Skip to main content

Advertisement

SpringerLink
Log in

Patients with haematological malignancies requiring invasive mechanical ventilation: differences between survivors and non-survivors in intensive care unit

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

Mortality of patients with haematological malignancies requiring intensive therapy is high. We wanted to establish reasons for intensive care unit (ICU) admission and treatment as well as outcome in subjects who required invasive mechanical ventilation. We were also interested in differences between ICU survivors and non-survivors at the moment of admission.

Patients and methods

Forty patients (21 women and 19 men) were included in the study. Median of age was 42 (range 16–73) years. All patients required mechanical ventilation. We analysed age, gender, disease character (acute/chronic), diagnosed pneumonia, multiple organ failure (MOF), history of bone marrow transplantation, peripheral blood parameters (leukocyte, neutrocyte, erythrocyte and thrombocyte counts, haemoglobin level and haematocrit), mean arterial pressure (obtained through direct measurement), necessity of catecholamine administration and symptoms of the acute renal insufficiency at the moment of ICU admission.

Main results

Sixty-five percent of patients died in ICU. Intergroup comparisons between survivors and non-survivors revealed statistically significant differences in the presence of neutropenia, thrombocyte count, mean arterial pressure and the necessity of catecholamines administration, as well as scores obtained through patient evaluation according to the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment (SOFA) and the New Simplified Acute Physiology Score (SAPS II) scales. Multivariate logistic regression revealed only one independent risk factor for ICU mortality in the analysed group—SAPS II score (p=0.009). Calculated value of the unitary odds ratio was 1.065 (95% confidence interval 1.017–1.116).

Conclusions

Mortality of patients with haematological malignancies requiring intensive mechanical ventilation remains high. Scoring with the SAPS II system was a useful tool for determination of ICU mortality risk in those patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ashkenazi YJ, Kramer BS, Harman E (1986) Short-term outcome among patients with leukemia and lymphoma admitted to a medical intensive care unit. South Med J 79:1086–1088

    PubMed  Google Scholar 

  2. Azoulay E, Fieux F, Moreau D, Thiery G, Rousselot P, Parrot A, Le Gall J-R, Dombret H, Schlemmer B (2003) Acute monocytic leukemia presenting as acute respiratory failure. Am J Respir Crit Care Med 167:1329–1333

    PubMed  Google Scholar 

  3. Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, Fermand JP, Schlemmer B (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401

    CAS  PubMed  Google Scholar 

  4. Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complications. Crit Care Med 31:104–112

    Article  PubMed  Google Scholar 

  5. Blot F, Guiguet M, Nitenberg G, Leclercq B, Gachot B, Escudier B (1997) Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures. Eur J Cancer 33:1031–1037

    Article  CAS  PubMed  Google Scholar 

  6. Brunet F, Lanore JJ, Dhainaut JF, Drefus F, Vaxelaire J, Nouira S, Giraud T, Armaganidis A, Monsallier JF (1990): Is intensive care justified for patients with hematological malignancies? Intensive Care Med 16:291–297

    CAS  PubMed  Google Scholar 

  7. Conti G, Marino P, Cogliati A, Dell’Utri D, Lappa A, Rosa G, Gasparetto A (1998) Noninvasive ventilation for the treatment of acute respiratory failure in patients with hematologic malignancies: a pilot study. Intensive Care Med 24:1283–1288

    CAS  PubMed  Google Scholar 

  8. Epner DE, White P, Krasnoff M, Khanduja S, Kimball KT, Knaus WA (1996) Outcome of mechanical ventilation for adults with hematologic malignancy J Investig Med 44:254–260

    CAS  Google Scholar 

  9. Estopa R, Torres Marti A, Kastanos N, Rives A, Agusti-Vidal A, Rozman C (1984) Acute respiratory failure in severe hematologic disorders. Crit Care Med 12:26–28

    CAS  PubMed  Google Scholar 

  10. Evison JM, Rickenbacher P, Ritz R, Gratwohl A, Haberthűr Ch, Elsasser S, Passweg JR (2001) Intensive care unit admission in patients with haematological disease: incidence, outcome and prognostic factors. Swiss Med Wkly 131:681–686

    CAS  PubMed  Google Scholar 

  11. Ewig S, Torres A, Riquelme R, El-Ebiary M, Rovira M, Carreras E, Rano A, Xaubet A (1998) Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU. Eur Respir J 12:116–122

    Article  CAS  PubMed  Google Scholar 

  12. Huaringa AJ, Leyva FJ, Giralt SA, Blanco J, Signes-Costa J, Velarde H, Champlin RE (2000) Outcome of bone marrow transplantation patients requiring mechanical ventilation. Crit Care Med 28:1014–1017

    CAS  PubMed  Google Scholar 

  13. Johnson MH, Gordon PW, Fitzgerald FT (1986) Stratification of prognosis in granulocytopenic patients with hematologic malignancies using the APACHE-II severity of illness score. Crit Care Med 14:693–697

