Hematologic Disease Clinical Trial
Official title:
Early Application of CPAP in Hematologic Neutropenic Patients Avoid Acute Respiratory Failure
The purpose of this study is to evaluate the use of CPAP in the prevention of acute respiratory failure in neutropenic ( or hematologic malignancy ) patients .CPAP applied preventively in hematological patients with high risk of ARF may reduce:need for intubations and mechanical ventilation, incidence of pneumonia and sepsis,mortality,length of ICU and hospital stay
Immunocompromised patients with a hematological malignancy that requiring admission in
intensive care unit (ICU) and subsequently mechanical ventilation for respiratory failure
was estimated between 20- 50 per cent of all admitted in hospital.
The survival rate of this patients that requiring mechanical ventilation is very poor.
In many cases the immunodepression with a great improvement in severe complication as
infections , pneumonia, sepsis , is the consequence of our therapy ( chemotherapy , bone
marrow transplantation and stem cell transplantation ) .
Pneumonia is very common cause of mechanical ventilation in about 45-74 per cent of the all
patient with acute respiratory failure (ARF) .
The trial was designed to enroll 40 patients in two groups to demonstrate reduction from 50%
to 10 % of the need of mechanical ventilation , with a type I risk of error of 5% and a
power of 80 %.
Patients were randomized to be treated for four days Venturi mask at a FiO2 of 0.4 (control)
or with oxygen at a FiO2 of 0.4 plus a CPAP of 10 cm H2O (CPAP). At the end of the 4-days
period, patients passed a screening test breathing ambient air. Patients returned to the
assigned treatment if SaO2 less than 95% a.a or respiratory rate more than 25 bpm.CPAP was
generated using a flow generator with an adjustable inspiratory oxygen fraction set to
deliver a flow of up to 140 liters per minute (Whisperflow, Caradyne, Ireland) and a
spring-loaded expiratory pressure valve (Vital Signs Inc, Totoma NJ) and applied using a
latex-free polyvinyl chloride transparent helmet (CaStar, Starmed, Italy) (15); all centers
measured the inspiratory oxygen fraction using an oxygen analyzer (Oxicheck, Caradyne,
Ireland) through the Venturi mask or the helmet.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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