Elsevier

Journal of Critical Care

Volume 30, Issue 4, August 2015, Pages 773-777
Journal of Critical Care

Ventilation
Feasibility of high-flow nasal cannula oxygen therapy for acute respiratory failure in patients with hematologic malignancies: A retrospective single-center study

https://doi.org/10.1016/j.jcrc.2015.03.014Get rights and content

Abstract

Purpose

This study investigated the feasibility of high-flow nasal cannula (HFNC) oxygen therapy for acute respiratory failure in adult patients with hematologic malignancies.

Materials and methods

We identified 45 acute respiratory failure patients with hematologic malignancies who received HFNC therapy between March 2012 and June 2014 at Seoul St Mary's Hospital. Their medical records were reviewed retrospectively to identify useful prognostic factors for successful treatment.

Results

Of the 45 patients, 15 (33.3%) successfully recovered, and 30 were changed to invasive ventilation due to failed HFNC treatment. The etiologies of acute respiratory failure were bacterial pneumonia (57.8%), Pneumocystis jirovecii pneumonia (17.8%), pulmonary edema (8.9%), and bronchiolitis obliterans organizing pneumonia (8.9%). The overall mortality rate was 62.2%. The HFNC treatment success rate was significantly different between the survivors and nonsurvivors. To evaluate risk factors for HFNC treatment failure, differences between the HFNC treatment success and failure groups were compared. There were no significant differences in the severity of underlying medical conditions. The percentage of bacterial pneumonia was significantly higher in the HFNC treatment failure group compared with the success group (73.3% vs 26.7%; P = .004).

Conclusions

High-flow nasal cannula offers an interesting alternative to invasive ventilation in acute respiratory failure patients with hematologic malignancies. However, attention must be paid to the appropriate choice of HFNC settings such as oxygen flow.

Introduction

Respiratory failure, the leading cause of intensive care unit (ICU) admission, has a high mortality rate in patients with hematologic malignancies [1]. Several studies have demonstrated that invasive ventilation (IV) is associated with increased mortality, whereas early noninvasive ventilation (NIV) has improved the clinical outcome [2], [3], [4]. A prospective randomized study that compared NIV to conventional oxygen therapy found that avoiding IV lowered the rate of ICU deaths and serious complications such as ventilator-associated pneumonia and septic shock [4]. This finding could be due to the immunocompromised state of patients with hematologic malignancies because IV could cause more opportunistic infections associated with tracheal intubation.

Recently, the prognosis of patients with hematologic malignancies has improved with the development of treatment methods [5]. A high-flow nasal cannula (HFNC) combined with a heated humidification system can deliver up to 100% at a maximum flow of 60 L/min of gas via a cannula or nasal prongs [6], [7]. Given its physiologic benefits, including positive expiratory pressure effects, alveolar recruitment, and increased comfort and tolerance compared to conventional facial masks, HFNCs have been widely used in pediatric patients [8], [9]. In adult patients with acute respiratory failure, a pilot prospective monocentric study [10] and prospective observational study [11] showed that HFNC use significantly improved both the clinical and biological parameters in patients. However, until now, data from adult patients with hematologic malignancies have been lacking.

This study investigated the feasibility of HFNC use in patients with hematologic malignancies for the treatment of acute respiratory failure by comparing the clinical characteristics between treatment failure and success groups and identifying prognostic factors associated with treatment failure.

Section snippets

Data collection and patients

More than 450 hematopoietic stem cell transplants are performed annually at Seoul St Mary's Hospital (Seoul, Republic of Korea), and a total of 6801 patients visited between March 2012 and June 2014. We identified 1424 adult patients older than 15 years with hematologic malignancies who received oxygen therapy at this hospital during the study period. Among the 1424 patients, 1138 (79.9%) improved with conventional oxygen therapy such as nasal prong or face mask, 234 (16.4%) were changed to IV,

Results

The general characteristics of the patients are shown in Table 1. The mean patient age was 49.6 ± 2.0 years, and 75.6% of the patients were male. The most common underlying hematologic diseases were acute myeloid leukemia (AML) (46.7%), myelodysplastic syndrome (13.3%), and lymphoma (11.1%). At the time of HFNC treatment, 33 patients (73.3%) had active disease, and 12 (26.7%) were in complete remission. In total, 21 patients (46.7%) underwent bone marrow transplantation (BMT), and 22 (48.9%)

Discussion

In our study, the failure rate of HFNC therapy was 66.7%, similar to that of NIV reported in other studies (50%-70%) [4], [12], [13]. Between the survivor and nonsurvivor groups, the status of underlying hematologic diseases, severity of acute respiratory failure (Pao2/Fio2 ratio), and APACHE II score were not significantly different, but the success or failure of HFNC therapy was significantly different (P < .001). This result is meaningful because previous studies concluded that the severity

Conclusions

This study analyzed the result of HFNC therapy in severe acute respiratory failure patients with hematologic malignancies. High-flow nasal cannula therapy delivered adequate ventilation with suitable tolerability in some patients. More than 30% of the patients were successfully recovered from the acute respiratory failure without IV. As the percentage of bacterial pneumonia was significantly higher in the treatment failure group compared with the success group, bacterial pneumonia could be the

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