Noninvasive ventilation for the treatment of acute respiratory failure in patients with hematologic malignancies: a pilot study

Conti, Giorgio; Marino, P.; Cogliati, Andrea A.; Dell’Utri, Donatella; Lappa, A.; Rosa, G.; Gasparetto, A

doi:10.1007/s001340050763

Cited by 103 publications

(56 citation statements)

References 26 publications

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“…Furthermore, it avoids the complications of intubation and the increased risk of ventilator-associated pneumonia. Moreover, other physiologic effects as minimizing or counterbalancing intrinsic positive end-expiratory pressure in critically ill patients with COPD have been described [1,2,3,4,5,6]. …”

Section: Introductionmentioning

confidence: 99%

Fiberoptic Bronchoscopy during Nasal Non-Invasive Ventilation in Acute Respiratory Failure

et al. 2010

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Background: Various methods have been described for safely performing fiberoptic bronchoscopy (FB) while applying non-invasive positive pressure ventilation (NIPPV) in patients with acute respiratory failure (ARF). Objectives: To evaluate the safety of a new method to perform FB in patients with ARF. Methods: Patients with ARF in whom FB was indicated were studied. The primary end-point was a mean drop in oxygen saturation (S_aO₂) after the procedure. During nasal NIPPV, FB was performed via the mouth using a bite block sealed with an elastic glove finger allowing bronchoscope insertion. Results: Thirty-five patients were included in the final study (63 ± 17 years, 74% men, P_aO₂/F_iO₂ ratio 168 ± 63). A total of 35 bronchoaspirates, 21 protected brushings, 11 bronchoalveolar lavages and 8 bronchial biopsies were done. The cardiorespiratory variables at the start and end of FB were: S_aO₂ 93 ± 3 to 94 ± 5%, heart rate 95 ± 17 to 99 ± 22 b.p.m. and respiratory rate 24 ± 11 to 25 ± 11 respirations/min. The lowest S_aO₂ value reached during the procedure was 86 ± 3% and the maximal ETCO₂ rise was 41 ± 4 mm Hg. Leakage was <50 ml/s in 32 patients. The clinical course was favorable in 66%. Invasive ventilation was necessary in 11%, 5 ± 4 days after FB. Twelve patients (33%) died 3 ± 2 days after FB as a result of their underlying disease. Conclusions: The system allowed to perform FB safely in patients with ARF. Although there is a relatively high rate of intubation and invasive mechanical ventilation due to illness severity, there was no worsening of oxygenation or complications attributable to the procedure.

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Section: Introductionmentioning

confidence: 99%

Fiberoptic Bronchoscopy during Nasal Non-Invasive Ventilation in Acute Respiratory Failure

et al. 2010

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“…Ancak NIV'nin akut solunum yetmezliği olan pnömoni, atelektazi, pulmoner ödem, astım nöbeti, spinal musküler atrofi ve ileri evre kistik fibroz tanılı çocuklarda başarıyla uygulandığı birçok çalışmada bildirilmiştir. [5][6][7][8][9][10] Bu çalışmalarda, hastaların solunum sayısı, kalp hızı, dispne skoru, oksijenizasyonu ve kan gazlarında iyileşme saptanmıştır. Bu yüzden akut solunum yetersizliği gelişen hastalarda NIV'nin önemli bir seçenek olabileceği ileri sürülmüştür.…”

Section: Discussionunclassified

Non-invasive Ventilation in Children with Acute Respiratory Failure

Kockar¹,

Erdoğan²,

Gündüz³

et al. 2016

Turkiye Klinikleri J Pediatr

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“…First, P aO 2 may be used as a criterion to initiate mechanical ventilation in patients with hematological malignancies, 29 along with clinical signs of respiratory distress. Coexisting conditions (pain, anxiety, cerebral leukostasis) may also cause tachypnea, reinforcing the pivotal role of P aO 2 in the clinical decision making.…”

Section: Discussionmentioning

confidence: 99%

Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Louw

Desai²,

Schneider³

et al. 2015

Respir Care

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BACKGROUND: Spurious hypoxemia has been described in case reports during extreme hyperleukocytosis and has led to recommendations for immediate cooling and analysis of arterial blood gases (ABGs). We sought to determine, in samples processed as recommended, the magnitude of spurious hypoxemia in acute leukemia subjects with hyperleukocytosis. METHODS: A retrospective chart review was conducted of all subjects admitted between 2003 and July 2014 for acute leukemia, who presented with white blood cell (WBC) count > 50 ؋ 10 9 cells/L and had ABGs performed. For each ABG, we collected P aO 2 , S aO 2 , simultaneous WBC count, and S pO 2 when available. Bland and Altman analysis was used to assess the agreement between S pO 2 and S aO 2 . RESULTS: One-hundred forty-six samples (from 45 subjects) were included, of which 57 samples (from 18 subjects) had data available for Bland and Altman analysis. Mean (S pO 2 ؊ S aO 2 ) was 2.5%, and 95% CI for limits of agreement between S pO 2 and S aO 2 was (؊10.1,15.1)%. The mean (S pO 2 -S aO 2 ) was significantly higher for WBC count > 100 ؋ 10 9 /L as compared with WBC count < 100 ؋ 10 9 /L (3.8% vs 0.4%, P ‫؍‬ .04), and the 95% CIs for limits of agreement were (؊10.3,18)% versus (؊7.9,8.6)%. S pO 2 and S aO 2 were poorly correlated (r 2 ‫؍‬ 0.19), whereas the difference (S pO 2 -S aO 2 ) was fairly correlated with WBC count (r 2 ‫؍‬ 0.44). Overall, 11 of 19 samples with WBC count > 150 ؋ 10 9 /L had P aO 2 < 55 mm Hg whereas S pO 2 was > 94%, the proportion being 5 of 62 samples for WBC count < 150 ؋ 10 9 /L (P < .001). Three subjects with WBC count > 150 ؋ 10 9 /L exhibited large S pO 2 to S aO 2 differences (10 -20%) before leukapheresis, which decreased to below 5% afterward. CONCLUSIONS: In subjects with acute leukemia and hyperleukocytosis, despite cooling and quickly analyzing the samples, we observed poor correlation and agreement between S pO 2 and S aO 2 , unacceptably low for WBC count > 100 ؋ 10 9 /L. Our results suggest that current guidelines may not totally prevent the diagnosis of spurious hypoxemia.

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Noninvasive ventilation for the treatment of acute respiratory failure in patients with hematologic malignancies: a pilot study

Abstract: NIV by nasal mask proved to be feasible and appropriate for the treatment of respiratory failure in hematologic patients who were at high risk of intubation-related complications.

Cited by 103 publications

References 26 publications

Fiberoptic Bronchoscopy during Nasal Non-Invasive Ventilation in Acute Respiratory Failure

Fiberoptic Bronchoscopy during Nasal Non-Invasive Ventilation in Acute Respiratory Failure

Non-invasive Ventilation in Children with Acute Respiratory Failure

Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

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