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Background Subglottic stenosis (SGS) and tracheal stenosis (TS) are characterized by a narrowing of the airways. The goal of this study was to describe the characteristics and prognosis of nontraumatic and nontumoral SGS or TS. Research Question What are the inflammatory etiologies of SGS and TS, and what are their characteristics and prognosis? Study Design and Methods This multicenter, observational retrospective study was performed in patients with SGS or TS that was neither traumatic nor tumoral. Results Eighty-one patients were included, 33 (41%) with granulomatosis with polyangiitis (GPA) and 21 (26%) with relapsing polychondritis (RP). GPA-related stenoses exhibited circumferential subglottic narrowing in 85% of cases, without calcifications. In contrast, RP-related stenoses displayed anterior involvement in 76%, in a longer distance from vocal cords (4 cm), with calcifications in 62%, and extension to bronchi in 86%. Other diagnoses included bullous dermatoses (n = 3), amyloidosis (n = 3), sarcoidosis (n = 2), and Crohn’s disease (n = 2); the remaining stenoses (n = 15) were idiopathic. SGS/TS was the initial manifestation of the disease in 66% of cases, with a median interval from stenosis to disease diagnosis of 12 months (interquartile range, 0-48 months). Despite the use of glucocorticoids in 80%, combined with methotrexate in 49%, endoscopic procedures were required in 68% of patients. Relapses of stenoses occurred in 76% without any difference between causes (82% in GPA, 67% in RP, and 75% in idiopathic SGS/TS). Three patients died due to the stenosis, two of RP and one of GPA. Interpretation These data show that GPA and RP are the two main inflammatory diseases presenting with SGS/TS. GPA-related stenoses are mostly subglottic and circumferential, whereas RP-related stenoses are mostly tracheal, anterior, and calcified with a frequent extension to bronchi. Relapses of stenoses are common, and relapse rates do not differ between causes. Diagnosis and management of SGS/TS require a multidisciplinary approach.

Pulmonary sequelae as assessed by pulmonary function tests (PFTs) are often reported in patients infected by SARS-CoV-2 during the post-COVID-19 period. Little is known, however, about the status of pulmonary inflammation during clinical recovery after patients’ discharge from the hospitals. We prospectively measured PFTs coupled with the exhaled nitric oxide (NO) stemming from the proximal airways (FeNO) and the distal lung (CaNO) in 169 consecutive patients with varying degrees of the severity of COVID-19 six weeks to one year after acute infection by SARS-CoV-2. The proportions of patients with abnormal PFTs, defined as the presence of either obstructive/restrictive patterns or impaired lung gas transfer, or both, increased with the severity of the initial lung disease (15, 30, and 52% in patients with mild, moderate, and severe COVID-19). FeNO values remained within normal ranges and did not differ between the three groups of patients. CaNO, however, was significantly higher in patients with severe or critical COVID-19, compared with patients with milder forms of the disease. There was also an inverse relationship between CaNO and DLCO. We conclude that the residual inflammation of the distal lung is still present in the post-COVID-19 follow-up period, in particular, in those patients with an initially severe form of COVID-19. This long-lasting alveolar inflammation might contribute to the long-term development of pulmonary fibrosis and warrants the regular monitoring of exhaled NO together with PFTs in patients with COVID-19.

Resume L’atteinte tracheo-bronchique touche 20 a 50 % des patients atteints de polychondrite atrophiante et peut representer le mode d’entree dans la maladie. Il convient de la rechercher lors du diagnostic et a chaque visite de suivi. La recherche d’une atteinte respiratoire doit inclure la realisation d’un scanner thoracique avec des coupes realisees en expiration et des epreuves fonctionnelles respiratoires. Ces examens complementaires doivent etre realises systematiquement au diagnostic, meme chez les patients asymptomatiques, et ils doivent etre repetes regulierement au cours du suivi. L’indication de la fibroscopie doit rester tres prudente et elle ne doit etre realisee que chez des patients symptomatiques par des endoscopistes experts. L’indication d’un geste local doit etre posee avec grande prudence, apres concertation pluridisciplinaire, en raison notamment des risques de perforation de la muqueuse tracheo-bronchique. Un depistage precoce et la prise en charge des atteintes tracheo-bronchiques de la polychondrite atrophiante ont permis l’amelioration de leur pronostic, notamment depuis le developpement de la fibroscopie interventionnelle.

