Severity of Acute Respiratory Distress Syndrome in haematology patients: long‐term impact and early predictive factors

Summary Severe forms of acute respiratory distress syndrome in patients with haematological diseases expose clinicians to specific medical and ethical considerations. We prospectively followed 143 patients with haematological malignancies, and whose lungs were mechanically ventilated for more than 2...

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Bibliographic Details
Published in:Anaesthesia 2016-09, Vol.71 (9), p.1081-1090
Main Authors: Lagier, D., Platon, L., Chow‐Chine, L., Sannini, A., Bisbal, M., Brun, J.‐P., Blache, J.‐L., Faucher, M., Mokart, D.
Format: Article
Language:English
Subjects:
ARDS: long‐term outcome
ARDS: predictive factors
ARDS: severity
haematological malignancy
Hematology
Medical prognosis
Mortality
Respiratory distress syndrome
Respiratory therapy
Smoke inhalation
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Summary:Summary Severe forms of acute respiratory distress syndrome in patients with haematological diseases expose clinicians to specific medical and ethical considerations. We prospectively followed 143 patients with haematological malignancies, and whose lungs were mechanically ventilated for more than 24 h, over a 5‐y period. We sought to identify prognostic factors of long‐term outcome, and in particular to evaluate the impact of the severity of acute respiratory distress syndrome in these patients. A secondary objective was to identify the early (first 48 h from ICU admission) predictive factors for acute respiratory distress syndrome severity. An evolutive haematological disease (HR 1.71; 95% CI 1.13–2.58), moderate to severe acute respiratory distress syndrome (HR 1.81; 95% CI 1.13–2.69) and need for renal replacement therapy (HR 2.24; 95% CI 1.52–3.31) were associated with long‐term mortality. Resolution of neutropaenia during ICU stay (HR 0.63; 95% CI 0.42–0.94) and early microbiological documentation (HR 0.62; 95% CI 0.42–0.91) were associated with survival. The extent of pulmonary infiltration observed on the first chest X‐ray and the diagnosis of invasive fungal infection were the most relevant early predictive factors of the severity of acute respiratory distress syndrome.
ISSN:0003-2409
1365-2044
DOI:10.1111/anae.13542