human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND This study was undertaken to evaluate the clinical characteristics and outcomes of patients with cancer requiring nonpalliative ventilatory support . METHODS This was a secondary analysis of a prospect i ve cohort study conducted in 28 Brazilian ICUs evaluating adult patients with cancer requiring invasive mechanical ventilation ( MV ) or noninvasive ventilation ( NIV ) during the first 48 h of their ICU stay . We used logistic regression to identify the variables associated with hospital mortality . RESULTS Of 717 patients , 263 ( 37 % ) ( solid tumors = 227 ; hematologic malignancies = 36 ) received  ventilatory support . NIV was initially used in 85 patients ( 32 % ) , and 178 ( 68 % ) received MV . Additionally , NIV followed by MV occurred in 45 patients ( 53 % ) . Hospital mortality rates were 67 % in all patients , 40 % in patients receiving NIV only , 69 % when NIV was followed by MV , and 73 % in patients receiving MV only ( P < .001 ) . Adjusting for the type of admission , newly diagnosed malignancy ( OR , 3.59 ; 95 % CI , 1.28 - 10.10 ) , recurrent or progressive malignancy ( OR , 3.67 ; 95 % CI , 1.25 - 10.81 ) , tumoral airway involvement ( OR , 4.04 ; 95 % CI , 1.30 - 12.56 ) , performance status ( PS ) 2 to 4 ( OR , 2.39 ; 95 % CI , 1.24 - 4.59 ) , NIV followed by MV ( OR , 3.00 ; 95 % CI , 1.09 - 8.18 ) ,  MV  as initial ventilatory strategy ( OR , 3.53 ; 95 % CI , 1.45 - 8.60 ) , and Sequential Organ Failure Assessment score ( each point except the respiratory domain ) ( OR , 1.15 ; 95 % CI , 1.03 - 1.29 ) were associated with hospital mortality . Hospital survival in patients with good PS and nonprogressive malignancy and without tumoral airway involvement was 53 % . Conversely , patients with poor functional capacity and cancer progression had unfavorable outcomes . CONCLUSIONS Patients with cancer with good PS and nonprogressive disease requiring ventilatory support should receive full intensive care , because one-half of these patients survive . On the other h and , provision of palliative care should be considered the main goal for patients with poor PS and progressive underlying malignancy Introduction Hematology patients admitted to the ICU frequently experience respiratory failure and require mechanical ventilation . Noninvasive mechanical ventilation ( NIMV ) may decrease the risk of intubation , but NIMV failure poses its own risks . Methods To establish the impact of ventilatory management and NIMV failure on outcome , data from a prospect i ve , multicenter , observational study were analyzed . All hematology patients admitted to one of the 34 participating ICUs in a 17-month period were followed up . Data on demographics , diagnosis , severity , organ failure , and supportive therapies were recorded . A logistic regression analysis was done to evaluate the risk factors associated with death and NIVM failure . Results Of 450 patients , 300 required ventilatory support  . A diagnosis of congestive heart failure and the initial use of NIMV significantly improved survival , whereas APACHE II score , allogeneic transplantation , and NIMV failure increased the risk of death . The risk factors associated with NIMV success were age , congestive heart failure , and bacteremia . Patients with NIMV failure experienced a more severe respiratory impairment than did those electively intubated . Conclusions NIMV improves the outcome of hematology patients with respiratory insufficiency , but NIMV failure may have the opposite effect . A careful selection of patients with rapidly reversible causes of respiratory failure may increase NIMV success Objective . To compare noninvasive positive pressure ventilation ( NPPV ) vs. invasive mechanical ventilation in AIDS patients with Pneumocystis carinii pneumonia (PCP)-related acute respiratory failure ( ARF ) . Design : A single-center , prospect i ve , case-control trial . Setting : An ICU of a private tertiary hospital specialized in infectious disease . Patients : Forty-eight AIDS patients with severe PCP-related ARF needing mechanical ventilation . Interventions : Twenty-four