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Outcomes and prognostic factors of patients with lung cancer and pneumonia-induced respiratory failure in a medical intensive care unit: a single-center study. J Crit Care 2014; 29:414-9. [PMID: 24630689 DOI: 10.1016/j.jcrc.2014.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 12/03/2013] [Accepted: 01/06/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the outcomes and prognostic factors of 28-day mortality following medical intensive care unit (MICU) admission of patients with lung cancer and pneumonia-induced respiratory failure. MATERIALS AND METHODS Patients admitted to the MICU of a tertiary referral hospital between 2000 and 2009 were retrospectively studied. RESULTS In total, 143 patients were included. Their mean age was 65±8 years and 94% were male. The 28-day mortality rate was 57%. Multivariate analysis was performed to identify variables associated with 28-day mortality. At 72 hours after admission, a history of radiotherapy (OR=2.80, 95% CI: 1.15-6.78), PaO2/FiO2 (P/F) ratio at admission of <100 mmHg (OR=5.62, 95% CI: 2.10-15.07), P/F ratio after 72 hours of <100 mmHg (OR=4.61, 95% CI: 1.24-17.15), and arterial pH after 72 hours of <7.30 (OR=5.78, 95% CI: 1.15-28.89) were associated with increased mortality. CONCLUSIONS The prognosis of patients with lung cancer and severe pneumonia after 72 hours of MICU management mainly depends on the severity of the underlying lung injury, which is reflected by a history of radiotherapy and a low P/F ratio, rather than on cancer stage or disease status.
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Radiotherapy for Intubated Patients with Malignant Airway Obstruction: Futile or Facilitating Extubation? J Thorac Oncol 2013; 8:1365-70. [DOI: 10.1097/jto.0b013e3182a47501] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Toffart AC, Timsit JF. Is prolonged mechanical ventilation of cancer patients futile? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:189. [PMID: 24053905 PMCID: PMC4056103 DOI: 10.1186/cc13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The issue of limiting life-sustaining treatments for intensive care unit (ICU)
patients is complex. The ethical principles applied by ICU staff when making
treatment-limitation decisions must comply with the law of their country. Until
2011, the law in Taiwan prohibited the withdrawal of mechanical ventilation.
Consequently, patients with severe underlying diseases could receive prolonged
mechanical ventilation. In a study conducted by Shih and colleagues in patients
with cancer in Taiwan, continuous mechanical ventilation for more than 21 days
was associated with poor outcomes, particularly in the subgroups of patients
with metastases, lung cancer, or liver cancer. These results highlight the need
for appropriate legislation regarding the withdrawal of life-sustaining
treatments in patients, especially those for whom no effective cancer treatments
are available.
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Shih CY, Hung MC, Lu HM, Chen L, Huang SJ, Wang JD. Incidence, life expectancy and prognostic factors in cancer patients under prolonged mechanical ventilation: a nationwide analysis of 5,138 cases during 1998-2007. Crit Care 2013; 17:R144. [PMID: 23876301 PMCID: PMC4057492 DOI: 10.1186/cc12823] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 07/22/2013] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION This study is aimed at determining the incidence, survival rate, life expectancy, quality-adjusted life expectancy (QALE) and prognostic factors in patients with cancer in different organ systems undergoing prolonged mechanical ventilation (PMV). METHODS We used data from the National Health Insurance Research Database of Taiwan from 1998 to 2007 and linked it with the National Mortality Registry to ascertain mortality. Subjects who received PMV, defined as having undergone mechanical ventilation continuously for longer than 21 days, were enrolled. The incidence of cancer patients requiring PMV was calculated, with the exception of patients with multiple cancers. The life expectancies and QALE of patients with different types of cancer were estimated. Quality-of-life data were taken from a sample of 142 patients who received PMV. A multivariable proportional hazards model was constructed to assess the effect of different prognostic factors, including age, gender, type of cancer, metastasis, comorbidities and hospital levels. RESULTS Among 9,011 cancer patients receiving mechanical ventilation for more than 7 days, 5,138 undergoing PMV had a median survival of 1.37 months (interquartile range [IQR], 0.50 to 4.57) and a 1-yr survival rate of 14.3% (95% confidence interval [CI], 13.3% to 15.3%). The incidence of PMV was 10.4 per 100 ICU admissions. Head and neck cancer patients seemed to survive the longest. The overall life expectancy was 1.21 years, with estimated QALE ranging from 0.17 to 0.37 quality-adjusted life years for patients with poor and partial cognition, respectively. Cancer of liver (hazard ratio [HR], 1.55; 95% CI, 1.34 to 1.78), lung (HR, 1.45; 95% CI, 1.30 to 1.41) and metastasis (HR, 1.53; 95% CI, 1.42 to 1.65) were found to predict shorter survival independently. CONCLUSIONS Cancer patients requiring PMV had poor long-term outcomes. Palliative care should be considered early in these patients, especially when metastasis has occurred.
