A Neuschwander1, V Lemiale1, M Darmon2, F Pène3, A Kouatchet4, P Perez5, F Vincent6, J Mayaux7, D Benoit8, F Bruneel9, A P Meert10, M Nyunga11, A Rabbat3, D Mokart12, E Azoulay13. 1. ICU, Saint Louis Teaching Hospital, Paris, France. 2. ICU, Saint Etienne, Teaching Hospital, France. 3. ICU, Cochin Teaching Hospital, Paris, France. 4. ICU, Angers Teaching Hospital, Angers, France. 5. ICU, Brabois Teatching Hospital, Nancy, France. 6. ICU, Monfermeil Hospital, Montfermeil, France. 7. ICU Pitié Salpétrière Teaching Hospital, Paris, France. 8. ICU, Ghent Teaching Hospital, Ghent, Belgium. 9. ICU, Mignot Hospital, Versailles, France. 10. ICU, Bordet Institut, Bruxelles, Belgium. 11. ICU, Roubaix Hospital, Roubaix, France. 12. ICU, Paoli Calmettes Institut Marseilles, Marseilles, France. 13. ICU, Saint Louis Teaching Hospital, Paris, France. Electronic address: elie.azoulay@aphp.fr.
Abstract
PURPOSE: The objectives of our study were to describe the outcome of patients with malignancies treated for acute respiratory distress syndrome (ARDS) with noninvasive ventilation (NIV) and to evaluate factors associated with NIV failure. METHODS: Post hoc analysis of a multicenter database within 20 years was performed. All patients with malignancies and Berlin ARDS definition were included. Noninvasive ventilation use was defined as NIV lasting more than 1 hour, whereas failure was defined as a subsequent requirement of invasive ventilation. Conditional backward logistic regression analyses were conducted. RESULTS: A total of 1004 met the Berlin definition of ARDS. Noninvasive ventilation was used in 387 patients (38.6%) and NIV failure occurred in 71%, with an in-hospital mortality of 62.7%. Severity of ARDS defined by the partial pressure arterial oxygen and fraction of inspired oxygen ratio (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.15-4.19), pulmonary infection (OR, 1.81; 95% CI, 1.08-3.03), and modified Sequential Organ Failure Assessment (SOFA) score (OR, 1.13; 95% CI, 1.06-1.21) were associated with NIV failure. Factors associated with hospital mortality were NIV failure (OR, 2.52; 95% CI, 1.56-4.07), severe ARDS as compared with mild ARDS (OR, 1.89; 95% CI, 1.05-1.19), and modified SOFA score (OR, 1.12; 95% CI, 1.05-1.19). CONCLUSION: Noninvasive ventilation failure in ARDS patients with malignancies is frequent and related to ARDS severity, SOFA score, and pulmonary infection-related ARDS. Noninvasive ventilation failure is associated with in-hospital mortality.
PURPOSE: The objectives of our study were to describe the outcome of patients with malignancies treated for acute respiratory distress syndrome (ARDS) with noninvasive ventilation (NIV) and to evaluate factors associated with NIV failure. METHODS: Post hoc analysis of a multicenter database within 20 years was performed. All patients with malignancies and Berlin ARDS definition were included. Noninvasive ventilation use was defined as NIV lasting more than 1 hour, whereas failure was defined as a subsequent requirement of invasive ventilation. Conditional backward logistic regression analyses were conducted. RESULTS: A total of 1004 met the Berlin definition of ARDS. Noninvasive ventilation was used in 387 patients (38.6%) and NIV failure occurred in 71%, with an in-hospital mortality of 62.7%. Severity of ARDS defined by the partial pressure arterial oxygen and fraction of inspired oxygen ratio (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.15-4.19), pulmonary infection (OR, 1.81; 95% CI, 1.08-3.03), and modified Sequential Organ Failure Assessment (SOFA) score (OR, 1.13; 95% CI, 1.06-1.21) were associated with NIV failure. Factors associated with hospital mortality were NIV failure (OR, 2.52; 95% CI, 1.56-4.07), severe ARDS as compared with mild ARDS (OR, 1.89; 95% CI, 1.05-1.19), and modified SOFA score (OR, 1.12; 95% CI, 1.05-1.19). CONCLUSION: Noninvasive ventilation failure in ARDS patients with malignancies is frequent and related to ARDS severity, SOFA score, and pulmonary infection-related ARDS. Noninvasive ventilation failure is associated with in-hospital mortality.
Authors: Elie Azoulay; Peter Schellongowski; Michael Darmon; Philippe R Bauer; Dominique Benoit; Pieter Depuydt; Jigeeshu V Divatia; Virginie Lemiale; Maarten van Vliet; Anne-Pascale Meert; Djamel Mokart; Stephen M Pastores; Anders Perner; Frédéric Pène; Peter Pickkers; Kathryn A Puxty; Francois Vincent; Jorge Salluh; Ayman O Soubani; Massimo Antonelli; Thomas Staudinger; Michael von Bergwelt-Baildon; Marcio Soares Journal: Intensive Care Med Date: 2017-07-19 Impact factor: 17.440
Authors: M G Kiehl; G Beutel; B Böll; D Buchheidt; R Forkert; V Fuhrmann; P Knöbl; M Kochanek; F Kroschinsky; P La Rosée; T Liebregts; C Lück; U Olgemoeller; E Schalk; A Shimabukuro-Vornhagen; W R Sperr; T Staudinger; M von Bergwelt Baildon; P Wohlfarth; V Zeremski; P Schellongowski Journal: Ann Hematol Date: 2018-04-27 Impact factor: 3.673