Outcomes for Patients with Cancer Admitted to the ICU Requiring Ventilatory Support: Results from a Prospective Multicenter Study.
Chest. 2014 Jan 30;
Authors: Azevedo LC, Caruso P, Silva UV, Torelly AP, Silva E, Rezende E, Netto JJ, Piras C, Lobo SM, Knibel MF, Teles JM, Lima RA, Ferreira BS, Friedman G, Rea-Neto A, Dal-Pizzol F, Bozza FA, Salluh JI, Soares M
Abstract
ABSTRACT BACKGROUND: To evaluate clinical characteristics and outcomes of cancer patients requiring non-palliative ventilatory support.
METHODS: Secondary analysis of a prospective cohort study conducted in 28 Brazilian intensive care units (ICU) evaluating adult cancer patients requiring invasive mechanical ventilation (MV) or non-invasive ventilation (NIV) during the first 48h of ICU. We used logistic regression to identify variables associated with hospital mortality.
RESULTS: Out of 717 patients, 263(37%) (solid tumors=227; hematological malignancies=36) received ventilatory support. NIV was initially used in 85(32%) patients and received 178(68%) MV. Additionally, NIV followed by MV occurred in 45(53%) patients. Hospital mortality rates were 67% in all patients, 40% in NIV only patients, 69% when NIV was followed by MV and 73% in MV only patients (P<0.001). Adjusting for the type of admission, newly diagnosed malignancy [odds-ratio (OR)=3.59 (95% confidence interval, 1.28-10.10)], recurrent or progressive malignancy [3.67(1.25-10.81)], tumoral airway involvement [4.04(1.30-12.56)], performance status (PS) 2-4 [2.39(1.24-4.59)], NIV followed by MV [3.00(1.09-8.18)], MV as initial ventilatory strategy [3.53(1.45-8.60)] and SOFA score (each point, excluding respiratory domain) [1.15(1.03-1.29)] were associated with hospital mortality. Hospital survival in patients with good PS, non-progressive malignancy and without tumoral airway involvement was 53%. Conversely, patients with poor functional capacity and cancer progression had unfavorable outcomes.
CONCLUSIONS: Cancer patients with good PS and non-progressive disease requiring ventilatory support should receive full intensive care, as half of these survive. On the other hand, provision of palliative care should be considered the main goal for patients with poor PS and progressive underlying malignancy.
PMID: 24480886 [PubMed - as supplied by publisher]