Acute respiratory failure in severe hematologic disorders

Long term prognosis and quality of life following intensive care for life-threatening complications of haematological malignancy

“…Both for a humane approach to the management of critically ill patients and to ensure that limited resources are used appropriately, it is therefore important to avoid admitting patients who cannot benefit from intensive care and to limit further aggressive therapy when the prognosis is clearly hopeless. Hospital mortality rates have been reported to be particularly high (69-80%) when patients with haematological malignancy develop an acute illness of sufficient severity to warrant intensive care admission, especially when they present with respiratory failure (80-96%) (Anger et al, 1987;Estopa et al, 1984;Hauser et al, 1982;Johnson et al, 1986;Lloyd-Thomas et al, 1988;Schuster & Marion, 1983;Snow et al, 1979). In this series of 92 adults admitted to our intensive care unit with life threatening medical complications of haematological malignancy, the in-hospital mortality rate was 77%; broadly similar to that reported by others.…”

“…Although hospital mortality rates are very high when patients with haematological malignancy develop an acute life-threatening illness, it is now clear that for a small but significant proportion of these patients intensive care is life-saving (Anger et al, 1987;Brunet et al, 1990;Estopa et al, 1984;Hauser et al, 1982;Johnson et al, 1986;Lloyd-Thomas et al, 1988;Peters et al, 1988;Schuster & Marion, 1983;Snow et al, 1979). When assessing the value of intensive care it is, however, essential to consider not only immediate mortality rates but also both the long term prognosis and quality of life of those who do survive to leave hospital.…”

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

“…The mean charges were $484 434 among those with continuous invasive mechanical ventilation of o96 h (total hospitalization charges for this cohort was $490.6 million), $762 515 among those with continuous mechanical ventilation ⩾ 96 h (total hospitalization charges for this cohort was $1.54 billion), $916 415 among those who had continuous invasive mechanical ventilation of both o 96 and ⩾ 96 h duration (total hospitalization charges for this cohort was $44.8 million) and $658 420 among those who had noninvasive mechanical ventilation (total hospitalization charges for this cohort was $235 million) ( Table 4 Table 4). The results of the multivariable linear regression analysis examining the association between types of mechanical ventilation and lengths of stay are summarized in Table 7 [17][18][19][20][24][25][26] Current national estimates and resource utilization are unknown. Using the largest all-payer in-patient database in United States, we show that the overall prevalence of acute respiratory distress/failure in all hospitalized stem cell transplant patients is 6%.…”

“…[11][12][13] Need for mechanical ventilation is a major determinant of prognosis in oncology patients with an ICU mortality exceeding 75% for patients who have respiratory failure associated with ARDS. [14][15][16][17] Approximately 25% of all BM recipients ultimately require mechanical ventilation for respiratory failure, usually within 60 days of marrow infusion. [18][19][20] In a large study of BM transplant patients with acute respiratory failure, invasive mechanical ventilation was associated with a poor prognosis, with only 6% of 865 surviving for more than 30 days after extubation.…”

Impact of factors at admittance predicting intensive care unit mortality in critically ill cancer patients

“…[9][10][11] The mortality rate of cancer patients in ICU was as high as 44-98% before 1996 but, currently decreased to 21-57%. [12][13][14][15][16] The common negative prognostic factors for all patients are multiple organ failure, the requirement for mechanical ventilation, vasopressors, renal replacement therapy, advanced age and high disease severity scores at admittance. [17][18][19][20][21] Other factors that may be responsible of mortality are the etiology and severity of respiratory failure, duration of invasive mechanical ventilation, the source of infection, presence of sepsis and neutropenia, the timing of ICU admittance and the procedures applied for diagnosis and treatment.…”