• Virginie Lemiale, Matthieu Resche-Rigon, Djamel Mokart, Frederic Pène, Antoine Rabbat, Achille Kouatchet, François Vincent, Fabrice Bruneel, Martine Nyunga, Christine Lebert, Pierre Perez, Anne-Pascale Meert, Dominique Benoit, Sylvie Chevret, and Elie Azoulay.
• AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France. virginie.lemiale@sls.aphp.fr.
• Ann Intensive Care. 2015 Dec 1;5(1):28.

BackgroundIn patients with hematological malignancies and acute respiratory failure (ARF), noninvasive ventilation was associated with a decreased mortality in older studies. However, mortality of intubated patients decreased in the last years. In this study, we assess outcomes in those patients according to the initial ventilation strategy.MethodsWe performed a post hoc analysis of a prospective multicentre study of critically ill hematology patients, in 17 intensive care units in France and Belgium. Patients with hematological malignancies admitted for ARF in 2010 and 2011 and who were not intubated at admission were included in the study. A propensity score-based approach was used to assess the impact of NIV compared to oxygen only on hospital mortality.ResultsAmong 1011 patients admitted to ICU during the study period, 380 met inclusion criteria. Underlying diseases included lymphoid (n = 162, 42.6 %) or myeloid (n = 141, 37.1 %) diseases. ARF etiologies were pulmonary infections (n = 161, 43 %), malignant infiltration (n = 65, 17 %) or cardiac pulmonary edema (n = 40, 10 %). Mechanical ventilation was ultimately needed in 94 (24.7 %) patients, within 3 [2-5] days of ICU admission. Hospital mortality was 32 % (123 deaths). At ICU admission, 142 patients received first-line noninvasive ventilation (NIV), whereas 238 received oxygen only. Fifty-five patients in each group (NIV or oxygen only) were matched according the propensity score. NIV was not associated with decreased hospital mortality [OR 1.5 (0.62-3.65)].ConclusionsIn hematology patients with acute respiratory failure, initial treatment with NIV did not improve survival compared to oxygen only.Clinical Trialgov number NCT 01172132.

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