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Squadrone V., Ferreyra G., Ranieri V. M.
Dipartimento Anestesia e Rianimazione, Presidio Molinette, Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza di Torino, Torino, Italia
Immunosuppressed patients are usually considered together without distinction. However, patients with hematologic malignancy should be included in a different subcategory. The outcome of this population has improved over the years. However, mortality rate continues to be high, especially when respiratory complications are present and mechanical ventilation is required. Non-invasive ventilation (NIV) demonstrated its efficacy on the process of respiratory failure improving clinical outcomes in patients of different diagnoses. Recommendations of guidelines to use NIV in immunosuppressed patients have been quite prudent. However, NIV has been recently applied in hematologic malignancy patients during an early or/and late respiratory failure, showing a favorable impact improving the outcome. At an early stage, one study showed CPAP to reduce respiratory complications and to improve the outcome of mortality rate from 75% in the control group to 15% in the treatment group, when compared to oxygen therapy. In other two randomized control trials, NIV in comparison to invasive mechanical ventilation demonstrated to reduce mortality rate from 100% to 53-61%. As most of the non-randomized control trials applied NIV in a general population of immunosuppressed patients, results are very difficult to analyze. So far, the treatment starting, and duration time are still not clearly defined. Novel clinical trials should be performed to elucidate the appropriate application of NIV in this population.