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Toffart AC, Sakhri L, Potton L, Minet C, Guillem P, Schwebel C, Moro-Sibilot D, Timsit JF. Admission en réanimation pour les cancers du poumon: quels patients pour quels bénéfices ? ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13546-012-0632-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Chou KT, Chen CS, Su KC, Hung MH, Hsiao YH, Tseng CM, Chen YM, Lee YC, Perng DW. Hospital Outcomes for Patients with Stage III and IV Lung Cancer Admitted to the Intensive Care Unit for Sepsis-Related Acute Respiratory Failure. J Palliat Med 2012; 15:1234-9. [DOI: 10.1089/jpm.2012.0084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kun-Ta Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Sheng Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Hui Hung
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Han Hsiao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Min Tseng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-chin Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Vincent F, Soares M. Lung Cancer and Intensive Care: Extending Our Look Beyond Crude Mortality. J Clin Oncol 2012; 30:3651-2. [DOI: 10.1200/jco.2012.44.3713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Marcio Soares
- D'Or Institute for Research and Education; Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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Murgu S, Langer S, Colt H. Bronchoscopic intervention obviates the need for continued mechanical ventilation in patients with airway obstruction and respiratory failure from inoperable non-small-cell lung cancer. ACTA ACUST UNITED AC 2012; 84:55-61. [PMID: 22759948 DOI: 10.1159/000339316] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/30/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with advanced non-small-cell lung cancer (NSCLC) and acute respiratory failure (ARF) from central airway obstruction (CAO) may be offered end-of-life care rather than intensive care treatment and palliative bronchoscopic intervention. OBJECTIVES To determine whether bronchoscopic intervention could be immediately successful in restoring airway patency and obviate the need for continued mechanical ventilation in a homogeneous group of inoperable mechanically ventilated patients with ARF and CAO from NSCLC. METHODS A retrospective study of 12 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 time-to-postintervention extubation and survival. Procedural success was defined as successful restoration of airway patency, extubation and removal from mechanical ventilation within 24 h after bronchoscopic intervention. RESULTS Twelve intubated and mechanically ventilated patients were admitted to the ICU during the 6-year study period. Airway patency was restored in 11/12 (91%) patients. Bronchoscopic intervention resulted in immediate extubation and discontinuation of mechanical ventilation in 9/12 (75%) patients. Overall median survival was 228 days (range 6-927). For the 9 patients extubated within 24 h after intervention, however, median survival was 313 days (range 6-927). CONCLUSIONS Intubated patients with respiratory failure caused by CAO from NSCLC can be successfully and rapidly removed from mechanical ventilation after bronchoscopic interventions aimed at restoring airway patency. Median survival greater than 10 months justifies ICU hospitalization and referral for bronchoscopic treatment.
