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Al-Dorzi HM, Atham S, Khayat F, Alkhunein J, Alharbi BT, Alageel N, Tlayjeh M, Tlayjeh H, Arabi YM. Characteristics, management, and outcomes of patients with lung cancer admitted to a tertiary care intensive care unit over more than 20 years. Ann Thorac Med 2024; 19:208-215. [PMID: 39144533 PMCID: PMC11321528 DOI: 10.4103/atm.atm_287_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 08/16/2024] Open
Abstract
RATIONALE The prognosis of patients with lung cancer admitted to the intensive care unit (ICU) is often perceived as poor. We described the characteristics, management, and outcomes of critically ill patients with lung cancer and determined the predictors of mortality. METHODS We retrospectively studied patients with lung cancer who were admitted to the ICU of a tertiary care hospital between 1999 and 2021 for the reasons other than routine postoperative care. We noted their characteristics, ICU management, and outcomes. We performed the multivariable logistic regression analysis to determine the predictors of hospital mortality. RESULTS In the 23-year period, 306 patients with lung cancer were admitted to the ICU (median age = 63.0 years, 68.3% males, 45.6% with moderate/severe functional disability, most had advanced lung cancer, and median Acute Physiology and Chronic Health Evaluation II score = 24.0). Life support measures included invasive mechanical ventilation (47.1%), vasopressors (34.0%), and new renal replacement therapy (8.8%). Do-Not-Resuscitate orders were implemented during ICU stay in 30.1%. The hospital mortality was 43.8% with a significantly lower rate in patients admitted after 2015 (28.0%). The predictors of mortality were moderate/severe baseline disability (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.22, 5.78), advanced lung cancer (OR 8.36, 95% CI 1.81, 38.58), lactate level (OR 1.45, 95% CI 1.12, 1.88, invasive mechanical ventilation (OR 10.92, 95% CI 4.98, 23.95), and admission period after 2015 (OR 0.37, 95% CI 0.16, 0.85). CONCLUSIONS The mortality rates in patients with lung cancer admitted to the ICU during a 23-year period decreased after 2015. Functional disability, advanced lung cancer stage, vasopressor use, and invasive mechanical ventilation predicted mortality.
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Affiliation(s)
- Hasan M. Al-Dorzi
- Department of Intensive, King Abdulaziz Medical City, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sadeem Atham
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Faten Khayat
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jullanar Alkhunein
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bushra T. Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Norah Alageel
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamed Tlayjeh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Haytham Tlayjeh
- Department of Intensive, King Abdulaziz Medical City, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- Department of Intensive, King Abdulaziz Medical City, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Huang T, Le D, Yuan L, Xu S, Peng X. Machine learning for prediction of in-hospital mortality in lung cancer patients admitted to intensive care unit. PLoS One 2023; 18:e0280606. [PMID: 36701342 PMCID: PMC9879439 DOI: 10.1371/journal.pone.0280606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUNDS The in-hospital mortality in lung cancer patients admitted to intensive care unit (ICU) is extremely high. This study intended to adopt machine learning algorithm models to predict in-hospital mortality of critically ill lung cancer for providing relative information in clinical decision-making. METHODS Data were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) for a training cohort and data extracted from the Medical Information Mart for eICU Collaborative Research Database (eICU-CRD) database for a validation cohort. Logistic regression, random forest, decision tree, light gradient boosting machine (LightGBM), eXtreme gradient boosting (XGBoost), and an ensemble (random forest+LightGBM+XGBoost) model were used for prediction of in-hospital mortality and important feature extraction. The AUC (area under receiver operating curve), accuracy, F1 score and recall were used to evaluate the predictive performance of each model. Shapley Additive exPlanations (SHAP) values were calculated to evaluate feature importance of each feature. RESULTS Overall, there were 653 (24.8%) in-hospital mortality in the training cohort, and 523 (21.7%) in-hospital mortality in the validation cohort. Among the six machine learning models, the ensemble model achieved the best performance. The top 5 most influential features were the sequential organ failure assessment (SOFA) score, albumin, the oxford acute severity of illness score (OASIS) score, anion gap and bilirubin in random forest and XGBoost model. The SHAP summary plot was used to illustrate the positive or negative effects of the top 15 features attributed to the XGBoost model. CONCLUSION The ensemble model performed best and might be applied to forecast in-hospital mortality of critically ill lung cancer patients, and the SOFA score was the most important feature in all models. These results might offer valuable and significant reference for ICU clinicians' decision-making in advance.
