PURPOSE: Specific recommendations for which cancer patients should be admitted to intensive care unit (ICU) are not well defined. Patients with malignancy complicated by central airway obstruction (CAO) may receive intensive treatment to relieve acute illness, however, limits on therapeutic efforts may be set, such as no intubation or cardiopulmonary resuscitation. The purpose of this study was to determine whether bronchoscopic interventions affected the need for continued mechanical ventilation in critically ill patients with acute respiratory failure (ARF) from inoperable CAO caused by non small cell lung carcinoma (NSCLC).
METHODS: Retrospective study of consecutive intubated and mechanically ventilated patients with inoperable or unresectable CAO from NSCLC referred for therapeutic bronchoscopic intervention between January 2003 and December 2008. Outcome measures included post intervention extubation within 24 hours and duration of survival.
RESULTS: Twelve patients were admitted to the ICU for ARF requiring mechanical ventilation prior to rigid bronchoscopic intervention during the 5-year study period. Nine patients (75%) were males and three (25%) were females. Mean patient age was 64.16 years (range 46-82). The mean duration of respiratory failure before intervention was 6 days (range 1-17). Airway patency was restored in 11/12 (91%) patients by a single or a combination of bronchoscopic interventions; eight patients (66.6%) required stent insertion. Bronchoscopic intervention resulted in immediate extubation and discontinuation of mechanical ventilation in 9/12 (75%) patients and in 1 patient after 8 days; two patients were discharged to referring facilities on mechanical ventilation: of these, one was successfully extubated only after completion of external beam radiation therapy. Overall median survival was 228 days (range 6-927).
CONCLUSION: Bronchoscopic interventions in patients with ARF and inoperable CAO from NSCLC results in successful immediate extubation and liberation from mechanical ventilation.
CLINICAL IMPLICATIONS: Patients with NSCLC and CAO causing ARF requiring intubation and mechanical ventilation should be referred for attempt at restoring airway patency. If prospective, multicenter studies confirm these findings than the prioritization model for ICU admission of this patient population might need to be revised.
DISCLOSURE: Septimiu Murgu, No Financial Disclosure Information; No Product/Research Disclosure Information