Introduction La granulomatose sarcoidosique necrosante (GSN) est une maladie rare, d’etiologie inconnue. Decrite pour la premiere fois par Liebow en 1973, elle associe histologiquement des granulomes sarcoidosiques, une vascularite et une necrose plus ou moins etendue. Cette entite se situe donc a la frontiere entre les vascularites necrosantes et la sarcoidose. De nombreux cas ont ete rapportes dans la litterature, mais les cas decrits avant la decouverte des ANCA et la classification des vascularites systemiques sont difficilement classables. L’objectif de ce travail est de decrire les caracteristiques cliniques, radiologiques et histologiques des GSN ainsi que leur evolution, apres les annees 1990, date de la caracterisation des vascularites a ANCA. Materiels et methodes Nous avons realise une etude descriptive retrospective de cas presentant une GSN definie selon les criteres suivants : presence de granulome « sarcoid-like » associe a de la necrose et a des lesions de vascularite sur une biopsie, apres exclusion des diagnostics differentiels, a savoir les vascularites associees aux ANCA, la sarcoidose et les infections chroniques (notamment a mycobacteries). Nous avons egalement realise une revue de la litterature medicale en se basant sur les mots-cles necrotizing sarcoid granulomatosis, et en excluant les diagnostics portes avant 1990 devant l’impossibilite de classer correctement ces patients. Resultats Treize patients ont ete inclus, dont la majorite etait des femmes (70 %) et ne presentait pas d’antecedent particulier hormis un tabagisme actif pour pres de la moitie. L’âge median au diagnostic etait de 37 ans. Cliniquement, 9 patients avaient des signes fonctionnels respiratoires et 5 des signes generaux, tandis qu’un seul etait asymptomatique. Biologiquement, un syndrome inflammatoire etait present chez 2 patients, aucun n’avait d’ANCA et l’enzyme de conversion de l’angiotensine (ECA) etait augmentee chez un patient. Tous presentaient une atteinte thoracique, avec au scanner des nodules dans 10 cas et/ou des masses pulmonaires dans 5 cas, associes dans pres de la moitie des cas a des adenopathies mediastinales et/ou hilaires. Huit patients (62 %) avaient des atteintes extra-thoraciques, dont la principale etait une atteinte ophtalmologique dans 4 cas. Le diagnostic etait porte chez tous les patients par une biopsie pulmonaire chirurgicale. Les traitements de premiere ligne comprenaient l’abstention therapeutique dans 5/12 cas, l’exerese chirurgicale seule dans 4/12 cas, une corticotherapie dans 3/12 cas et un traitement immunosuppresseur chez un patient. Apres une duree mediane de suivi de 2.65 ans, aucun deces n’est survenu. Dix patients ont presente une evolution favorable mais la moitie a rechute secondairement. La revue de la litterature a retrouve 64 cas repondant a nos criteres d’inclusion, rapportes entre 1993 et 2020. On notait une predominance feminine (59 %) et un âge moyen de 38,3 ans. Seuls 4 % des patients etaient asymptomatiques. En revanche, 53 % des patients presentaient des signes generaux (fievre dans 30 %) et 67 % des signes respiratoires. Les atteintes extra-respiratoires etaient principalement des atteintes ophtalmologiques (16 %), hepatiques (14 %), neurologiques (13 %) et articulaires (11 %). Une atteinte thoracique etait retrouvee dans 83 % des cas, avec des nodules pulmonaires uniques ou multiples dans 70 % des cas et des adenopathies mediastinales ou hilaires dans un tiers des cas. L’ECA etait augmentee dans 18 % des cas. Le diagnostic histologique, le plus souvent porte sur des biopsies pulmonaires chirurgicales, montrait, outre les granulomes sarcoidosiques, de la necrose de taille variable et des lesions de vascularite qui pouvaient etre granulomateuses, a cellules geantes ou representees par un infiltrat lymphocytaire. L’evolution initiale etait favorable dans tous les cas suite a une prise en charge therapeutique reposant sur une corticotherapie dans 60 %, une resection chirurgicale dans 11 %, et une abstention therapeutique dans 28 % des cas. Des rechutes etaient observees dans un quart des cas, avec 3 deces tous en lien avec la GSN. Conclusion Nos donnees et celles de la litterature sont concordantes. La GSN est une maladie a predominance feminine et de presentation principalement pulmonaire, dont l’evolution est classiquement benigne. La distinction entre une entite a part entiere, une forme de sarcoidose ou une vascularite necrosante reste controversee.