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Affiliation(s)
- Tianzhi Huang
- Department of Rehabilitation, The Second Affiliated Hospital of Jianghan University, Wuhan, China
| | - Dejin Le
- Department of Respiratory Medicine, People’s Hospital of Daye, The Second Affiliated Hospital of Hubei Polytechnic University, Daye, Hubei, China
| | - Lili Yuan
- Department of Anesthesiology, The Second Affiliated Hospital of Jianghan University, Wuhan, China
| | - Shoujia Xu
- Department of Orthopedics, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- * E-mail: (XP); (SX)
| | - Xiulan Peng
- Department of Oncology, The Second Affiliated Hospital of Jianghan University, Wuhan, China
- * E-mail: (XP); (SX)
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Rice DR, Hyer JM, Tsilimigras D, Pawlik TM. Implications of intensive care unit admissions among medicare beneficiaries following resection of pancreatic cancer. J Surg Oncol 2021; 125:405-413. [PMID: 34608989 DOI: 10.1002/jso.26710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intensive care unit (ICU) use has increased among patients with cancer. We sought to define factors associated with ICU admissions among patients with pancreatic cancer and characterize trends in mortality among hospital survivors. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was used to identify patients with pancreatic cancer who underwent resection. Multivariable analyses were conducted to identify factors associated with ICU admission and mortality among hospital survivors. RESULTS Among 6422 Medicare beneficiaries who underwent resection of pancreatic cancer, 2386 (37.1%) had an ICU admission. Patients with ICU admissions were more likely to be younger (10-year increase odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.77-0.89), male (OR: 1.17, 95% CI 1.05-1.30) and undergo resection at a teaching hospital (OR: 1.19, 95% CI: 1.05-1.36). While the majority of patients survived to hospital discharge (n = 2106; 88.3%), a majority of patients (n = 1296; 54.3%) died within 6 months. Among patients who had subsequent ICU admissions, 1- and 5-year survival was only 31.8% and 11.0%, respectively. CONCLUSIONS Over one-third of patients with pancreatic cancer had an ICU admission. While most patients survived hospitalization, more than one-half of patients died within 6 months of discharge and two-thirds died within 1 year. These data should serve to guide patient-provider discussions around prognosis relative to ICU utilization.
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Affiliation(s)
- Daniel R Rice
- The Ohio State Wexner Medical Center, James Cancer Center, Columbus, Ohio, USA
| | - J Madison Hyer
- The Ohio State Wexner Medical Center, James Cancer Center, Columbus, Ohio, USA
| | | | - Timothy M Pawlik
- The Ohio State Wexner Medical Center, James Cancer Center, Columbus, Ohio, USA
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Kızılgöz D, Akın Kabalak P, Kavurgacı S, İnal Cengiz T, Yılmaz Ü. The success of non-invasive mechanical ventilation in lung cancer patients with respiratory failure. Int J Clin Pract 2021; 75:e14712. [PMID: 34383989 DOI: 10.1111/ijcp.14712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND AIM Despite the improvement in survival among patients with lung cancer as a result of the development of novel treatment options, acute respiratory failure (ARF), which may occur because of the disease itself, comorbidities or complications in treatment may be life threatening. The most commonly utilised treatment option in cancer patients with ARF is invasive mechanical ventilation (IMV). The prognosis of lung cancer patients admitted to the intensive care unit is poor. The use of non-invasive mechanical ventilation (NIMV) in the setting of ARF not only supports the respiratory muscles and facilitates alveolar ventilation and airway patency, but also reduces the risk of serious complications of IMV, such as ventilator-associated pneumonia. NIMV treatment in the event of respiratory failure has been associated with a high rate of mortality in recently diagnosed or progressive lung cancer with organ failure. However, studies in this regard are limited, and the role of NIMV has yet to be investigated in patients in hospital wards. Accordingly, the present study investigates retrospectively the success of NIMV among patients with lung cancer (including all stages and histopathological types) in a hospital ward setting and the