TY - JOUR
T1 - Noninvasivepositive pressure ventilation vsinvasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure in cancer patients
AU - Rathi, Nisha K.
AU - Haque, Sajid A.
AU - Nates, Ron
AU - Kosturakis, Alyssa
AU - Wang, Hao
AU - Dong, Wenli
AU - Feng, Lei
AU - Erfe, Rose J.
AU - Guajardo, Christina
AU - Withers, Laura
AU - Finch, Clarence
AU - Price, Kristen J.
AU - Nates, Joseph L.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Purpose The objective was to describe the characteristics and outcomes of critically ill cancer patients who received noninvasive positive pressure ventilation (NIPPV) vs invasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure. Material and methods A retrospective cohort study of consecutive adult intensive care unit (ICU) cancer patients who received either conventional invasive mechanical ventilation or NIPPV as first-line therapy for hypoxemic respiratory failure. Results Of the 1614 patients included, the NIPPV failure group had the greatest hospital length of stay, ICU length of stay, ICU mortality (71.3%), and hospital mortality (79.5%) as compared with the other 2 groups (P <. 0001). The variables independently associated with NIPPV failure included younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99; P = .031), non-Caucasian race (OR, 1.61; 95% CI, 1.14-2.26; P = .006), presence of a hematologic malignancy (OR, 1.87; 95% CI, 1.33-2.64; P = .0003), and a higher Sequential Organ Failure Assessment score (OR, 1.12; 95% CI, 1.08-1.17; P < .0001). There was no difference in mortality when comparing early vs late intubation (less than or greater than 24 or 48 hours) for the NIPPV failure group. Conclusion Noninvasive positive pressure ventilation failure is an independent risk factor for ICU mortality, but NIPPV patients who avoided intubation had the best outcomes compared with the other groups. Early vs late intubation did not have a significant impact on outcomes.
AB - Purpose The objective was to describe the characteristics and outcomes of critically ill cancer patients who received noninvasive positive pressure ventilation (NIPPV) vs invasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure. Material and methods A retrospective cohort study of consecutive adult intensive care unit (ICU) cancer patients who received either conventional invasive mechanical ventilation or NIPPV as first-line therapy for hypoxemic respiratory failure. Results Of the 1614 patients included, the NIPPV failure group had the greatest hospital length of stay, ICU length of stay, ICU mortality (71.3%), and hospital mortality (79.5%) as compared with the other 2 groups (P <. 0001). The variables independently associated with NIPPV failure included younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99; P = .031), non-Caucasian race (OR, 1.61; 95% CI, 1.14-2.26; P = .006), presence of a hematologic malignancy (OR, 1.87; 95% CI, 1.33-2.64; P = .0003), and a higher Sequential Organ Failure Assessment score (OR, 1.12; 95% CI, 1.08-1.17; P < .0001). There was no difference in mortality when comparing early vs late intubation (less than or greater than 24 or 48 hours) for the NIPPV failure group. Conclusion Noninvasive positive pressure ventilation failure is an independent risk factor for ICU mortality, but NIPPV patients who avoided intubation had the best outcomes compared with the other groups. Early vs late intubation did not have a significant impact on outcomes.
KW - Cancer
KW - Hypoxemic respiratory failure
KW - Noninvasive ventilation
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U2 - 10.1016/j.jcrc.2017.01.007
DO - 10.1016/j.jcrc.2017.01.007
M3 - Article
C2 - 28213266
AN - SCOPUS:85017615714
SN - 0883-9441
VL - 39
SP - 56
EP - 61
JO - Journal of critical care
JF - Journal of critical care
ER -