title: Noninvasivepositive pressure ventilation vsinvasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure in cancer patients.
abstract: The objective was to describe the characteristics and outcomes of critically ill cancer patients who received noninvasive positive pressure ventilation (NIPPV) vs invasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure.
  
  
  
  A retrospective cohort study of consecutive adult intensive care unit (ICU) cancer patients who received either conventional invasive mechanical ventilation or NIPPV as first-line therapy for hypoxemic respiratory failure.
  
  
  
  Of the 1614 patients included, the NIPPV failure group had the greatest hospital length of stay, ICU length of stay, ICU mortality (71.3%), and hospital mortality (79.5%) as compared with the other 2 groups (P < .0001). The variables independently associated with NIPPV failure included younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99; P=.031), non-Caucasian race (OR, 1.61; 95% CI, 1.14-2.26; P=.006), presence of a hematologic malignancy (OR, 1.87; 95% CI, 1.33-2.64; P=.0003), and a higher Sequential Organ Failure Assessment score (OR, 1.12; 95% CI, 1.08-1.17; P < .0001). There was no difference in mortality when comparing early vs late intubation (less than or greater than 24 or 48 hours) for the NIPPV failure group.
  
  
  
  Noninvasive positive pressure ventilation failure is an independent risk factor for ICU mortality, but NIPPV patients who avoided intubation had the best outcomes compared with the other groups. Early vs late intubation did not have a significant impact on outcomes.
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: nrathi@mdanderson.org.
authors.forename: Nisha K
authors.initials: NK
authors.lastname: Rathi
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Sajid A
authors.initials: SA
authors.lastname: Haque
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ron
authors.initials: R
authors.lastname: Nates
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Kosturakis
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Wenli
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Rose J
authors.initials: RJ
authors.lastname: Erfe
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Christina
authors.initials: C
authors.lastname: Guajardo
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Laura
authors.initials: L
authors.lastname: Withers
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Clarence
authors.initials: C
authors.lastname: Finch
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Price
authors.affiliation: Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Nates
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: Cancer; Hypoxemic respiratory failure; Noninvasive ventilation