Noninvasive ventilation in the treatment of acute respiratory failure induced by all-trans retinoic acid (retinoic acid syndrome) in children with acute promyelocytic leukemia

Abstract

PURPOSE: To evaluate the feasibility of noninvasive ventilation through a nasal mask in the treatment of acute respiratory failure induced by all-trans retinoic acid. DESIGN: Observational, nonrandomized report of two cases. SETTING: Intensive care unit in a university hospital. PATIENTS: Two pediatric patients (an 11-yr-old male and a 12-yr-old female) affected by acute promyelocytic leukemia. INTERVENTIONS: Pressure support ventilation was delivered via a nasal mask by means of a bilevel positive pressure ventilator (Respironics, Murrysville, PA). MEASUREMENTS AND MAIN RESULTS: We evaluated the effects of the bilevel positive pressure ventilator on blood gas analysis, respiratory rate, hemodynamics, patient tolerance, complications, and outcome. Patients showed an improvement of blood gas analysis and respiratory rate after 3-6 hrs of noninvasive ventilation. The nasal mask was well tolerated by the two patients. No complications were observed. Patients were discharged from the intensive care unit in stable clinical conditions after 3-4 days. CONCLUSIONS: Noninvasive ventilation by a nasal mask can offer effective ventilatory support and improve gas exchange in the treatment of acute respiratory failure in pediatric hematologic patients. In addition, noninvasive ventilation may decrease the risk of life-threatening complications associated with endotracheal intubation and conventional mechanical ventilation in patients with hematologic malignancies.