influential factors. MATERIAL AND METHOD The data of 42 patients with lung cancer and respiratory failure who were admitted to the palliative care service and received NIMV between 2014 and 2018 were reviewed retrospectively. Demographic features, comorbidities, respiratory failure types, rate of withdrawal from NIMV, frequencies of tracheostomy and intubation, bacteriologic examination of the airway samples, rate of discharge from hospital and any history of NIMV/USOT use at home were recorded. NIMV success was defined as the discharge of the patient from the hospital, with or without a respiratory support device. The primary end-point of the study was NIMV success, while the secondary end-point was NIMV success with respect to the underlying diagnosis and respiratory failure type. RESULTS A total of 42 patients (38 males and 4 females) were included in the study, with a mean age of 67.4 ± 9.5 years. The rate of discharge from hospital was 71% across the entire study population, among which, 13 (31%) were discharged with USOT and 16 (38.1%) with NIMV. Among the 12 patients under palliative supportive treatment, 8 were discharged from the hospital. The success rates of NIMV in the respiratory failure aetiological subgroups were: 66% (12 patients) in the pneumonia subgroup and 71.4% (15 patients) in the COPD subgroup. The difference between these subgroups was not significant (P = .841). The success rate of NIMV in the hypercapnic and hypoxaemic respiratory failure subgroups was 72.7% (24 patients) and 66.6% (6 patients), respectively. There were no significant differences between the type of respiratory failure subgroups (P = .667). The success rate of NIMV was similar in patients with a positive airway sample microbiology (71.4%, n = 14) and those with no growth identified in the culture (70.3%, n = 28) (P = .834). CONCLUSION In lung cancer patients with no contraindication, NIMV can be used to reduce or postpone the need for ICU admission, independent of disease stage, cellular type and underlying cause.
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Affiliation(s)
- Derya Kızılgöz
- Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Pınar Akın Kabalak
- Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Suna Kavurgacı
- Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Tuba İnal Cengiz
- Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Ülkü Yılmaz
- Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
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Park J, Kim WJ, Hong JY, Hong Y. Clinical outcomes in patients with lung cancer admitted to intensive care units. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:836. [PMID: 34164470 PMCID: PMC8184420 DOI: 10.21037/atm-21-298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Recent advances in critical care and infection control have led to improved intensive care unit (ICU) survival rates. However, controversy exists regarding the benefits of ICU treatment for patients with lung cancer. In this study, we evaluated the clinical outcomes of patients from the Korean national database, who had been diagnosed with lung cancer and had received ICU treatment. Methods We investigated patients in Korea who had been newly diagnosed with lung cancer between January 1, 2008 and December 31, 2010. We classified these critically ill patients with lung cancer according to their lung cancer treatment pathways, with a specific focus on those who had undergone ICU treatment. Results We found that 31.3% of patients newly diagnosed with lung cancer had been admitted to the ICU for any reason, and 18.5% of patients with lung cancer were admitted to the ICU for reasons other than postoperative surgical lung cancer resection. The ICU mortality rate was 2.9% in patients admitted to the ICU for postoperative care and 47.5% in patients admitted for other reasons. Clinical cancer staging (HR, 7.02; 95% CI, 5.82–8.48; P<0.01) and the need for mechanical ventilator (HR, 1.34; 95% CI, 1.27–1.41; P<0.01) were independently associated with ICU mortality. The importance of mechanical ventilator intervention as a predictor for survival was significantly greater in the earlier stages of lung cancer (HR, 1.97; 95% CI, 1.15–3.38; P<0.01). Conclusions This study suggests that goals and treatment plans for critically ill patients with lung cancer should be determined by the individual patient’s clinical cancer stage, regardless of the reason for admission to the ICU.
