Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes
Abstract Background The usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate. Aim To analyze the rate of noninvasive ventilation failure and the main characteristics associated with this endpoint in oncohematological patients with acute r...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40560-020-00484-x |
| _version_ | 1818994060493324288 |
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| author | Lídia Miranda Barreto Cecilia Gómez Ravetti Thiago Bragança Athaíde Renan Detoffol Bragança Nathália Costa Pinho Lucas Vieira Chagas Fabrício de Lima Bastos Vandack Nobre on behalf of the Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI) |
| author_facet | Lídia Miranda Barreto Cecilia Gómez Ravetti Thiago Bragança Athaíde Renan Detoffol Bragança Nathália Costa Pinho Lucas Vieira Chagas Fabrício de Lima Bastos Vandack Nobre on behalf of the Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI) |
| author_sort | Lídia Miranda Barreto |
| collection | DOAJ |
| description | Abstract Background The usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate. Aim To analyze the rate of noninvasive ventilation failure and the main characteristics associated with this endpoint in oncohematological patients with acute respiratory failure (ARF). Methods A ventilatory support protocol was developed and implemented before the onset of the study. According to the PaO2/FiO2 (P/F) ratio and clinical judgment, patients received supplementary oxygen therapy, NIMV, or invasive mechanical ventilation (IMV). Results Eighty-two patients were included, average age between 52.1 ± 16 years old; 44 (53.6%) were male. The tested protocol was followed in 95.1% of cases. Six patients (7.3%) received IMV, 59 (89.7%) received NIMV, and 17 (20.7%) received oxygen therapy. ICU mortality rates were significantly higher in the IMV (83.3%) than in the NIMV (49.2%) and oxygen therapy (5.9%) groups (P < 0.001). Among the 59 patients who initially received NIMV, 30 (50.8%) had to eventually be intubated. Higher SOFA score at baseline (1.35 [95% CI = 1.12–2.10], P = 0.007), higher respiratory rate (RR) (1.10 [95% CI = 1.00–1.22], P = 0.048), and sepsis on admission (16.9 [95% CI = 1.93–149.26], P = 0.011) were independently associated with the need of orotracheal intubation among patients initially treated with NIMV. Moreover, NIMV failure was independently associated with ICU (P < 0.001) and hospital mortality (P = 0.049), and mortality between 6 months and 1 year (P < 0.001). Conclusion The implementation of a NIMV protocol is feasible in patients with hematological neoplasia admitted to the ICU, even though its benefits still remain to be demonstrated. NIMV failure was associated with higher SOFA and RR and more frequent sepsis, and it was also related to poor prognosis. |
| first_indexed | 2024-12-20T20:51:57Z |
| format | Article |
| id | doaj.art-679abb03bac1439e9f56a020d80bb4ec |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-12-20T20:51:57Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-679abb03bac1439e9f56a020d80bb4ec2022-12-21T19:26:54ZengBMCJournal of Intensive Care2052-04922020-09-01811910.1186/s40560-020-00484-xFactors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomesLídia Miranda Barreto0Cecilia Gómez Ravetti1Thiago Bragança Athaíde2Renan Detoffol Bragança3Nathália Costa Pinho4Lucas Vieira Chagas5Fabrício de Lima Bastos6Vandack Nobre7on behalf of the Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI)Hospital das Clínicas, Universidade Federal de Minas GeraisHospital das Clínicas, Universidade Federal de Minas GeraisHospital das Clínicas, Universidade Federal de Minas GeraisHospital das Clínicas, Universidade Federal de Minas GeraisSchool of Medicine, Universidade Federal de Minas GeraisSchool of Medicine, Universidade Federal de Minas GeraisSchool of Medicine, Universidade Federal de Minas GeraisHospital das Clínicas, Universidade Federal de Minas GeraisAbstract Background The usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate. Aim To analyze the rate of noninvasive ventilation failure and the main characteristics associated with this endpoint in oncohematological patients with acute respiratory failure (ARF). Methods A ventilatory support protocol was developed and implemented before the onset of the study. According to the PaO2/FiO2 (P/F) ratio and clinical judgment, patients received supplementary oxygen therapy, NIMV, or invasive mechanical ventilation (IMV). Results Eighty-two patients were included, average age between 52.1 ± 16 years old; 44 (53.6%) were male. The tested protocol was followed in 95.1% of cases. Six patients (7.3%) received IMV, 59 (89.7%) received NIMV, and 17 (20.7%) received oxygen therapy. ICU mortality rates were significantly higher in the IMV (83.3%) than in the NIMV (49.2%) and oxygen therapy (5.9%) groups (P < 0.001). Among the 59 patients who initially received NIMV, 30 (50.8%) had to eventually be intubated. Higher SOFA score at baseline (1.35 [95% CI = 1.12–2.10], P = 0.007), higher respiratory rate (RR) (1.10 [95% CI = 1.00–1.22], P = 0.048), and sepsis on admission (16.9 [95% CI = 1.93–149.26], P = 0.011) were independently associated with the need of orotracheal intubation among patients initially treated with NIMV. Moreover, NIMV failure was independently associated with ICU (P < 0.001) and hospital mortality (P = 0.049), and mortality between 6 months and 1 year (P < 0.001). Conclusion The implementation of a NIMV protocol is feasible in patients with hematological neoplasia admitted to the ICU, even though its benefits still remain to be demonstrated. NIMV failure was associated with higher SOFA and RR and more frequent sepsis, and it was also related to poor prognosis.http://link.springer.com/article/10.1186/s40560-020-00484-xHematological diseasesMechanical ventilationNon-invasive mechanical ventilationRespiratory insufficiencyIntensive care unit (ICU) |
| spellingShingle | Lídia Miranda Barreto Cecilia Gómez Ravetti Thiago Bragança Athaíde Renan Detoffol Bragança Nathália Costa Pinho Lucas Vieira Chagas Fabrício de Lima Bastos Vandack Nobre on behalf of the Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI) Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes Journal of Intensive Care Hematological diseases Mechanical ventilation Non-invasive mechanical ventilation Respiratory insufficiency Intensive care unit (ICU) |
| title | Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes |
| title_full | Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes |
| title_fullStr | Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes |
| title_full_unstemmed | Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes |
| title_short | Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes |
| title_sort | factors associated with non invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes |
| topic | Hematological diseases Mechanical ventilation Non-invasive mechanical ventilation Respiratory insufficiency Intensive care unit (ICU) |
| url | http://link.springer.com/article/10.1186/s40560-020-00484-x |
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