PULMONARY COMPLICATIONS IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES TREATED AT A RESPIRATORY ICU

Patients with haematological malignancies developing severe pulmonary complications have a poor outcome, especially after bone-marrow transp lantation (BMT).We studied the aetiology, the yield of different diagn ostic tools, as well as the outcome and prognostic factors in the corr esponding population admitted to our respiratory intensive care unit ( RICU), Overall, 89 patients with haematological malignancies and pulmo nary complications treated within a 10 yr period were included. The un derlying malignancies were predominantly acute leukaemia and chronic m yeloid leukaemia (66/89, 74%). Fifty-two of 89 (58%) patients were bon e marrow recipients, An aetiological diagnosis could be obtained in 61 /89 (69%) of cases. The aetiology was infectious in 37/89 (42%) and no ninfectious in 24/89 (27%). Blood cultures and cytological examination s of bronchoalveolar lavage fluid were the diagnostic tools with the h ighest yield (13/43 (30%) and 13/45 (29%) positive results, respective ly), Necropsy results were coincident with results obtained during the lifetime in 43% of cases with infectious and 60% with noninfectious a etiologies, Overall mortality was 70/89 (79%), and 47/52 (90%) in tran splant recipients. The requirement of mechanical ventilation, BMT, and an interval <90 days of BMT prior to ICU admission were independent a dverse prognostic factors. The outcome in this patient population was uniformly poor. It was worst in bone marrow recipients developing pulm onary complications <90 days after transplantation and requiring mecha nical ventilation, Decisions about intensive care unit admission and m ech-anical ventilation should seriously consider the dismal prognosis of these patients.