Intensive Care Medicine

, Volume 36, Issue 10, pp 1666–1674 | Cite as

Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy

  • Vincenzo Squadrone
  • Massimo Massaia
  • Benedetto Bruno
  • Filippo Marmont
  • Michele Falda
  • Carlotta Bagna
  • Stefania Bertone
  • Claudia Filippini
  • Arthur S. Slutsky
  • Umberto Vitolo
  • Mario Boccadoro
  • V. Marco Ranieri
Original

Abstract

Purpose

Although chemotherapy and transplantation improve outcome of patients with hematological malignancy, complications of these therapies are responsible for a 20–50% mortality rate that increases when respiratory symptoms evolve into acute lung injury (ALI). The aim of this study is to determine the effectiveness of early continuous positive airway pressure (CPAP) delivered in the ward to prevent occurrence of ALI requiring intensive care unit (ICU) admission for mechanical ventilation.

Methods

Patients with hematological malignancy presenting in the hematological ward with early changes in respiratory variables were randomized to receive oxygen (N = 20) or oxygen plus CPAP (N = 20). Primary outcome variables were need of mechanical ventilation requiring ICU admission, and intubation rate among those patients who required ICU admission.

Results

At randomization, arterial-to-inspiratory O2 ratio in control and CPAP group was 282 ± 41 and 256 ± 52, respectively. Patients who received CPAP had less need of ICU admission for mechanical ventilation (4 versus 16 patients; P = 0.0002). CPAP reduced the relative risk for developing need of ventilatory support to 0.25 (95% confidence interval: 0.10–0.62). Among patients admitted to ICU, intubation rate was lower in the CPAP than in the control group (2 versus 14 patients; P = 0.0001). CPAP reduced the relative risk for intubation to 0.46 (95% confidence interval: 0.27–0.78).

Conclusions

This study suggests that early use of CPAP on the hematological ward in patients with early changes in respiratory variables prevents evolution to acute lung injury requiring mechanical ventilation and ICU admission.

Keywords

CPAP Acute respiratory failure Hematological cancer Mechanical ventilation 

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Vincenzo Squadrone
    • 1
  • Massimo Massaia
    • 2
  • Benedetto Bruno
    • 2
  • Filippo Marmont
    • 3
  • Michele Falda
    • 3
  • Carlotta Bagna
    • 1
  • Stefania Bertone
    • 1
  • Claudia Filippini
    • 1
  • Arthur S. Slutsky
    • 1
    • 4
    • 5
    • 6
  • Umberto Vitolo
    • 3
  • Mario Boccadoro
    • 2
  • V. Marco Ranieri
    • 1
  1. 1.Dipartimento di Anestesia e di Medicina degli Stati Critici, Azienda Ospedaliera S. Giovanni Battista-MolinetteUniversità di TorinoTurinItaly
  2. 2.Divisione di Ematologia Universitaria, Azienda Ospedaliera S.Giovanni Battista-MolinetteUniversità di TorinoTurinItaly
  3. 3.Divisione di Ematologia OspedalieraAzienda Ospedaliera S.Giovanni Battista-MolinetteTurinItaly
  4. 4.Keenan Research Center, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  5. 5.Interdepartmental Division of Critical Care, Division of Respiratory MedicineUniversity of TorontoTorontoCanada
  6. 6.King Saud UniversityRiyadhSaudi Arabia

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