patients treated with NPPV by a facial mask strictly matched with 24 patients treated with invasive ventilation by endotracheal intubation . Results : Use of NPPV  avoided intubation in 67 % of patients , and avoidance of intubation was associated with improved survival ( 100 % vs. 38 % ; P=0.003 ) . NPPV-treated patients required fewer invasive devices ( P<0.001 ) and had a lower incidence of pneumothoraces ( 8.3 % vs. 37.5 % ; P=0.039 ) . The NPPV-treated group required a nurse workload similar to that of the conventional ventilation group , but this group had a shorter duration of stay in the ICU ( P=0.013 ) . The NPPV-treated group had a lower mortality in the ICU , the hospital and within 2 months of study entry . Differences in mortality between the two groups disappeared after 6 months . Conclusions : The findings of this study seem to provide further support for applying NPPV in AIDS patients with severe PCP-related ARF as a first-line therapeutic choice , but r and omized controlled trials are required to confirm our results CONTEXT Noninvasive ventilation ( NIV ) has been associated with lower rates of endotracheal intubation in population s of patients with acute respiratory failure . OBJECTIVE To compare NIV with st and ard treatment using supplemental oxygen administration to avoid endotracheal intubation in recipients of solid organ transplantation with acute hypoxemic respiratory failure . DESIGN AND SETTING Prospect i ve r and omized study conducted at a 14-bed , general intensive care unit of a university hospital . PATIENTS Of 238 patients who underwent solid organ transplantation from December 1995 to October 1997 , 51 were treated for acute respiratory failure . Of these , 40 were eligible and 20 were r and omized to each group . INTERVENTION Noninvasive ventilation vs st and ard treatment with supplemental oxygen administration . MAIN OUTCOME MEASURES The need for endotracheal intubation and mechanical ventilation at any time during the study , complications not present on admission , duration of ventilatory assistance , length of hospital stay , and intensive care unit mortality . RESULTS The 2 groups were similar at study entry . Within the first hour of treatment , 14 patients ( 70 % ) in the NIV group , and 5 patients ( 25 % ) in the st and ard treatment group improved their ratio of the PaO2 to the fraction of inspired oxygen ( FIO2 ) . Over time , a sustained improvement in PaO2 to FIO2 was noted in 12 patients ( 60 % ) in the NIV group , and in 5 patients ( 25 % ) r and omized to st and ard treatment ( P = .03 ) . The use of NIV was associated with a significant reduction in the rate of endotracheal intubation ( 20 % vs 70 % ; P = .002 ) , rate of fatal complications ( 20 % vs 50 % ; P = .05 ) , length of stay in the intensive care unit by survivors ( mean [ SD ] days , 5.5 [ 3 ] vs 9 [ 4 ] ; P = .03 ) , and intensive care unit mortality ( 20 % vs 50 % ; P = .05 ) . Hospital mortality did not differ . CONCLUSIONS These results indicate that transplantation programs should consider NIV in the treatment of selected recipients of transplantation with acute respiratory failure Abstract Background We investigated the clinical course and mortality of acute respiratory distress syndrome ( ARDS ) in patients with hematological malignancies . Methods Sixty-eight patients with hematological malignancies and ARDS admitted to medical intensive care unit ( ICU ) of a university hospital were analyzed semi- prospect ively in the study . Results The most common etiology of ARDS was pneumonia . The ratio of partial pressure of oxygen in arterial blood to fractional concentration of inspired oxygen ( PO2/FiO2 ) was 104 ( 74–165 ) . Ten patients ( 15 % ) received non-invasive mechanical ventilation ( NIV ) , 21 ( 31 % ) received invasive mechanical ventilation ( MV ) , and 36 ( 53 % ) received both NIV and invasive MV .  