Ventilatory support in critically ill haematological patients with respiratory failure
Critical Care, 07/31/2012
Molina R et al. – Non–invasive mechanical ventilation (NIMV) improves the outcome of haematological 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.Methods
- To establish the impact of ventilatory management and NIMV failure on outcome, data from a prospective, multicentre, observational study were analysed.
- All haematological patients admitted to one of the 34 participating ICUs in a 17–month period were followed.
- 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.
- 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 to NIMV success were age, congestive heart failure, and bacteraemia.
- Patients with NIMV failure experience a more severe respiratory impairment than those electively intubated.