0
Original Research: Critical Care |

Outcomes for Patients With Cancer Admitted to the ICU Requiring Ventilatory SupportPatients With Cancer Requiring Ventilatory Support: Results From a Prospective Multicenter Study

Luciano C. P. Azevedo, MD, PhD; Pedro Caruso, MD, PhD; Ulysses V. A. Silva, MD; André P. Torelly, MD; Eliézer Silva, MD, PhD; Ederlon Rezende, MD; José J. Netto, MD; Claudio Piras, MD, PhD; Suzana M. A. Lobo, MD, PhD; Marcos F. Knibel, MD; José M. Teles, MD; Ricardo. A. Lima, MD, PhD; Bruno S. Ferreira, MD; Gilberto Friedman, MD, PhD; Alvaro Rea-Neto, MD, PhD, FCCP; Felipe Dal-Pizzol, MD, PhD; Fernando A. Bozza, MD, PhD; Jorge I. F. Salluh, MD, PhD; Márcio Soares, MD, PhD on behalf of the Brazilian Research in Intensive Care Network (BRICNet)
Author and Funding Information

From the ICU (Dr Azevedo), Hospital Sirio-Libanes; ICU (Dr Caruso), Hospital A. C. Camargo; ICU (Dr E. Silva), Hospital Israelita Albert Einstein; and ICU (Dr Rezende), Hospital do Servidor Público Estadual, São Paulo; Programa de Pós-Graduação em Oncologia (Drs Azevedo, Salluh, and Soares) and ICU (Dr Netto), Instituto Nacional de Câncer, Hospital do Câncer II; ICU (Dr Lima), Hospital Samaritano; ICU (Dr Knibel), Hospital São Lucas; Hospital Pasteur (Dr Ferreira); and D’Or Institute for Research and Education (Drs Bozza, Salluh, and Soares), Rio de Janeiro; ICU (Dr U. V. A. Silva), Fundação Pio XII, Hospital do Câncer de Barretos, Barretos; ICU (Dr Torelly), Santa Casa de Misericórdia de Porto Alegre; and ICU (Dr Friedman), Universidade Federal do Rio Grande do Sul, Porto Alegre; ICU (Dr Piras), Vitória Apart Hospital, Vitória; the Division of Critical Care Medicine (Dr Lobo), Department of Internal Medicine, Medical School and Hospital de Base, São José do Rio Preto; ICU (Dr Teles), Hospital Português, Salvador; ICU (Dr Rea-Neto), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba; and Laboratório de Fisiopatologia Experimental (Dr Dal-Pizzol), Programa de Pós-Graduação Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil.

CORRESPONDENCE TO: Márcio Soares, MD, PhD, D’Or Institute for Research and Education, Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, Brazil, 22281-100; e-mail:marciosoaresms@gmail.com.


FOR EDITORIAL COMMENT SEE PAGE 241

FUNDING/SUPPORT: This article was supported by the Instituto Nacional de Câncer, the National Council for Scientific and Technological Development of Brazil (CNPq), and Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):257-266. doi:10.1378/chest.13-1870
Text Size: A A A
Published online

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 prospective 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 hand, provision of palliative care should be considered the main goal for patients with poor PS and progressive underlying malignancy.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543