ICU mortality was 77 % in the cohort . None of the variables with relevance to the underlying hematological disease was associated with mortality . The presence of two or more organ failures was the only independent risk factor for mortality ( P = 0.045 ) , whereas NIV was associated with low mortality ( P = 0.001 ) . The Kaplan – Meier curve of mortality , with respect to the type of MV support , demonstrated that NIV was associated with the lowest mortality ( P < 0.001 ) . Conclusion The mortality of ARDS in critically ill patients with hematological malignancies is quite high . The presence of multi-organ failure is independently associated with high mortality whereas the use of NIV is independently associated with low mortality Abstract Objectives To analyze clinical characteristics , treatment , outcomes of critically ill patients with hematologic malignancies ( HM ) admitted to the medical intensive care unit ( ICU ) and to identify predictors of adverse outcome . Methods We analyzed prospect ively 170 patients . Data included : demographic characteristics , hematologic diagnosis , reasons for ICU admission , transplant status , the presence of neutropenia , acute physiology and chronic health evaluation-II and sequential organ failure assessment scores , and level of organ support . Predictors of ICU mortality were evaluated using univariate and multivariate analysis . Results In total , 73 % of patients had high- grade malignancy , 47.6 % received intensive chemotherapy before admission , and 30 % underwent hematologic stem cell transplantation procedure . In total , 116 ( 68.2 % ) of patients were mechanically ventilated ; 88 ( 51.8 % ) required invasive mechanical ventilation ( MV ) . Non-invasive ventilation started in 28 ( 16.5 % ) patients and was successful in 11 ( 6.5 % ) . The ICU mortality rate was 53.5 % , and the mortality of MV patients was 75.9 % . Need for vasopressors at admission and MV were identified as independent predictors of fatal outcome . Conclusion The ICU mortality of critically ill patients with HM is high , particularly in the group of MV . Need for vasopressors at admission and MV were independent predictors of ICU mortality . Majority of patients required invasive MV due to severe respiratory failure and non-invasive MV was sufficient only in small number of cases with favorable outcome IMPORTANCE Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure . However , its effectiveness for this indication remains unclear . OBJECTIVE To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acute hypoxemic respiratory failure . DESIGN , SETTING , AND PARTICIPANTS Multicenter r and omized trial conducted among 374 critically ill immunocompromised patients , of whom 317 ( 84.7 % ) were receiving treatment for hematologic malignancies or solid tumors , at 28 intensive care units ( ICUs ) in France and Belgium between August 12 , 2013 , and January 2 , 2015 . INTERVENTIONS Patients were r and omly assigned to early noninvasive ventilation ( n = 191 ) or oxygen therapy alone ( n = 183 ) . MAIN OUTCOMES AND MEASURES The primary outcome was day-28 mortality . Secondary outcomes were intubation , Sequential Organ Failure Assessment score on day 3 , ICU-acquired infections , duration of mechanical ventilation , and ICU length of stay . RESULTS At r and omization , median oxygen flow was 9 L/min ( interquartile range , 5 - 15 ) in the noninvasive ventilation group and 9 L/min ( interquartile range , 6 - 15 ) in the oxygen group . All patients in the noninvasive ventilation group received the first noninvasive ventilation session immediately after r and omization . On day 28 after r and omization , 46 deaths ( 24.1 % ) had occurred in the noninvasive ventilation group vs 50 ( 27.3 % ) in the oxygen group ( absolute difference , -3.2 [ 95 % CI , -12.1 to 5.6 ] ; P = .47 ) . Oxygenation failure occurred in 155 patients overall ( 41.4 % ) , 73 ( 38.2 % ) in the noninvasive ventilation group and 82 ( 44.8 % ) in the oxygen group ( absolute difference , -6.6 [ 95 % CI , -16.6 to 3.4 ] ; P = .20 ) . There were no significant differences in ICU-acquired infections , duration of mechanical ventilation , or lengths of ICU or hospital stays . CONCLUSIONS AND RELEVANCE Among immunocompromised patients admitted to the ICU with hypoxemic acute respiratory failure , early noninvasive ventilation compared with oxygen therapy alone did not reduce 28- 