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Lemiale V, Resche-Rigon M, Mokart D, et al. 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. Ann Intensive Care. 2015;5(1):28doi: 10.1186/s13613-015-0070-z.
Lemiale, V., Resche-Rigon, M., Mokart, D., Pène, F., Rabbat, A., Kouatchet, A., Vincent, F., Bruneel, F., Nyunga, M., Lebert, C., Perez, P., Meert, A. P., Benoit, D., Chevret, S., & Azoulay, E. (2015). 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. Annals of intensive care, 5(1), 28. https://doi.org/10.1186/s13613-015-0070-z
Lemiale, Virginie, et al. "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." Annals of intensive care vol. 5,1 (2015): 28. doi: https://doi.org/10.1186/s13613-015-0070-z
Lemiale V, Resche-Rigon M, Mokart D, Pène F, Rabbat A, Kouatchet A, Vincent F, Bruneel F, Nyunga M, Lebert C, Perez P, Meert AP, Benoit D, Chevret S, Azoulay E. 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. Ann Intensive Care. 2015 Dec;5(1):28. doi: 10.1186/s13613-015-0070-z. Epub 2015 Sep 30. PMID: 26429355; PMCID: PMC4883632.
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Ann Intensive Care. 2015 Dec;5(1):28. doi: 10.1186/s13613-015-0070-z. Epub 2015 Sep 30.

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.

Annals of intensive care

Virginie Lemiale, Matthieu Resche-Rigon, Djamel Mokart, Frederic Pène, Antoine Rabbat, Achille Kouatchet, François Vincent, Fabrice Bruneel, Martine Nyunga, Christine Lebert, Pierre Perez, Anne-Pascale Meert, Dominique Benoit, Sylvie Chevret, Elie Azoulay

Affiliations

  1. AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France. [email protected].
  2. Biostatistics Department, Saint Louis Teaching Hospital, Paris, France. [email protected].
  3. ICU, Paoli Calmettes Institut, Marseilles, France. [email protected].
  4. ICU, Cochin Teaching Hospital, Paris, France. [email protected].
  5. Respiratory Unit, Cochin Teaching Hospital, Paris, France. [email protected].
  6. ICU, Angers Teaching Hospital, Angers, France. [email protected].
  7. ICU, Avicenne Teaching Hospital, Bobigny, France. [email protected].
  8. ICU, Mignot Hospital, Versailles, France. [email protected].
  9. ICU, Roubaix Hospital, Roubaix, France. [email protected].
  10. ICU, CH vendée, La Roche sur Yon, France. [email protected].
  11. ICU, Brabois Teaching Hospital, Nancy, France. [email protected].
  12. ICU, Bordet Institut, Brussels, Belgium. [email protected].
  13. ICU, Ghent Teaching Hospital, Ghent, Belgium. [email protected].
  14. Biostatistics Department, Saint Louis Teaching Hospital, Paris, France. [email protected].
  15. AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France. [email protected].

PMID: 26429355 PMCID: PMC4883632 DOI: 10.1186/s13613-015-0070-z

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.

CLINICAL TRIAL: gov number NCT 01172132.

Keywords: Immunosuppression; Leukemia; Lymphoma; Mechanical ventilation; Neutropenia; Noninvasive ventilation

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