Clarence Finch

Noninvasivepositive pressure ventilation vsinvasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure in cancer patients ☆ ☆☆

Purpose: The objective was to describe the characteristics and outcomes of critically ill cancer patients who received noninvasive positive pressure ventilation (NIPPV) vs invasive mechanical ventilation as first‐line therapy for acute hypoxemic respiratory failure. Material and methods: A retrospective cohort study of consecutive adult intensive care unit (ICU) cancer patients who received either conventional invasive mechanical ventilation or NIPPV as first‐line therapy for hypoxemic respiratory failure. Results: Of the 1614 patients included, the NIPPV failure group had the greatest hospital length of stay, ICU length of stay, ICU mortality (71.3%), and hospital mortality (79.5%) as compared with the other 2 groups (P < .0001). The variables independently associated with NIPPV failure included younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98‐0.99; P = .031), non‐Caucasian race (OR, 1.61; 95% CI, 1.14‐2.26; P = .006), presence of a hematologic malignancy (OR, 1.87; 95% CI, 1.33‐2.64; P = .0003), and a higher Sequential Organ Failure Assessment score (OR, 1.12; 95% CI, 1.08‐1.17; P < .0001). There was no difference in mortality when comparing early vs late intubation (less than or greater than 24 or 48 hours) for the NIPPV failure group. Conclusion: Noninvasive positive pressure ventilation failure is an independent risk factor for ICU mortality, but NIPPV patients who avoided intubation had the best outcomes compared with the other groups. Early vs late intubation did not have a significant impact on outcomes. HighlightsLarge cohort of 1614 cancer patients with hypoxemic respiratory failurePatients who failed noninvasive ventilation as first‐line treatment had lower survival rates than those who succeeded or those who were intubated.Younger age, nonwhite race, hematologicmalignancy, and a higher SOFA score were independent predictors of failure.No difference in mortality between early vs late intubation

862: MEASURING ETT CARINA DISTANCE USING THE AIRWAVE DEVICE IN PATIENTS IDENTIFIED AS A DIFFICULT AIRWAY.

(p<0.01).Overall, elective surgery hospital mortality decreased from 1.78% in Phase 1 to 1.44% in Phase 2 (NS). Conclusions: The strategy of safely moving surgical elective patients from ICU to IMCU has been successful. The majority of the elective surgical cases now go directly to IMCU and overall HLOS is lower by transitioning patients to IMCU post operatively instead of ICU. There are positive trends for decreases in transfers from IMCU to ICU and morality rates. Though the Intermediate Care Unit concept is popular, the literature on safety and efficient remains mixed. We attribute our improvement to careful planning, good case selection and monitoring.