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND This study was undertaken to evaluate the clinical characteristics and outcomes of patients with cancer requiring nonpalliative ventilatory support . METHODS This was a secondary analysis of a prospect i ve cohort study conducted in 28 Brazilian ICUs evaluating adult patients with cancer requiring invasive mechanical ventilation ( MV ) or noninvasive ventilation ( NIV ) during the first 48 h of their ICU stay . We used logistic regression to identify the variables associated with hospital mortality . RESULTS Of 717 patients , 263 ( 37 % ) ( solid tumors = 227 ; hematologic malignancies = 36 ) received  ventilatory support . NIV was initially used in 85 patients ( 32 % ) , and 178 ( 68 % ) received MV . Additionally , NIV followed by MV occurred in 45 patients ( 53 % ) . Hospital mortality rates were 67 % in all patients , 40 % in patients receiving NIV only , 69 % when NIV was followed by MV , and 73 % in patients receiving MV only ( P < .001 ) . Adjusting for the type of admission , newly diagnosed malignancy ( OR , 3.59 ; 95 % CI , 1.28 - 10.10 ) , recurrent or progressive malignancy ( OR , 3.67 ; 95 % CI , 1.25 - 10.81 ) , tumoral airway involvement ( OR , 4.04 ; 95 % CI , 1.30 - 12.56 ) , performance status ( PS ) 2 to 4 ( OR , 2.39 ; 95 % CI , 1.24 - 4.59 ) , NIV followed by MV ( OR , 3.00 ; 95 % CI , 1.09 - 8.18 ) ,  MV  as initial ventilatory strategy ( OR , 3.53 ; 95 % CI , 1.45 - 8.60 ) , and Sequential Organ Failure Assessment score ( each point except the respiratory domain ) ( OR , 1.15 ; 95 % CI , 1.03 - 1.29 ) were associated with hospital mortality . Hospital survival in patients with good PS and nonprogressive malignancy and without tumoral airway involvement was 53 % . Conversely , patients with poor functional capacity and cancer progression had unfavorable outcomes . CONCLUSIONS Patients with cancer with good PS and nonprogressive disease requiring ventilatory support should receive full intensive care , because one-half of these patients survive . On the other h and , provision of palliative care should be considered the main goal for patients with poor PS and progressive underlying malignancy Introduction Hematology patients admitted to the ICU frequently experience respiratory failure and require mechanical ventilation . Noninvasive mechanical ventilation ( NIMV ) may decrease the risk of intubation , but NIMV failure poses its own risks . Methods To establish the impact of ventilatory management and NIMV failure on outcome , data from a prospect i ve , multicenter , observational study were analyzed . All hematology patients admitted to one of the 34 participating ICUs in a 17-month period were followed up . Data on demographics , diagnosis , severity , organ failure , and supportive therapies were recorded . A logistic regression analysis was done to evaluate the risk factors associated with death and NIVM failure . Results Of 450 patients , 300 required ventilatory support  . A diagnosis of congestive heart failure and the initial use of NIMV significantly improved survival , whereas APACHE II score , allogeneic transplantation , and NIMV failure increased the risk of death . The risk factors associated with NIMV success were age , congestive heart failure , and bacteremia . Patients with NIMV failure experienced a more severe respiratory impairment than did those electively intubated . Conclusions NIMV improves the outcome of hematology patients with respiratory insufficiency , but NIMV failure may have the opposite effect . A careful selection of patients with rapidly reversible causes of respiratory failure may increase NIMV success Objective . To compare noninvasive positive pressure ventilation ( NPPV ) vs. invasive mechanical ventilation in AIDS patients with Pneumocystis carinii pneumonia (PCP)-related acute respiratory failure ( ARF ) . Design : A single-center , prospect i ve , case-control trial . Setting : An ICU of a private tertiary hospital specialized in infectious disease . Patients : Forty-eight AIDS patients with severe PCP-related ARF needing mechanical ventilation . Interventions : Twenty-four patients treated with NPPV by a