Introduction Les stenoses sous-glottiques (SGS) sont une affection congenitale ou acquise caracterisees par un retrecissement des voies respiratoires superieures s’etendant juste en dessous des cordes vocales jusqu’au bord inferieur du cartilage cricoide. Nous avons cherche a decrire les caracteristiques et le pronostic des SGS non tumorales et non traumatiques. Patients et methodes Nous avons mene une etude retrospective observationnelle multicentrique, incluant les patients hospitalises pour stenose sous-glottique non tumorale et non traumatique de 2010 a 2020. Nous avons pour cela fait appel aux codages hospitaliers afin d’etre le plus exhaustif dans notre recueil. Resultats Quatre-vingt-deux patients etaient inclus dans l’etude, avec un âge median de 42 ans [28–57] et une predominance feminine (n = 59, 72 %). Trente-trois (40 %) patients avaient un diagnostic de granulomatoses avec polyangeite (GPA) et 21 (26 %) un diagnostic de polychondrite atrophiante (PCA). Les SGS survenant au cours des GPA etaient circonferentielles dans 85 % des cas (n = 28) et majoritairement non calcifiees. En revanche, celles survenant au cours des PCA se situaient essentiellement a la face anterieure de la trachee dans 76 % des cas (n = 16), etaient calcifies dans 62 % des cas (n = 13) et s’etendaient vers les bronches dans 86 % des cas (n = 18). La presence d’une tracheobronchomalacie n’etait pas significativement associees a l’une ou l’autre des etiologies. Les autres etiologies de SGS, beaucoup plus rares, etaient les dermatoses bulleuses (n = 3), l’amylose AL (n = 3), la sarcoidose (n = 2), la maladie de Crohn (n = 2) et la cause hormonale (n = 3). Enfin, 12 SGS (15 %) etaient considerees d’origine idiopathique. La SGS etait la manifestation inaugurale de la maladie dysimmunitaire dans 44 cas (66 %), avec dans ce cas un delai median entre la SGS et le diagnostic etiologique de 12 mois [0–48]. Malgre l’utilisation d’une corticotherapie systemique chez 66 patients (80 %), en association au methotrexate chez 40 patients (49 %), une procedure endoscopique etait necessaire chez 56 patients (68 %). Soixante-deux patients (76 %) rechutaient de leur stenose. Aucune difference n’etait retrouvee en termes de rechute selon l’etiologie sous-jacente (82 % des GPA, 67 % des PCA et 75 % des idiopathiques, p = 0,69). Trois patients sont decedes de leur SGS, deux PCA et une GPA. Conclusion Cette etude souligne que les GPA et les PCA sont les etiologies dysimmunitaires les plus frequemment responsables de SGS. Les SGS de GPA sont circonferentielles alors que celles des PCA sont majoritairement strictement anterieures et calcifiees. Le clinicien peut alors s’aider des resultats immunologiques, scannographiques et endoscopiques.

Mechanical ventilation (MV) is necessary for many patients admitted in intensive care unit (ICU). In intubated patients, weaning from invasive MV is a major event during their ICU stay (1,2). Delayed extubation increases the risks associated with IMV and extubation failure is associated with prolonged ICU and hospital stays and increased mortality, particularly attributable to nosocomial infection (3-5).

Background Metastatic spread to the tracheobronchial tree from other than bronchopulmonary tumors is a common clinical problem. However, malignant melanoma, a highly metastatic potential tumor, is rarely metastasing in the airways. Therefore little is known about survival of patients with endobronchial metastasis from melanoma. Objectives The aim of our study was to assess survival of patients with endobronchial metastasis of melanomas according to clinical and radiological features, to determine any possible factor affecting survival. Methods This retrospective study included 19 patients who underwent a bronchoscopy from 11 different hospitals. Data about patients' demographics, symptoms, radiographic, endoscopic findings and treatment were investigated to evaluate any possible impact on survival. Results Endobronchial metastases occurred at a median of 48 months (range 0-120) following the diagnosis of the primary tumor. About 73.7% of patients had other proven metastases when the endobronchial involvement was diagnosed. Symptoms are not specific as well as radiological features. Median overall survival of the studied population was 6 months (range 1-46). Factors of poor survival were multiple metastatic sites (P = 0.019), pleural (P = 0.0014) and soft tissue metastasis (P = 0.024). Different treatment modalities applied in our patients showed no effect on survival. Conclusion Patients with endobronchial metastasis have overall poor survival, affected by multiple organ involvement, the presence of pleural and soft tissue disease, while no impact on survival has been shown by any treatment applied.

