Journal Article

Respiratory failure in patients undergoing allogeneic hematopoietic SCT—a randomized trial on early non-invasive ventilation based on standard care hematology wards

Illmer, T, Schiemanck, S, Höffken, G, Ehninger, G, Bornhäuser, M, Wermke, M

2012

Overview

The prognosis of patients suffering from respiratory failure (RF) after allogeneic hematopoietic SCT (HSCT) is poor. However, early treatment for using non-invasive ventilation (NIV) may be of benefit. We conducted a randomized trial to prove the impact of early NIV in patients in the early post-transplant period. A total of 526 patients undergoing HSCT in a single center were monitored for signs of RF. Patients with RF were enrolled into either treatment arm A (oxygen supply only) or treatment arm B (oxygen+intermittent NIV). RF had to be diagnosed in 86 patients (16%). RF was an independent risk factor for both short-term (100 day mortality/ OR 2.76; P <0.001) and long-term survival (OR 1.57; P <0.01). Although early RF treatment with NIV was associated with a decreased rate of failure to achieve sufficient oxygenation (39% in arm A vs 24% in arm B, P =0.17), neither intensive care unit admission rate, nor need for intubation or survival parameters were affected by the treatment strategy. An early interventional strategy using NIV was not associated with improvement of the prognosis of the patients. The limited influence of NIV may be related to the study design allowing for switching of treatment in case of unsatisfactory efficacy.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: Adolescent / Adult / Aged / Artificial respiration / Blood diseases / Bone marrow / Bone marrow transplantation / Care and treatment / Cell Biology / Child / Child, Preschool / Clinical trials / Disease-Free Survival / Failure / Health aspects / Hematologic Neoplasms - complications / Hematologic Neoplasms - mortality / Hematologic Neoplasms - therapy / Hematology / Hematopoietic Stem Cell Transplantation / Hematopoietic stem cells / Hemopoiesis / Humans / Infant / Intensive care units / Internal Medicine / Intubation / Male / Mechanical ventilation / Medical prognosis / Medicine / Medicine & Public Health / Middle Aged / Mortality / original-article / Oxygen / Oxygen - pharmacology / Oxygen therapy / Oxygenation / Patients / Prognosis / Public Health / Respiration, Artificial / Respiratory failure / Respiratory Insufficiency - etiology / Respiratory Insufficiency - mortality / Respiratory Insufficiency - therapy / Risk analysis / Risk factors / Stem cell transplantation / Stem Cells / Strategy / Survival / Survival Rate / Transplantation / Transplantation, Homologous / Ventilation / Ventilators