title: Ventilatory support in critically ill hematology patients with respiratory failure.
abstract: BACKGROUND
  Hematology patients admitted to the ICU frequently experience respiratory failure and require mechanical ventilation. Noninvasive mechanical ventilation (NIMV) may decrease the risk of intubation, but NIMV failure poses its own risks.
  
  
  METHODS
  To establish the impact of ventilatory management and NIMV failure on outcome, data from a prospective, multicenter, observational study were analyzed. All hematology patients admitted to one of the 34 participating ICUs in a 17-month period were followed up. Data on demographics, diagnosis, severity, organ failure, and supportive therapies were recorded. A logistic regression analysis was done to evaluate the risk factors associated with death and NIVM failure.
  
  
  RESULTS
  Of 450 patients, 300 required ventilatory support. A diagnosis of congestive heart failure and the initial use of NIMV significantly improved survival, whereas APACHE II score, allogeneic transplantation, and NIMV failure increased the risk of death. The risk factors associated with NIMV success were age, congestive heart failure, and bacteremia. Patients with NIMV failure experienced a more severe respiratory impairment than did those electively intubated.
  
  
  CONCLUSIONS
  NIMV improves the outcome of hematology patients with respiratory insufficiency, but NIMV failure may have the opposite effect. A careful selection of patients with rapidly reversible causes of respiratory failure may increase NIMV success.
authors: Rosario
authors: R
authors: Molina
authors: Teresa
authors: T
authors: Bernal
authors: Marcio
authors: M
authors: Borges
authors: Rafael
authors: R
authors: Zaragoza
authors: Juan
authors: J
authors: Bonastre
authors: Rosa María
authors: RM
authors: Granada
authors: Juan Carlos
authors: JC
authors: Rodriguez-Borregán
authors: Karla
authors: K
authors: Núñez
authors: Iratxe
authors: I
authors: Seijas
authors: Ignacio
authors: I
authors: Ayestaran
authors: Guillermo M
authors: GM
authors: Albaiceta
mesh_terms: D018806:APACHE; D016638:Critical Illness; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D013030:Spain; D016896:Treatment Outcome