OUTCOME OF MECHANICAL VENTILATION FOR ADULTS WITH HEMATOLOGIC MALIGNANCY

Background: Patients with hematologic malignancy who develop respirato ry failure generally have a very poor prognosis, A few such patients, however, enjoy long-term survival, The objective of this study was to identify clinical characteristics of patients with hematologic maligna ncy and respiratory failure that are predictive of outcome, Methods: W e performed a retrospective chart review of all patients who required mechanical ventilation for acute respiratory failure while on the leuk emia or bone marrow transplantation units at the Johns Hopkins Oncolog y Center between January 1985 and October 1991 (n = 157), Results: Ove rall hospital mortality was 83%, Major organ system dysfunction, as me asured by the acute physiology score (APS) of the APACHE III prognosti c system, was significantly (P < 0.05) related to hospital mortality, Three disease-specific clinical characteristics were predictive of mor tality: 1) stage beyond first complete remission, 2) duration of neutr openia greater than 30 days, and 3) treatment with bone marrow transpl antation, especially if HLA-mismatched, None of the 15 (10%) patients with neutropenia greater than 30 days or the four patients who underwe nt HLA-mismatched transplantation survived to discharge, Age was also a significant predictor of hospital mortality, Conclusions: Overall ou tcome of patients with hematologic malignancy and acute respiratory fa ilure is poor, A larger prospective study will be required to confirm the relative value of disease-specific variables identified in this st udy when combined with established predictive variables, In the future , it may be possible to develop a predictive instrument that is specif ically tailored for patients with hematologic malignancy who develop r espiratory failure.