We report an overall 24%(95% CI; 17–32%) cumulative incidence of pulmonary embolism in patients with COVID-19 pneumonia, 50% (30–70%) in ICU and 18% (12–27%) in other patients

To investigate whether prophylactic postoperative NIV prevents respiratory complications following lung resection surgery in COPD patients. In seven thoracic surgery departments, 360 COPD patients undergoing lung resection surgery were randomly assigned to two groups: conventional postoperative treatment without (n = 179) or with (n = 181) prophylactic NIV, applied intermittently during 6 h per day for 48 h following surgery. The primary endpoint was the rate of acute respiratory events (ARE) at 30 days postoperatively (ITT analysis). Secondary endpoints were acute respiratory failure (ARF), intubation rate, mortality rate, infectious and non-infectious complications, and duration of ICU and hospital stay. ARE rates did not differ between the prophylactic NIV and control groups (57/181, 31.5 vs. 55/179, 30.7 %, p = 0.93). ARF rate was 18.8 % in the prophylactic NIV group and 24.5 % in controls (p = 0.20). Re-intubation rates were similar in the prophylactic NIV and control group [10/181 (5.5 %) and 13/179 (7.2 %), respectively, p = 0.53]. Mortality rates were 5 and 2.2 % in the control and prophylactic NIV groups, respectively (p = 0.16). Infectious and non-infectious complication rates, and duration of ICU and hospital stays were similar between groups. Prophylactic postoperative NIV did not reduce the rate of ARE in COPD patients undergoing lung resection surgery and did not influence other postoperative complications rates, mortality rates, and duration of ICU and hospital stay.

Metastatic spread to the tracheobronchial tree from other than bronchopulmonary tumors is a common clinical problem. However, malignant melanoma, a highly metastatic potential tumor, is rarely metastasing in the airways. Therefore little is known about survival of patients with endobronchial metastasis from melanoma.The aim of our study was to assess survival of patients with endobronchial metastasis of melanomas according to clinical and radiological features, to determine any possible factor affecting survival.This retrospective study included 19 patients who underwent a bronchoscopy from 11 different hospitals. Data about patients' demographics, symptoms, radiographic, endoscopic findings and treatment were investigated to evaluate any possible impact on survival.Endobronchial metastases occurred at a median of 48 months (range 0-120) following the diagnosis of the primary tumor. About 73.7% of patients had other proven metastases when the endobronchial involvement was diagnosed. Symptoms are not specific as well as radiological features. Median overall survival of the studied population was 6 months (range 1-46). Factors of poor survival were multiple metastatic sites (P = 0.019), pleural (P = 0.0014) and soft tissue metastasis (P = 0.024). Different treatment modalities applied in our patients showed no effect on survival.Patients with endobronchial metastasis have overall poor survival, affected by multiple organ involvement, the presence of pleural and soft tissue disease, while no impact on survival has been shown by any treatment applied.

We conducted a study to evaluate a noninvasive strategy including spiral computed tomography (CT) in patients with suspected pulmonary embolism (PE). We systematically performed spiral CT, ventilation/perfusion lung scanning, and D-dimer (DD) measurement (VIDAS test), and in some cases (with a normal CT with nondiagnostic lung scan and increased DD) performed venous ultrasonography (US) on 247 consecutive patients with clinically suspected PE in our hospital. Patients in whom PE was deemed absent were not given anticoagulants. All patients were followed for 3 mo. The prevalence of PE in the 228 patients who could be evaluated was 42% (96 of 228). PE was confirmed by spiral CT in 73% of the patients, by a high-probability lung scan in 4%, and by findings on US in 23%. PE was ruled out by a normal lung scan in 14% of the patients, by a normal DD concentration (500 ng/ml) in 31%, by an obvious differential diagnosis on spiral CT in 18%, by a similar prior lung scan in 11%, and by the combination of normal spiral CT findings, a nondiagnostic lung scan, a DD concentration500 ng/ml, and normal US in 26%. Pulmonary angiography was performed in only two patients, both of whom had a normal spiral CT scan and a high-probability lung scan, and was normal. The 3-mo risk of thromboembolism in patients not given anticoagulants, based on the results of the diagnostic protocol, was 1.7% (95% confidence interval: 1.5 to 2.3%). There were no deaths. The noninvasive strategy of combining spiral CT, lung scanning, DD measurement, and in some cases US, in patients with suspected PE yielded a definite diagnosis in 99% of patients, and appeared to be safe.