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Affiliation(s)
- Jinkyeong Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine, School of Medicine, Kangwon National University, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Ji Young Hong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon, Republic of Korea
| | - Yoonki Hong
- Department of Internal Medicine, School of Medicine, Kangwon National University, Kangwon National University Hospital, Chuncheon, Republic of Korea
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Predictors of In-Hospital Death in Patients with Lung Cancer Admitted for Acute Radiation Pneumonitis: A Healthcare Cost and Utilization Project (HCUP) Analysis. Clin Lung Cancer 2021; 22:e716-e722. [PMID: 33658160 DOI: 10.1016/j.cllc.2021.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Radiation pneumonitis (RP) is a dose-limiting and potentially fatal toxicity of thoracic radiotherapy most often seen in patients treated for primary lung cancer. The purpose of this study was to identify predictors of in-hospital death among lung cancer patients admitted for acute RP in the Healthcare Cost and Utilization Project (HCUP) database. MATERIALS AND METHODS The HCUP National Inpatient Sample database was queried from 2012 through 2016 to capture adult lung cancer patients admitted to the hospital with a principal diagnosis of acute RP. Multivariate logistic regression modeling and χ2 tests were used to determine predictors of in-hospital death. RESULTS Of the 882 patients with lung cancer admitted for RP, 67 patients (7.6%) died during the hospitalization and 90 patients (10.2%) required mechanical ventilation. Of those requiring mechanical ventilation, 38 patients (42.2%) died. The average age at hospitalization was 70.4 years (range, 35-90). Of those factors associated with death on univariate analysis, interstitial lung disease (odds ratio [OR] = 6.14; 95% confidence interval [CI], 1.9-19.4; P = .002), pulmonary hypertension (OR = 3.1; 95% CI, 1.6-6.2; P = .001), diabetes mellitus (OR = 2.0; 95% CI, 1.1-3.3; P = .013), and more affluent Zip Code (OR = 1.9; 95% CI, 1.1-3.2; P = .021) remained statistically significant on multivariate logistic regression. CONCLUSION In the largest reported cohort of patients with lung cancer hospitalized with a principal diagnosis of acute RP, the presence of interstitial lung disease, pulmonary hypertension, diabetes mellitus, and more affluent Zip Code were associated with in-hospital death. Comorbid diagnoses may be useful for risk-stratified management of inpatients with RP.
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Gao S, Wang Y, Yang L, Wang Z, Huang W. Characteristics and clinical subtypes of cancer patients in the intensive care unit: a retrospective observational study for two large databases. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:13. [PMID: 33553306 PMCID: PMC7859733 DOI: 10.21037/atm-20-4634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Previous studies have reported very different mortality rates among cancer patients in the intensive care unit (ICU), implying different clinical subtypes. We aimed to reveal the clinical subtypes and demonstrate the importance of segregating the patients in clinical research, and to report the ICD-level mortality of cancer patients in the ICU. Methods Two ICU databases (MIMIC-III and eICU) were utilized to identify cancer patients. Mortality based on ICD-level diagnoses were calculated, and K-means clustering was used to identify different clinical subtypes in the MIMIC database. Clinical characteristics and outcomes were compared among subtypes, and the calibration of SAPS II and APACHE IV among different subtypes was evaluated. Results In total, 6,505 (13.8%) cancer patients of the MIMIC database and 7,351 (4.9%) ones in eICU database, were enrolled in the study. Metastasis involving pleura, metastasis involving the liver, and acute myeloid leukemia were in the top 5 diagnoses with the highest mortality in both databases. Clinical subtypes identified by K-means clustering were closely associated with admission type (elective or emergency) and clinical service provider (surgical or medical). In a four-cluster pattern, nearly all patients in the first cluster were elective admissions (99.1%), whereas in the rest of the clusters, most were emergency admissions (93.7%). Most surgical patients were in the 1+2 clusters (92.0%) and most medical patients were in the 3+4 clusters (93.5%). Most characteristics and outcomes as well as the calibration of SAPS II and APACHE IV scoring systems were significantly different among clinical subtypes. Conclusions Different clinical subtypes can be well identified by admission type and clinical service provider among ICU patients with cancer. Caution should be exercised when considering these patients as a whole population both in clinical practice and research. Moreover, APACHE IV has better calibration than SAPS II for cancer patients at low risk of mortality in the ICU.
