Non-invasive ventilation : new bricks in the wall

Prognosis of cancer patients requiring invasive mechanical ventilation (IMV) is poor. Non invasive ventilation (NIV) has been shown associated with better results. The objective of the present study is to compare NIV and IMV in an overall cancer patients population. 47 patients treated by NIV were matched with 47 historical controls treated by IMV. Matching was performed according to 5 variables: type of cancer, leucopenia, allogeneic bone marrow transplantation, SAPS II score and cause of ventilation. 60%, 21% and 19% of the patients had respectively solid tumours, leucopenia and bone marrow transplantation. 72% of the patients were ventilated for hypoxemic respiratory failure, 21% for hypercapnic respiratory failure and 6% for acute pulmonary haemodynamic oedema. NIV was provided by BiPAP Vision ventilator and IMV by Servo or Evita 4 ventilator. 55% and 48% patients treated by NIV versus 27% and 23% treated by IMV were discharged from the ICU and from the hospital respectively. NIV was statistically more effective than IMV in solid tumours, non transplanted and non leucopenic patients. The probability of death in ICU and hospital was statistically higher in the IMV group and in leucopenic patients. In conclusion, initial NIV is more effective than IMV in cancer patients with acute respiratory failure. If non contra-indicated, NIV should be considered for cancer patients with acute respiratory failure requiring ventilation support, especially for non leucopenic patients.