VentilationFeasibility of high-flow nasal cannula oxygen therapy for acute respiratory failure in patients with hematologic malignancies: A retrospective single-center study
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.
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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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Contributed equally to this work.