To investigate whether prophylactic postoperative NIV prevents respiratory complications following lung resection surgery in COPD patients.In seven thoracic surgery departments, 360 COPD patients undergoing lung resection surgery were randomly assigned to two groups: conventional postoperative treatment without (n = 179) or with (n = 181) prophylactic NIV, applied intermittently during 6 h per day for 48 h following surgery. The primary endpoint was the rate of acute respiratory events (ARE) at 30 days postoperatively (ITT analysis). Secondary endpoints were acute respiratory failure (ARF), intubation rate, mortality rate, infectious and non-infectious complications, and duration of ICU and hospital stay.ARE rates did not differ between the prophylactic NIV and control groups (57/181, 31.5 vs. 55/179, 30.7%, p = 0.93). ARF rate was 18.8% in the prophylactic NIV group and 24.5% in controls (p = 0.20). Re-intubation rates were similar in the prophylactic NIV and control group [10/181 (5.5%) and 13/179 (7.2%), respectively, p = 0.53]. Mortality rates were 5 and 2.2% in the control and prophylactic NIV groups, respectively (p = 0.16). Infectious and non-infectious complication rates, and duration of ICU and hospital stays were similar between groups.Prophylactic postoperative NIV did not reduce the rate of ARE in COPD patients undergoing lung resection surgery and did not influence other postoperative complications rates, mortality rates, and duration of ICU and hospital stay.

We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk stratification in comparison to the PESI alone. The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of cardiac troponin I and brain natriuretic peptide. 30-day adverse outcome was defined as death, recurrent PE or shock. 529 patients were included, 25 (4.7%, 95% CI 3.2-6.9%) had at least one outcome event. The proportion of patients with adverse events increased from 2.1% in PESI class I-II to 8.4% in PESI class III-IV, and to 14.3% in PESI class V (p

International audience; BACKGROUND: The safety of fiberoptic bronchoscopy (FOB) in nonintubated critically ill patients with acute respiratory failure has not been extensively evaluated. We aimed to measure the incidence of intubation and the need to increase ventilatory support following FOB and to identify predictive factors for this event. METHODS: A prospective multicenter observational study was carried out in eight French adult intensive care units. The study included 169 FOB performed in patients with a PaO(2)/FiO(2) ratio ≤ 300. The main end-point was intubation rate. The secondary end-point was rate of increased ventilatory support defined as an increase in oxygen requirement >50 %, the need to start noninvasive positive pressure ventilation (NI-PPV) or increase NI-PPV support. RESULTS: Within 24 h, an increase in ventilatory support was required following 59 bronchoscopies (35 %), of which 25 (15 %) led to endotracheal intubation. The existence of chronic obstructive pulmonary disease (COPD; OR 5.2, 95 % CI 1.6-17.8; p = 0.007) or immunosuppression (OR 5.4, 95 % CI 1.7-17.2; p = 0.004] were significantly associated with the need for intubation in the multivariable analysis. None of the baseline physiological parameters including the PaO(2)/FiO(2) ratio was associated with intubation. CONCLUSIONS: Bronchoscopy is often followed by an increase in ventilatory support in hypoxemic critically ill patients, but less frequently by the need for intubation. COPD and immunosuppression are associated with the need for invasive ventilation in the 24 h following bronchoscopy.

International audience; BACKGROUND: Idiopathic tracheal stenosis (ITS) is a rare condition representing a difficult therapeutic challenge. Endoscopic management is a therapeutic option but long-term results are not established. The aim of this retrospective multicenter study was to analyze long-term outcome after endoscopic management of ITS. METHODS: Nine institutions involved in interventional bronchoscopy were contacted and asked to identify ITS endoscopically treated. A standard form was used to report the main characteristics and long-term outcome after endoscopic management. RESULTS: Twenty-three patients, 96% women, aged 45±16 years, were endoscopically treated for ITS. Time between first symptoms and diagnosis was 19±18 months. Bronchoscopy showed a weblike (61%) or complex (39%) stenosis, located in the upper part of the trachea, mainly in the cricoid area. Endoscopic treatment included mechanical dilation only (52%) or associated with laser or electrocoagulation (30%) and stent placement (18%). All procedures were efficient. The follow-up after endoscopic management was 41±34 months. The ITS recurrence occurred in 30% at 6 months, 59% at 2 years, and 87% at 5 years, with a delay of 14±16 months. The treatment of recurrence (n=13) included endoscopic management in 12 cases. CONCLUSIONS: Endoscopic management of ITS provides a safe and efficient therapeutic option but late recurrences are frequent and require long-term follow-up.