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Affiliation(s)
- Shaowei Gao
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaqing Wang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lu Yang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhongxing Wang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenqi Huang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Lillemoe K, Lord A, Torres J, Ishida K, Czeisler B, Lewis A. Factors Associated With DNR Status After Nontraumatic Intracranial Hemorrhage. Neurohospitalist 2020; 10:168-175. [PMID: 32549939 DOI: 10.1177/1941874419873812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background We explored factors associated with admission and discharge code status after nontraumatic intracranial hemorrhage. Methods We extracted data from patients admitted to our institution between January 1, 2013, and March 1, 2016 with nontraumatic intracerebral hemorrhage or subarachnoid hemorrhage who had a discharge modified Rankin Scale (mRS) of 4 to 6. We reviewed data based on admission and discharge code status. Results Of 88 patients who met inclusion criteria, 6 (7%) were do not resuscitate (DNR) on admission (aDNR). Do not resuscitate on admission patients were significantly older than those who were full code on admission (P = 0.04). There was no significant difference between admission code status and sex, marital status, active cancer, premorbid mRS, admission Glasgow Coma scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, or bleed severity. At discharge, 66 (75%) patients were full code (dFULL), 11 (13%) were DNR (dDNR), and 11 (13%) were comfort care. African American and Hispanic patients were significantly more likely to be dFULL than Asian or white patients (P = .01) and less likely to be seen by palliative care (P = .004). Patients with less aggressive code status had higher median APACHE II scores (P = .008) and were more likely to have active cancer (P = .06). There was no significant difference between discharge code status and sex, age, marital status, premorbid mRS, discharge GCS, or bleed severity. Conclusions Limitation of code status after nontraumatic intracranial hemorrhage appears to be associated with older age, white race, worse APACHE II score, and active cancer. The role of palliative care after intracranial hemorrhage and the racial disparity in limitation and de-escalation of treatment deserves further exploration.
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Affiliation(s)
- Kaitlyn Lillemoe
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Aaron Lord
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA.,Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Jose Torres
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Koto Ishida
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Barry Czeisler
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA.,Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA.,Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
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Acute and Chronic Respiratory Failure in Cancer Patients. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7123817 DOI: 10.1007/978-3-319-74588-6_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 2016, there was an estimated 1.8 million new cases of cancer diagnosed in the United States. Remarkable advances have been made in cancer therapy and the 5-year survival has increased for most patients affected by malignancy. There are growing numbers of patients admitted to intensive care units (ICU) and up to 20% of all patients admitted to an ICU carry a diagnosis of malignancy. Respiratory failure remains the most common reason for ICU admission and remains the leading causes of death in oncology patients. There are many causes of respiratory failure in this population. Pneumonia is the most common cause of respiratory failure, yet there are many causes of respiratory insufficiency unique to the cancer patient. These causes are often a result of immunosuppression, chemotherapy, radiation treatment, or hematopoietic stem cell transplant (HCT). Treatment is focused on supportive care and specific therapy for the underlying cause of respiratory failure. Noninvasive modalities of respiratory support are available; however, careful patient selection is paramount as indiscriminate use of noninvasive positive pressure ventilation is associated with a higher mortality if mechanical ventilation is later required. Historically, respiratory failure in the cancer patient had a grim prognosis. Outcomes have improved over the past 20 years. Survivors are often left with significant disability.
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Collart C, Moro-Sibilot D, Maignan M, Schwebel C, Giaj Levra M, Ferrer L, Paquier C, Viglino D, Toffart AC. [Emergency room management of patients with lung cancer and organ failure]. Rev Mal Respir 2019; 36:672-678. [PMID: 31255316 DOI: 10.1016/j.rmr.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND When patients with lung cancer present to the emergency department with organ failure the question of admission to intensive care has to be considered. Our aim is to describe the process leading to the proposed management. METHODS Retrospectively, all patients admitted to the emergency room between December 2010 and January 2015 with a diagnosis of ICD-10 C34.9 (lung cancer) were reviewed. Those with at least one organ failure were included. RESULTS The records of 561 patients were reviewed, 79 (14%) had at least one organ failure. The majority of these patients received maximal medical care (59%), 25% exclusive palliative care, and 15% intensive care. Performance status, metastatic status and efficacy of anti-tumor treatment were recorded in the emergency medical record in 20%, 66% and 74% of cases, respectively. An opinion was obtained from the oncologist in 44% of cases and from the intensivist in 41% of cases. No external advice was provided in 27% of cases. CONCLUSION In the majority of cases, the decision on the intensity of care to be provided to patients with lung cancer and organ failure was made in a collective manner.
