title: Acute respiratory failure in patients with hematological malignancies: outcomes according to initial ventilation strategy. A groupe de recherche respiratoire en réanimation onco-hématologique (Grrr-OH) study.
abstract: BACKGROUND
  In patients with hematological malignancies and acute respiratory failure (ARF), noninvasive ventilation was associated with a decreased mortality in older studies. However, mortality of intubated patients decreased in the last years. In this study, we assess outcomes in those patients according to the initial ventilation strategy.
  
  
  METHODS
  We performed a post hoc analysis of a prospective multicentre study of critically ill hematology patients, in 17 intensive care units in France and Belgium. Patients with hematological malignancies admitted for ARF in 2010 and 2011 and who were not intubated at admission were included in the study. A propensity score-based approach was used to assess the impact of NIV compared to oxygen only on hospital mortality.
  
  
  RESULTS
  Among 1011 patients admitted to ICU during the study period, 380 met inclusion criteria. Underlying diseases included lymphoid (n = 162, 42.6 %) or myeloid (n = 141, 37.1 %) diseases. ARF etiologies were pulmonary infections (n = 161, 43 %), malignant infiltration (n = 65, 17 %) or cardiac pulmonary edema (n = 40, 10 %). Mechanical ventilation was ultimately needed in 94 (24.7 %) patients, within 3 [2-5] days of ICU admission. Hospital mortality was 32 % (123 deaths). At ICU admission, 142 patients received first-line noninvasive ventilation (NIV), whereas 238 received oxygen only. Fifty-five patients in each group (NIV or oxygen only) were matched according the propensity score. NIV was not associated with decreased hospital mortality [OR 1.5 (0.62-3.65)].
  
  
  CONCLUSIONS
  In hematology patients with acute respiratory failure, initial treatment with NIV did not improve survival compared to oxygen only.
  
  
  BACKGROUND
  gov number NCT 01172132.
authors.affiliation: AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France. virginie.lemiale@sls.aphp.fr.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.affiliation: Biostatistics Department, Saint Louis Teaching Hospital, Paris, France. matthieu.resche-rigon@univ-paris-diderot.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Resche-Rigon
authors.affiliation: ICU, Paoli Calmettes Institut, Marseilles, France. MOKARTD@ipc.unicancer.fr.
authors.forename: Djamel
authors.initials: D
authors.lastname: Mokart
authors.affiliation: ICU, Cochin Teaching Hospital, Paris, France. frederic.pene@cch.aphp.fr.
authors.forename: Frederic
authors.initials: F
authors.lastname: Pène
authors.affiliation: Respiratory Unit, Cochin Teaching Hospital, Paris, France. antoine.rabbat@aphp.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.affiliation: ICU, Angers Teaching Hospital, Angers, France. AcKouatchet@chu-angers.fr.
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.affiliation: ICU, Avicenne Teaching Hospital, Bobigny, France. frncsvncnt@aol.com.
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.affiliation: ICU, Mignot Hospital, Versailles, France. FBRUNEEL@ch-versailles.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.affiliation: ICU, Roubaix Hospital, Roubaix, France. martine.nyunga@ch-roubaix.fr.
authors.forename: Martine
authors.initials: M
authors.lastname: Nyunga
authors.affiliation: ICU, CH vendée, La Roche sur Yon, France. christine.lebert@chd-vendee.fr.
authors.forename: Christine
authors.initials: C
authors.lastname: Lebert
authors.affiliation: ICU, Brabois Teaching Hospital, Nancy, France. p.perez@chu-nancy.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Perez
authors.affiliation: ICU, Bordet Institut, Brussels, Belgium. ap.meert@bordet.be.
authors.forename: Anne-Pascale
authors.initials: AP
authors.lastname: Meert
authors.affiliation: ICU, Ghent Teaching Hospital, Ghent, Belgium. Dominique.Benoit@UGent.be.
authors.forename: Dominique
authors.initials: D
authors.lastname: Benoit
authors.affiliation: Biostatistics Department, Saint Louis Teaching Hospital, Paris, France. sylvie.chevret@paris7.jussieu.fr.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.affiliation: AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France. elie.azoulay@sls.aphp.fr.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
keywords: Immunosuppression; Leukemia; Lymphoma; Mechanical ventilation; Neutropenia; Noninvasive ventilation