[Noninvasive ventilation of the lungs in the treatment of acute respiratory failure in immunocompromised patients].

The purpose of this study was to evaluate the efficiency and place of noninvasive ventilation of the lungs (NVL) in the treatment of hypoxemic acute respiratory failure (ARF) in patients with tumorous diseases of the blood. The study was carried out in 12 patients (3 men and 9 women) with tumorous diseases of the blood system, in whom NVL was used for treating ARF. Central hemodynamic and oxygen transport parameters were studied using Swan-Hanz catheter. NVL was uneventfully carried out in 5 (41.7%) of 12 patients (group 1). Group 2 consisted of 7 patients intubated after the beginning of NVL: 2 had to be transferred to forced ventilation of the lungs (FVL) because of loss of consciousness and 5 because of augmenting severity of ARD. All patients transferred to FVL died. During the first 3 h of NVL, oxygen delivery increased from 371.3 +/- 84.9 to 443.9 +/- 92.7 gm/m2 and oxygen consumption from 123.9 +/- 35.9 to 173.5 +/- 34 m/m2, oxygen alveolar-arterial difference decreased from 400.8 +/- 165.3 to 210 +/- 57.5 mm Hg, pulmonary shunt from 41.8 +/- 11.9 to 19 +/- 7.9%, PaO2/FiO2 from 140.4 +/- 210 +/- 84.9, left-ventricular stroke index increased from 38.2 +/- 14.9 to 50.6 +/- 21.8 ml/m2, left-ventricular output index from 37 +/- 19.5 to 47.4 +/- 23.7 gm/m2, and heart rate decreased from 119.2 +/- 17.5 to 111.4 +/- 23.8 min-1. In group 2 greater fraction of inhaled oxygen and higher positive pressure at the end of inspiration were required than in group 1. Heart rate and oxygen alveolar-arterial difference were higher in group 2. Side effects of NVL were skin maceration, hematomas on the bridge of the nose, and conjunctivitis. A specific complication associated with thrombocytopenia was the hemorrhagic syndrome (nasal bleeding, hemorrhagic stomatitis). Hence, NVL is the first stage of respiratory support in hypoxemic ARF. In immunocompromised patients NVL is effective only in cases when the cause of damage to the lung is rapidly diagnosed and effective pathogenetic therapy promptly started.