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Slatore CG, Cecere LM, Letourneau JL, O'Neil ME, Duckart JP, Wiener RS, Farjah F, Cooke CR. Intensive care unit outcomes among patients with lung cancer in the surveillance, epidemiology, and end results-medicare registry. J Clin Oncol 2012; 30:1686-91. [PMID: 22473159 DOI: 10.1200/jco.2011.40.0846] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lung cancer is the leading cause of cancer-related mortality. Intensive care unit (ICU) use among patients with cancer is increasing, but data regarding ICU outcomes for patients with lung cancer are limited. PATIENTS AND METHODS We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare registry (1992 to 2007) to conduct a retrospective cohort study of patients with lung cancer who were admitted to an ICU for reasons other than surgical resection of their tumor. We used logistic and Cox regression to evaluate associations of patient characteristics and hospital mortality and 6-month mortality, respectively. We calculated adjusted associations for mechanical ventilation receipt with hospital and 6-month mortality. RESULTS Of the 49,373 patients with lung cancer admitted to an ICU for reasons other than surgical resection, 76% of patients survived the hospitalization, and 35% of patients were alive 6 months after discharge. Receipt of mechanical ventilation was associated with increased hospital mortality (adjusted odds ratio, 6.95; 95% CI, 6.89 to 7.01; P < .001), and only 15% of these patients were alive 6 months after discharge. Of all ICU patients with lung cancer, the percentage of patients who survived 6 months from discharge was 36% for patients diagnosed in 1992 and 32% for patients diagnosed in 2005, whereas it was 16% and 11% for patients who received mechanical ventilation, respectively. CONCLUSION Most patients with lung cancer enrolled in Medicare who are admitted to an ICU die within 6 months of admission. To improve patient-centered care, these results should guide shared decision making between patients with lung cancer and their clinicians before an ICU admission.
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Gay EB, Weiss SP, Nelson JE. Integrating palliative care with intensive care for critically ill patients with lung cancer. Ann Intensive Care 2012; 2:3. [PMID: 22339793 PMCID: PMC3306209 DOI: 10.1186/2110-5820-2-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/16/2012] [Indexed: 01/22/2023] Open
Abstract
With newer information indicating more favorable outcomes of intensive care therapy for lung cancer patients, intensivists increasingly are willing to initiate an aggressive trial of this therapy. Concerns remain, however, that the experience of the intensive care unit for patients with lung cancer and their families often may be distressing. Regardless of prognosis, all patients with critical illness should receive high-quality palliative care, including symptom control, communication about appropriate care goals, and support for both patient and family throughout the illness trajectory. In this article, we suggest strategies for integrating palliative care with intensive care for critically ill lung cancer patients. We address assessment and management of symptoms, knowledge and skill needed for effective communication, and interdisciplinary collaboration for patient and family support. We review the role of expert consultants in providing palliative care in the intensive care unit, while highlighting the responsibility of all critical care clinicians to address basic palliative care needs of patients and their families.
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Affiliation(s)
- Elizabeth B Gay
- Department of Pulmonary and Critical Care Medicine, University of Virginia Health Systems, Charlottesville, VA
| | - Stefanie P Weiss
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY
| | - Judith E Nelson
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY
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Six-month survival of patients with lung cancer admitted to a medical ICU: a retrospective study. Crit Care 2012. [PMCID: PMC3363828 DOI: 10.1186/cc11017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Critical care for patients with lung cancer. J Thorac Oncol 2011; 6:1144. [PMID: 21623282 DOI: 10.1097/jto.0b013e31821557ff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chooljian DM, Liu V. Benefit or burden? Sending patients with nonresectable lung cancer to the ICU. Chest 2011; 140:558. [PMID: 21813540 DOI: 10.1378/chest.11-0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- David McAvoy Chooljian
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA.
| | - Vincent Liu
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
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A roundup of recently published articles relevant to thoracic oncology. J Thorac Oncol 2011; 6:1295-7. [PMID: 21847045 DOI: 10.1097/jto.0b013e31821fbf86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We selected six publications for the "best of the month," published recently in peer-reviewed journals, covering a broad range of topics including second-hand smoking, intensive care unit admissions for patients with lung cancer, role of aspirin in preventing lung cancer, bleeding events in patients undergoing treatment with bevacizumab and requiring full anticoagulation, level of evidence used to support the National Comprehensive Cancer Network guidelines, and the use of prophylactic cranial irradiation in patient with locally advanced non-small cell lung cancer.
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