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

Objective: To evaluate treatment with noninvasive ventilation (NIV) by nasa l mask as an alternative to endotracheal intubation and conventional mechan ical ventilation in patients with hematologic malignancies complicated by a cute respiratory failure to decrease the risk of hemorrhagic complications and increase clinical tolerance. Design: Prospective clinical study. Setting: Hematologic and general intensive care unit (ICU), University of R ome "La Sapienza". Patients: 16 consecutive patients with acute respiratory failure complicati ng hematologic malignancies. Interventions: NIV was delivered via nasal mask by means of a BiPAP ventila tor (Respironics, USA); we evaluated the effects on blood gases, respirator y rate, and hemodynamics along with tolerance, complications, and outcome. Measurements and results: 15 of the 16 patients showed a significant improv ement in blood gases and respiratory rate within the first 24 h of treatmen t. Arterial oxygen tension (PaO2), PaO2/FIO2 (fractional inspired oxygen) r atio, and arterial oxygen saturation significantly improved after 1 h of tr eatment (43 +/- 10 vs 88 +/- 37 mmHg; 87 +/- 22 vs 175 +/- 64; 81 +/- 9 vs 95 +/- 4 %, respectively) and continued to improve in the following 24 h (p < 0.01). Five patients died in the ICU following complications independent of the respiratory failure, while 11 were discharged from the ICU in stabl e condition after a mean stay of 4.3 +/- 2.4 days and were discharged in go od condition from the hospital. Conclusions: NIV by nasal mask proved to be feasible and appropriate for th e treatment of respiratory failure in hematologic patients who were at high risk of intubation - related complications.