METHODS
Patients with hematological malignancy presenting in the hematological ward with early changes in respiratory variables were randomized to receive oxygen (N = 20) or oxygen plus CPAP (N = 20). Primary outcome variables were need of mechanical ventilation requiring ICU admission, and intubation rate among those patients who required ICU admission.


RESULTS
At randomization, arterial-to-inspiratory O(2) ratio in control and CPAP group was 282 ± 41 and 256 ± 52, respectively. Patients who received CPAP had less need of ICU admission for mechanical ventilation (4 versus 16 patients; P = 0.0002). CPAP reduced the relative risk for developing need of ventilatory support to 0.25 (95% confidence interval: 0.10-0.62). Among patients admitted to ICU, intubation rate was lower in the CPAP than in the control group (2 versus 14 patients; P = 0.0001). CPAP reduced the relative risk for intubation to 0.46 (95% confidence interval: 0.27-0.78).


CONCLUSIONS
This study suggests that early use of CPAP on the hematological ward in patients with early changes in respiratory variables prevents evolution to acute lung injury requiring mechanical ventilation and ICU admission.
Squadrone
Vincenzo
V
Dipartimento di Anestesia e di Medicina degli Stati Critici, Azienda Ospedaliera S. Giovanni Battista-Molinette, Università di Torino, Corso Dogliotti 14, 10126, Turin, Italy.
Massaia
Massimo
M
Divisione di Ematologia Universitaria, Azienda Ospedaliera S.Giovanni Battista-Molinette, Università di Torino, Turin, Italy.
Bruno
Benedetto
B
Divisione di Ematologia Universitaria, Azienda Ospedaliera S.Giovanni Battista-Molinette, Università di Torino, Turin, Italy.
Marmont
Filippo
F
Divisione di Ematologia Ospedaliera, Azienda Ospedaliera S.Giovanni Battista-Molinette, Turin, Italy.
Falda
Michele
M
Divisione di Ematologia Ospedaliera, Azienda Ospedaliera S.Giovanni Battista-Molinette, Turin, Italy.
Bagna
Carlotta
C
Dipartimento di Anestesia e di Medicina degli Stati Critici, Azienda Ospedaliera S. Giovanni Battista-Molinette, Università di Torino, Corso Dogliotti 14, 10126, Turin, Italy.
Bertone
Stefania
S
Dipartimento di Anestesia e di Medicina degli Stati Critici, Azienda Ospedaliera S. Giovanni Battista-Molinette, Università di Torino, Corso Dogliotti 14, 10126, Turin, Italy.
Filippini
Claudia
C
Dipartimento di Anestesia e di Medicina degli Stati Critici, Azienda Ospedaliera S. Giovanni Battista-Molinette, Università di Torino, Corso Dogliotti 14, 10126, Turin, Italy.
Slutsky
Arthur S
AS
Dipartimento di Anestesia e di Medicina degli Stati Critici, Azienda Ospedaliera S. Giovanni Battista-Molinette, Università di Torino, Corso Dogliotti 14, 10126, Turin, Italy.|Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.|Interdepartmental Division of Critical Care, Division of Respiratory Medicine, University of Toronto, Toronto, ON, Canada.|King Saud University, Riyadh, Saudi Arabia.
Vitolo
Umberto
U
Divisione di Ematologia Ospedaliera, Azienda Ospedaliera S.Giovanni Battista-Molinette, Turin, Italy.
Boccadoro
Mario
M
Divisione di Ematologia Universitaria, Azienda Ospedaliera S.Giovanni Battista-Molinette, Università di Torino, Turin, Italy.
Ranieri
V Marco
VM
Dipartimento di Anestesia e di Medicina degli Stati Critici, Azienda Ospedaliera S. Giovanni Battista-Molinette, Università di Torino, Corso Dogliotti 14, 10126, Turin, Italy. marco.ranieri@unito.it.
D055371:Acute Lung Injury / Q000517:prevention & control*; D045422:Continuous Positive Airway Pressure; D019337:Hematologic Neoplasms / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007362:Intensive Care Units; D011014:Pneumonia / Q000150:complications; D018805:Sepsis / Q000150:complications; D016019:Survival Analysis