    CAS  PubMed  Google Scholar 

  14. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Apache II: a severity of disease classification system. Crit Care Med 13:818–829

    CAS  PubMed  Google Scholar 

  15. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ-system failure. Ann Surg 11:685–693

    Google Scholar 

  16. Kongsgaard UE, Meidell NK (1999) Mechanical ventilation in critically ill cancer patients: outcome and utilisation of resources. Support Care Cancer 7:95–99

    CAS  PubMed  Google Scholar 

  17. Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med. 160: 1957–1961

  18. Kroschinsky F, Weise M, Illmer T, Haenel M, Bornhaeuser M, Hoeffken G, Ehninger G, Schuler U (2002) Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies. Intensive Care Med 28:1294–1300

    Article  PubMed  Google Scholar 

  19. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicentre study. JAMA 270:2957–2963

    PubMed  Google Scholar 

  20. Lloyd-Thomas AR, Dhaliwal HS, Lister TA, Hinds CJ (1986) Intensive therapy for life-threatening medical complications of haematological malignancy. Intensive Care Med. 12:317–324

    Google Scholar 

  21. Lloyd-Thomas AR, Wright I, Lister TA, Hinds CJ (1988) Prognosis of patients receiving intensive care for life threatening medical complications of haematological malignancy. Br Med J 296:1025–1029

    CAS  Google Scholar 

  22. Massion PB, Dive AM, Doyen C, Bulpa P, Bosly A, Installe E (2002) Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med 30:2260–2270

    Article  PubMed  Google Scholar 

  23. Meert AP, Close L, Hardy M, Berghmans T, Markiewicz E, Sculier JP (2003) Noninvasive ventilation: application to the cancer patient admitted in the intensive care unit. Support Care Cancer 11:56–59

    CAS  PubMed  Google Scholar 

  24. Peters S, Meadows JA, Gracey D (1988) Outcome of respiratory failure in hematologic malignancy. Chest 94:99–102

    CAS  PubMed  Google Scholar 

  25. Poletti V, Trisolini R, Tura S (2002) Pulmonary disease in patients with hematologic malignancies. Sarcoidosis Vasc Diffuse Lung Dis 191:29–45

    Google Scholar 

  26. Rabe C, Mey U, Paashaus M, Musch A, Tasci S, Glasmacher A, Schmidt-Wolf IG, Sauerbruch T, Dumoulin FL (2004) Outcome of patients with acute myeloid leukemia and pulmonary infiltrates requiring invasive mechanical ventilation-a retrospective analysis. J Crit Care 19:29–35

    PubMed  Google Scholar 

  27. Schuster D, Marion J (1983) Precedents for meaningful recovery during treatment in a medical intensive care unit: outcome in patients with hematologic malignancy. Am J Med 75:402–308

    Article  CAS  PubMed  Google Scholar 

  28. Shorr AF, Moores LK, Edenfield WJ, Christie RJ, Fitzpatrick TM (1999) Mechanical ventilation in hematopoietic stem cell transplantation. Chest 116:1012–1018

    CAS  PubMed  Google Scholar 

  29. Silfvast T, Pettilä V, Ihalainen A, Elonen E (2003) Multiple organ failure and outcome of critically ill patients with haematological malignancy. Acta Anaesthesiol Scand 47:301–306

    CAS  PubMed  Google Scholar 

  30. Trebmlay LN, Hyland RH, Schouten BD, Hanly PJ (1995) Survival of acute myelogenous leukemia patients requiring intubation/ventilatory support. Clin Invest Med 18:19–24

    PubMed  Google Scholar 

  31. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710

    Article  CAS  PubMed  Google Scholar 

  32. Wedding U, Bokemeyer C, Meran JG (2004) Elderly patients with acute myeloid leukaemia: characteristics in biology, patients and treatment. Recommendations of the Working Group Geriatric Oncology of the German Society for Haematology and Oncology (DGHO), the Austrian Society for Haematology and Oncology (OGHO) and the German Society for Geriatrics (DGG). Onkologie 27:72–82

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Debinki 7 str., 80–211, Gdansk, Poland

    Radoslaw Owczuk, Magdalena A. Wujtewicz, Wioletta Sawicka, Anna Wadrzyk & Maria Wujtewicz

Authors
  1. Radoslaw Owczuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Magdalena A. Wujtewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wioletta Sawicka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Wadrzyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Wujtewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Radoslaw Owczuk.

Additional information

This study was presented in part at the Euroanaesthesia 2004 Meeting, Lisbon, Portugal, 5–8 June 2004.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Owczuk, R., Wujtewicz, M.A., Sawicka, W. et al. Patients with haematological malignancies requiring invasive mechanical ventilation: differences between survivors and non-survivors in intensive care unit. Support Care Cancer 13, 332–338 (2005). https://doi.org/10.1007/s00520-004-0750-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-004-0750-y

Keywords

Search

Navigation