Non-invasive ventilation indication for critically ill cancer patients admitted to the intensive care unit for acute respiratory failure

• Published in: PloS one 2020-06, Vol.15 (6), p.e0234495
• Main Authors: Saillard, Colombe, Mallet, Damien, Chow-Chine, Laurent, Bisbal, Magali, Faucher, Marion, Sannini, Antoine, Mokart, Djamel
• Format: Article
• Language: English
• Subjects: Adult respiratory distress syndrome; Cancer patients; Care and treatment; Complications and side effects; Critical care medicine; Heart diseases; Mechanical ventilation; Methods; Mycoses; Patient outcomes; Prognosis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0234495

Acute respiratory failure (ARF) is a life-threatening complication in onco-hematology patients. Optimal ventilation strategy in immunocompromised patients has been highly controversial over the last decade. Data are lacking on patients presenting with ARF associating isolated cardiac dysfunction or in combination with another etiology. The aim of this study was to assess prognostic impact of initial ventilation strategy in onco-hematology patients presenting ARF with associated cardiac dysfunction. We conducted an observational retrospective study in Institut Paoli-Calmettes, a cancer-referral center, assessing all critically ill cancer patients admitted to the ICU for a ARF with cardiac dysfunction. Between 2010-2017, 127 patients were admitted. ICU and hospital mortality were 29% and 57%. Initial ventilation strategy was invasive mechanical ventilation (MV) in 21%. Others ventilation strategies were noninvasive ventilation (NIV) in 50%, associated with oxygen in 21% and high flow nasal oxygen (HFNO) in 29%, HFNO alone in 6% and standard oxygen in 23%. During ICU stay, 48% of patients required intubation. Multivariate analysis identified 3 independent factors associated with ICU mortality: SAPSII at admission (OR = 1.07/point, 95%CI = 1.03-1.11, p