International audience; RATIONALE: The short-term prognosis of pulmonary embolism (PE) depends on hemodynamic status and underlying disease. The prognostic value of right ventricular dysfunction and injury is less well established. OBJECTIVES: To evaluate prognostic factors of PE in a multicenter prospective cohort study. METHODS: Echocardiography, brain natriuretic peptide (BNP), N-terminal-proBNP and cardiac troponin I measurements were done on admission of 570 consecutive patients with an acute PE. A predictive model was based on independent predictors of thirty-day adverse events defined as death, secondary cardiogenic shock or recurrent venous thromboembolism. MEASUREMENTS AND MAIN RESULTS: At 30 days, 42 patients (7.4%; 95% confidence interval (CI), 5.5% to 9.8%) had adverse events. On multivariate analysis, altered mental state (OR 6.8; 95% CI, 2.0 to 23.3), shock on admission (OR 2.8; 95% CI, 1.1 to 7.5), cancer (OR 2.9; 95% CI, 1.2 to 6.9), BNP (OR 1.3 for an increase of 250 ng/L; 95% CI, 1.1 to 1.6) and right to left ventricle diameter ratio (OR 1.2 for an increase of 0.1; 95% CI, 1.1 to 1.4) were associated with 30-day adverse events. The predictive performance of the model was good (area under receiver operating characteristics curve 0.84 (95% CI, 0.78 to 0.90)), making it possible to develop a bedside prognostic score. CONCLUSION: BNP and echocardiography may be useful determinants of the short-term outcome for patients with PE, together with clinical findings. PE patients can be stratified according to the initial risk of adverse outcome, using a simple score based on clinical, echocardiographic and biochemical variables.

A single prospective randomized study found that, in selected patients with acute respiratory failure (ARF) following lung resection, noninvasive ventilation (NIV) decreases the need for endotracheal mechanical ventilation and improves clinical outcome.We prospectively evaluated early NIV use for ARF after lung resection during a 4-year period in the setting of a medical and a surgical ICU of a university hospital. We documented demographics, initial clinical characteristics and clinical outcomes. NIV failure was defined as the need for tracheal intubation.Among 690 patients at risk of severe complications following lung resection, 113 (16.3%) experienced ARF, which was initially supported by NIV in 89 (78.7%), including 59 with hypoxemic ARF (66.3%) and 30 with hypercapnic ARF (33.7%). The overall success rate of NIV was 85.3% (76/89). In-ICU mortality was 6.7% (6/89). The mortality rate following NIV failure was 46.1%. Predictive factors of NIV failure in univariate analysis were age (P = 0.046), previous cardiac comorbidities (P = 0.0075), postoperative pneumonia (P = 0.0016), admission in the surgical ICU (P = 0.034), no initial response to NIV (P0.0001) and occurrence of noninfectious complications (P = 0.037). Only two independent factors were significantly associated with NIV failure in multivariate analysis: cardiac comorbidities (odds ratio, 11.5; 95% confidence interval, 1.9-68.3; P = 0.007) and no initial response to NIV (odds ratio, 117.6; 95% confidence interval, 10.6-1305.8; P = 0.0001).This prospective survey confirms the feasibility and efficacy of NIV in ARF following lung resection.

This retrospective study assessed the prognostic factors associated with early and long-term outcome in consecutive patients with acute myeloid leukaemia (AML) admitted to the intensive care unit (ICU) over a 9-year period. A total of 83 patients were studied (age 48 +/- 16 years), among whom 60% were neutropenic on admission. For 68%, admission occurred within the first month following diagnosis of AML. The main reason for ICU admission was an acute respiratory disease in 82% of cases. Mechanical ventilation (MV) was required in 57% of patients. In-ICU mortality was 34%. Among patients discharged alive from ICU, 49% died within a year after discharge. Factors significantly associated with in-ICU death in multivariate analysis were simplified acute physiology score II and need for invasive MV (IMV). Age, performance status, AML3 subtype and complete remission were significantly associated with 1-year survival. Patients with acute respiratory failure initially supported with non-invasive MV had significantly better ICU outcome than patients initially supported with IMV. In conclusion, ICU admission is justified for selected patients with AML. The ICU mortality rate is highly predictable by the acute illness severity score. A 1-year survival is predicted by haematological prognostic factors.