facial mask strictly matched with 24 patients treated with invasive ventilation by endotracheal intubation . Results : Use of NPPV  avoided intubation in 67 % of patients , and avoidance of intubation was associated with improved survival ( 100 % vs. 38 % ; P=0.003 ) . NPPV-treated patients required fewer invasive devices ( P<0.001 ) and had a lower incidence of pneumothoraces ( 8.3 % vs. 37.5 % ; P=0.039 ) . The NPPV-treated group required a nurse workload similar to that of the conventional ventilation group , but this group had a shorter duration of stay in the ICU ( P=0.013 ) . The NPPV-treated group had a lower mortality in the ICU , the hospital and within 2 months of study entry . Differences in mortality between the two groups disappeared after 6 months . Conclusions : The findings of this study seem to provide further support for applying NPPV in AIDS patients with severe PCP-related ARF as a first-line therapeutic choice , but r and omized controlled trials are required to confirm our results CONTEXT Noninvasive ventilation ( NIV ) has been associated with lower rates of endotracheal intubation in population s of patients with acute respiratory failure . OBJECTIVE To compare NIV with st and ard treatment using supplemental oxygen administration to avoid endotracheal intubation in recipients of solid organ transplantation with acute hypoxemic respiratory failure . DESIGN AND SETTING Prospect i ve r and omized study conducted at a 14-bed , general intensive care unit of a university hospital . PATIENTS Of 238 patients who underwent solid organ transplantation from December 1995 to October 1997 , 51 were treated for acute respiratory failure . Of these , 40 were eligible and 20 were r and omized to each group . INTERVENTION Noninvasive ventilation vs st and ard treatment with supplemental oxygen administration . MAIN OUTCOME MEASURES The need for endotracheal intubation and mechanical ventilation at any time during the study , complications not present on admission , duration of ventilatory assistance , length of hospital stay , and intensive care unit mortality . RESULTS The 2 groups were similar at study entry . Within the first hour of treatment , 14 patients ( 70 % ) in the NIV group , and 5 patients ( 25 % ) in the st and ard treatment group improved their ratio of the PaO2 to the fraction of inspired oxygen ( FIO2 ) . Over time , a sustained improvement in PaO2 to FIO2 was noted in 12 patients ( 60 % ) in the NIV group , and in 5 patients ( 25 % ) r and omized to st and ard treatment ( P = .03 ) . The use of NIV was associated with a significant reduction in the rate of endotracheal intubation ( 20 % vs 70 % ; P = .002 ) , rate of fatal complications ( 20 % vs 50 % ; P = .05 ) , length of stay in the intensive care unit by survivors ( mean [ SD ] days , 5.5 [ 3 ] vs 9 [ 4 ] ; P = .03 ) , and intensive care unit mortality ( 20 % vs 50 % ; P = .05 ) . Hospital mortality did not differ . CONCLUSIONS These results indicate that transplantation programs should consider NIV in the treatment of selected recipients of transplantation with acute respiratory failure Abstract Background We investigated the clinical course and mortality of acute respiratory distress syndrome ( ARDS ) in patients with hematological malignancies . Methods Sixty-eight patients with hematological malignancies and ARDS admitted to medical intensive care unit ( ICU ) of a university hospital were analyzed semi- prospect ively in the study . Results The most common etiology of ARDS was pneumonia . The ratio of partial pressure of oxygen in arterial blood to fractional concentration of inspired oxygen ( PO2/FiO2 ) was 104 ( 74–165 ) . Ten patients ( 15 % ) received non-invasive mechanical ventilation ( NIV ) , 21 ( 31 % ) received invasive mechanical ventilation ( MV ) , and 36 ( 53 % ) received both NIV and invasive MV .  