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Affiliation(s)
- C Collart
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - D Moro-Sibilot
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - M Maignan
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U1042, laboratoire hypoxie physiopathologie, université Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - C Schwebel
- Clinique universitaire de médecine intensive et réanimation, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U1039, biocliniques radiopharmaceutiques, université Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - M Giaj Levra
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - L Ferrer
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - C Paquier
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - D Viglino
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U1042, laboratoire hypoxie physiopathologie, université Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - A-C Toffart
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U 1209, CNRS UMR 5309, centre de recherche UGA, institut pour l'avancée des biosciences, 38700 La Tronche, France.
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McPherson K, Carlos WG, Emmett TW, Slaven JE, Torke AM. Limitation of Life-Sustaining Care in the Critically Ill: A Systematic Review of the Literature. J Hosp Med 2019; 14:303-310. [PMID: 30794145 PMCID: PMC6625435 DOI: 10.12788/jhm.3137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022]
Abstract
When life-sustaining treatments (LST) are no longer effective or consistent with patient preferences, limitations may be set so that LSTs are withdrawn or withheld from the patient. Many studies have examined the frequency of limitations of LST in intensive care unit (ICU) settings in the past 30 years. This systematic review describes variation and patient characteristics associated with limitations of LST in critically ill patients in all types of ICUs in the United States. A comprehensive search of the literature was performed by a medical librarian between December 2014 and April 2017. A total of 1,882 unique titles and abstracts were reviewed, 113 were selected for article review, and 36 studies were fully reviewed. Patient factors associated with an increased likelihood of limiting LST included white race, older age, female sex, poor preadmission functional status, multiple comorbidities, and worse illness severity score. Based on several large, multicenter studies, there was a trend toward a higher frequency of limitation of LST over time. However, there is large variability between ICUs in the proportion of patients with limitations and on the proportion of deaths preceded by a limitation. Increases in the frequency of limitations of LST over time suggests changing attitudes about aggressive end-of-life-care. Limitations are more common for patients with worse premorbid health and greater ICU illness severity. While some differences in the frequency of limitations of LST may be explained by personal factors such as race, there is unexplained wide variability between units.
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Affiliation(s)
- Katie McPherson
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver Colorado
| | - W Graham Carlos
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas W Emmett
- Ruth Lilly Medical Library at Indiana University School of Medicine, Indianapolis, Indiana
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexia M Torke
- Indiana University Center for Aging Research, Indianapolis Indiana
- Daniel F. Evans Center for Spiritual and Religious Values in Healthcare and Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana
- Corresponding Author: Alexia M Torke, MD, MS; E-mail: ; Telephone: 317-274-9221; Twitter: @AlexiaMTorke
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12
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Herrscher H, Artzner T, Severac F, Faitot F, Kurtz JE, Janssen-Langenstein R, Maestraggi Q, Schneider F, Michard B. Intensive care for patients with gastric cancers: outcome and survival prognostic factors. J Gastrointest Oncol 2019; 10:292-299. [PMID: 31032097 DOI: 10.21037/jgo.2018.10.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Admission and management of patients with solid malignancies in intensive care unit (ICU) is a controversial topic. To this day, there is no data published concerning patients with gastric cancers hospitalized in ICU. This single center retrospective study reports the characteristics, outcome and prognostic factors of patients hospitalized in ICU for medical reasons over a period of 10 years. Methods We performed a single center retrospective study which reports the characteristics, outcome and prognostic factors of patients hospitalized in ICU for medical reasons over a period of 10 years. Results Thirty-seven patients were included, among whom 24 (64.9%) had metastatic cancer. The most frequent diagnosis on admission was septic shock (48.6%) and 24 patients (64.9%) required intubation. Ten patients (27.0%) were alive 3 months after their admission in ICU. Metastatic cancer and intubation were independently associated with a higher risk of dying within 3 months of admission in multivariate analysis: odds ratio (OR) =13.7; 95% confidence interval (CI), 1.7-108 (P<0.01). Seventeen patients (45.9%) died during their ICU stay. Metastatic cancer: OR =89; 95% CI, 2.7-6,588, therapeutic intensification: OR =1,471; 95% CI, 9.8-811,973 and the logistic organ dysfunction score (LODS) on admission: OR =1.4; 95% CI, 1.1-2.3 were independently associated with mortality within the ICU in multivariate analysis (P<0.01). Conclusions This is the first study that examines the outcome and prognostic factors of patients with gastric cancers who require life-sustaining therapy in ICU. The identification of 3 months and ICU mortality prognostic factors could contribute to guiding clinicians in the management of these patients and assist health professionals in their discussions with these patients and their families.
