Schnell David, Lemiale Virginie, Azoulay Élie
Crit Care. 2012 Nov 19;16(6):175. doi: 10.1186/cc11830.
Acute respiratory failure is a dreaded and life-threatening event that represents the main reason for ICU admission. Respiratory events occur in up to 50% of hematology patients, including one-half of those admitted to the ICU. Mortality from acute respiratory failure in hematology patients depends on the patient's general status, acute respiratory failure etiology, need for mechanical ventilation and associated organ dysfunction. Non-invasive mechanical ventilation is clearly beneficial for chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema. These benefits are based mainly on the avoidance of invasive mechanical ventilation complications. Non-invasive mechanical has also been recommended in hematology patients with acute respiratory failure but its real benefits remain unclear in these settings. There is growing concern about the safety of non-invasive mechanical ventilation to treat hypoxemic acute respiratory failure overall, but also in hematology patients. Prophylactic non-invasive mechanical ventilation in patients with acute respiratory failure but not respiratory distress seems to be effective in hematology patients with a reduced rate of intubation. However, curative non-invasive mechanical ventilation should be restricted to those patients with isolated respiratory failure, with fast improvement of respiratory distress under non-invasive mechanical ventilation, and with rapid switch to intubation to avoid deleterious delays in optimal invasive mechanical ventilation.
急性呼吸衰竭是一种可怕的、危及生命的事件，是重症监护病房（ICU）收治患者的主要原因。高达50%的血液学患者会发生呼吸事件，其中包括一半入住ICU的患者。血液学患者急性呼吸衰竭的死亡率取决于患者的一般状况、急性呼吸衰竭的病因、机械通气需求以及相关器官功能障碍。无创机械通气对慢性阻塞性肺疾病加重期和心源性肺水肿明显有益。这些益处主要基于避免有创机械通气的并发症。无创机械通气也被推荐用于急性呼吸衰竭的血液学患者，但在这些情况下其实际益处仍不明确。人们越来越关注无创机械通气治疗低氧性急性呼吸衰竭的安全性，在血液学患者中也是如此。对于急性呼吸衰竭但无呼吸窘迫的患者，预防性无创机械通气似乎对减少插管率的血液学患者有效。然而，治疗性无创机械通气应仅限于那些单纯呼吸衰竭的患者，这些患者在无创机械通气下呼吸窘迫能迅速改善，并且能迅速转为插管以避免在最佳有创机械通气中出现有害延误。
