- Paper Report
- Open Access
Multiple myeloma in the ICU
- Richard Venn
© Current Science Ltd 2000
- Published: 24 January 2000
- Bone marrow transplantation
- haematological patients
- intensive care
- mechanical ventilation
- multiple myeloma
- noninvasive mechanical ventilation
Intensivists have been reluctant in the past to offer intensive care to patients with haematological malignancies since the outcome is so poor. Haematologists argue that new chemotherapy regimes along with autologous stem cell transplantation have improved life-expectancy and perhaps attitudes should be changing with regard to some of these malignancies.
To identify prognostic factors affecting mortality in MM patients admitted to the ITU.
Retrospective analysis of case notes from 75 consecutive MM patients admitted to a teaching hospital ITU between 1992 and 1998.
Thirty day mortality was 57.2% (43 deaths) with 27.7% (37) occurring in the ITU. The mortality rate was 78% in patients requiring invasive mechanical ventilation. Univariate analysis revealed that neutropaenia on admission, requirement for vasopressor agents, and invasive mechanical ventilation were significantly associated with mortality, whereas NIV was not. In the multivariate analysis, female gender, invasive mechanical ventilation and vasopressor agents were independently associated with an increased mortality whereas ITU admission after 1995 and disease remission were not.
The very poor outcome in patients with MM requiring the use of vasopressor agents or invasive mechanical ventilation is similar to that seen in previously reported studies. The very small number of patients (4) who required only NIV were alive at 30 days and this form of ventilation has been proposed for patients with cancer. Neutropaenia is known to significantly affect outcome but unfortunately, since only one of the neutropaenic patients in this study didn't require ventilation, firm conclusions can not be drawn (because of the lack of statistical power). The lower 30 day mortality in those admissions after 1995 may have been due to different patient selection criteria or new treatments, and the authors comment on the increased use of NIV after 1995.