ICU mortality was 77 % in the cohort . None of the variables with relevance to the underlying hematological disease was associated with mortality . The presence of two or more organ failures was the only independent risk factor for mortality ( P = 0.045 ) , whereas NIV was associated with low mortality ( P = 0.001 ) . The Kaplan – Meier curve of mortality , with respect to the type of MV support , demonstrated that NIV was associated with the lowest mortality ( P < 0.001 ) . Conclusion The mortality of ARDS in critically ill patients with hematological malignancies is quite high . The presence of multi-organ failure is independently associated with high mortality whereas the use of NIV is independently associated with low mortality Abstract Objectives To analyze clinical characteristics , treatment , outcomes of critically ill patients with hematologic malignancies ( HM ) admitted to the medical intensive care unit ( ICU ) and to identify predictors of adverse outcome . Methods We analyzed prospect ively 170 patients . Data included : demographic characteristics , hematologic diagnosis , reasons for ICU admission , transplant status , the presence of neutropenia , acute physiology and chronic health evaluation-II and sequential organ failure assessment scores , and level of organ support . Predictors of ICU mortality were evaluated using univariate and multivariate analysis . Results In total , 73 % of patients had high- grade malignancy , 47.6 % received intensive chemotherapy before admission , and 30 % underwent hematologic stem cell transplantation procedure . In total , 116 ( 68.2 % ) of patients were mechanically ventilated ; 88 ( 51.8 % ) required invasive mechanical ventilation ( MV ) . Non-invasive ventilation started in 28 ( 16.5 % ) patients and was successful in 11 ( 6.5 % ) . The ICU mortality rate was 53.5 % , and the mortality of MV patients was 75.9 % . Need for vasopressors at admission and MV were identified as independent predictors of fatal outcome . Conclusion The ICU mortality of critically ill patients with HM is high , particularly in the group of MV . Need for vasopressors at admission and MV were independent predictors of ICU mortality . Majority of patients required invasive MV due to severe respiratory failure and non-invasive MV was sufficient only in small number of cases with favorable outcome IMPORTANCE Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure . However , its effectiveness for this indication remains unclear . OBJECTIVE To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acute hypoxemic respiratory failure . DESIGN , SETTING , AND PARTICIPANTS Multicenter r and omized trial conducted among 374 critically ill immunocompromised patients , of whom 317 ( 84.7 % ) were receiving treatment for hematologic malignancies or solid tumors , at 28 intensive care units ( ICUs ) in France and Belgium between August 12 , 2013 , and January 2 , 2015 . INTERVENTIONS Patients were r and omly assigned to early noninvasive ventilation ( n = 191 ) or oxygen therapy alone ( n = 183 ) . MAIN OUTCOMES AND MEASURES The primary outcome was day-28 mortality . Secondary outcomes were intubation , Sequential Organ Failure Assessment score on day 3 , ICU-acquired infections , duration of mechanical ventilation , and ICU length of stay . RESULTS At r and omization , median oxygen flow was 9 L/min ( interquartile range , 5 - 15 ) in the noninvasive ventilation group and 9 L/min ( interquartile range , 6 - 15 ) in the oxygen group . All patients in the noninvasive ventilation group received the first noninvasive ventilation session immediately after r and omization . On day 28 after r and omization , 46 deaths ( 24.1 % ) had occurred in the noninvasive ventilation group vs 50 ( 27.3 % ) in the oxygen group ( absolute difference , -3.2 [ 95 % CI , -12.1 to 5.6 ] ; P = .47 ) . Oxygenation failure occurred in 155 patients overall ( 41.4 % ) , 73 ( 38.2 % ) in the noninvasive ventilation group and 82 ( 44.8 % ) in the oxygen group ( absolute difference , -6.6 [ 95 % CI , -16.6 to 3.4 ] ; P = .20 ) . There were no significant differences in ICU-acquired infections , duration of mechanical ventilation , or lengths of ICU or hospital stays . CONCLUSIONS AND RELEVANCE Among immunocompromised patients admitted to the ICU with hypoxemic acute respiratory failure , early noninvasive ventilation compared with oxygen therapy alone did not reduce 28- 
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