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Optimizing Noninvasive Ventilation in Hematological Patients with Acute Respiratory Failure

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Pulmonary Involvement in Patients with Hematological Malignancies

Abstract

In hematological patients with acute respiratory failure (ARF), recourse to mechanical ventilation is still associated with increased mortality, although the prognosis has improved during the last decade. Thus, avoiding intubation remains a major objective. Noninvasive ventilation (NIV) has mainly been validated among onco-hematology patients with ARF. Above all, NIV makes it possible to reduce the mortality of these patients.

Before starting NIV, we should always consider the possible contraindications to its use. Patients in whom ARF does not resolve at 1–2 h are most in need of efforts to try improving their adaptation to NIV and the outcome. Clinical experience suggests that full facemasks are more appropriate than others for use in the setting of severe hypoxemic ARF. Many factors must be considered when pressure support and PEEP are used, and particular attention should be given to the leaks responsible of ineffective efforts during persistent insufflations; several adjustments can eliminate prolonged inspiration by reducing either the leaks or the ventilator insufflation time.

Undoubtedly, ARF in hematological patients belongs to the indications for NIV, which requires experience and good mastery of the technique. This indication justifies practicing NIV in intensive care units.

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Authors and Affiliations

  1. The Division of Medical Intensive Care, University Hospital, Bordeaux, France

    Gilles Hilbert

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  1. Gilles Hilbert
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Correspondence to Gilles Hilbert .

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  1. Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010, France

    Elie Azoulay

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Hilbert, G. (2011). Optimizing Noninvasive Ventilation in Hematological Patients with Acute Respiratory Failure. In: Azoulay, E. (eds) Pulmonary Involvement in Patients with Hematological Malignancies. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15742-4_47

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  • DOI: https://doi.org/10.1007/978-3-642-15742-4_47

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  • Online ISBN: 978-3-642-15742-4

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