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

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• 作者：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)
  
• 关键词：CPAP ; Acute respiratory failure ; Hematological cancer ; Mechanical ventilation
• 刊名：Intensive Care Medicine
• 出版年：2010
• 出版时间：October 2010
• 年：2010
• 卷：36
• 期：10
• 页码：1666-1674
• 全文大小：275KB
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• 作者单位：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. Dipartimento di Anestesia e di Medicina degli Stati Critici, Azienda Ospedaliera S. Giovanni Battista-Molinette, Università di Torino, Corso Dogliotti 14, 10126, Turin, Italy
  2. Divisione di Ematologia Universitaria, Azienda Ospedaliera S.Giovanni Battista-Molinette, Università di Torino, Turin, Italy
  3. Divisione di Ematologia Ospedaliera, Azienda Ospedaliera S.Giovanni Battista-Molinette, Turin, Italy
  4. Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
  5. Interdepartmental Division of Critical Care, Division of Respiratory Medicine, University of Toronto, Toronto, ON, Canada
  6. King Saud University, Riyadh, Saudi Arabia
  

文摘

Purpose Although chemotherapy and transplantation improve outcome of patients with hematological malignancy, complications of these therapies are responsible for a 20-0% 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-.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-.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.