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Original Research: CRITICAL CARE |

Use of Intensive Care in Patients With Nonresectable Lung Cancer

Anne-Claire Toffart, MD; Clémence Minet, MD; Bruno Raynard, MD; Carole Schwebel, MD, PhD; Rebecca Hamidfar-Roy, MD; Samia Diab, MD; Sébastien Quetant, MD; Denis Moro-Sibilot, MD, PhD; Elie Azoulay, MD, PhD; Jean-François Timsit, MD, PhD
Author and Funding Information

From the Clinique de Pneumologie (Drs Toffart, Diab, Quetant, and Moro-Sibilot) and Clinique de Réanimation (Drs Minet, Schwebel, Hamidfar-Roy, and Timsit), Pôle Médecine Aiguë Communautaire, Centre Hospitalier Universitaire de Grenoble, Grenoble; Réanimation Médico-Chirurgicale (Dr Raynard), Institut Gustave Roussy, Villejuif; Inserm U823 (Drs Moro-Sibilot, Azoulay, and Timsit), Université Joseph Fourier, Grenoble; and Réanimation (Dr Azoulay), Centre Hospitalier Universitaire Saint-Louis, Paris, France.

Correspondence to: Jean-François Timsit, MD, PhD, Medical Polyvalent ICU, University Hospital, 38000 Grenoble, France; e-mail: JFTimsit@chu-grenoble.fr


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(1):101-108. doi:10.1378/chest.09-2863
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Background:  Admission of patients with lung cancer to the ICU has been criticized. We evaluated whether ICU admission improved 3-month survival in patients with nonresectable lung cancer. Factors associated with survival were identified.

Methods:  A retrospective study was conducted in consecutive nonsurgical patients with lung cancer admitted to three ICUs in France between 2000 and 2007, 2005 and 2007, and 2005 and 2006.

Results:  We included 103 patients with a median (interquartile range) Simplified Acute Physiology Score II of 33 (25-46) and logistic organ dysfunction (LOD) score of 3 (1-4). Invasive mechanical ventilation was required in 41 (40%) patients. Sixty-three (61%) patients had metastasis and 26 (25%) an Eastern Cooperative Oncology Group performance status (ECOG-PS) > 2. The reason for ICU admission was acute respiratory failure in 58 (56%) patients. Three-month survival rate was 37% (95% CI, 28%-46%). By multivariate analysis, variables associated with mortality were ECOG-PS > 2 (hazard ratio [HR], 2.65; 95% CI, 1.43-4.88), metastasis at admission (HR, 1.90; 95% CI, 1.08-3.33), and worse LOD score (HR, 1.19; 95% CI, 1.08-1.32). An LOD score decrease over the first 72 h was associated with survival.

Conclusions:  Survival in nonsurgical patients with lung cancer requiring ICU admission was 37% after 90 days. Our results provide additional evidence that ICU management may be appropriate in patients with nonresectable lung cancer and organ failure.

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