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Affiliation(s)
- Hugo Herrscher
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,FMTS, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Thierry Artzner
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,FMTS, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - François Severac
- Service de Santé Publique, Département d'Information Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - François Faitot
- Service de Chirurgie Hépato-Biliaire et digestive, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Emmanuel Kurtz
- FMTS, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France.,Service d'Onco-Hématologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Ralph Janssen-Langenstein
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Quentin Maestraggi
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,FMTS, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Francis Schneider
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,FMTS, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France.,INSERM U1121, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Baptiste Michard
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,FMTS, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France
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13
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Shin SH, Lee H, Kang HK, Park JH. Twenty-eight-day mortality in lung cancer patients with metastasis who initiated mechanical ventilation in the emergency department. Sci Rep 2019; 9:4941. [PMID: 30894559 PMCID: PMC6427029 DOI: 10.1038/s41598-019-39671-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/30/2019] [Indexed: 12/15/2022] Open
Abstract
Few data are available regarding treatment outcomes in lung cancer patients with metastasis who initiated mechanical ventilation in the emergency department (ED). We aimed to evaluate 28-day mortality in lung cancer patients with metastasis who initiated mechanical ventilation in the ED. Patients with solid malignancy who initiated mechanical ventilation in the ED of a tertiary hospital were retrospectively identified and stratified into four groups according to the presence of lung cancer and metastasis. Among 212 included patients, the mortality rates by the 28th hospital day were as follows: 44.2% (19/43) in non-lung cancer patients without metastasis, 63.2% (43/68) in non-lung cancer patients with metastasis, 52.4% (11/21) in lung cancer patients without metastasis, and 66.2% (53/80) in lung cancer patients with metastasis. In multivariable analysis, lung cancer patients with metastasis had significantly higher odds ratio for 28-day mortality than non-lung cancer patients without metastasis (adjusted odds ratio [OR] = 7.17, 95% confidence interval [CI] = 2.14-24.01). Sepsis-related respiratory failure (adjusted OR = 2.60, 95% CI = 1.16-5.84) and cardiopulmonary resuscitation (adjusted OR = 13.34, 95% CI = 4.45-39.95) over respiratory failure without sepsis and acute organ dysfunction process measured by sequential organ failure assessment (SOFA) score (adjusted OR = 1.15, 95% CI = 1.05-12.6) were independently associated with an increase in mortality rate. In conclusion, the treatment outcomes in lung cancer patients with metastasis who initiated mechanical ventilation in the ED were poor. Aggressive resuscitation versus end-of-life care in advance of an unexpected medical crisis should be considered in lung cancer patients with metastasis via a multidisciplinary approach with a consideration of underlying comorbid illnesses in the acute organ dysfunction processes.
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Affiliation(s)
- Sun Hye Shin
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University, School of Medicine, Seoul, Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Joo Hyun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. .,Department of respiratory medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea.
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14
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Gorham J, Ameye L, Paesmans M, Berghmans T, Sculier JP, Meert AP. [Lung cancer: Prognosis in intensive care depends mainly on the acute complication]. Rev Mal Respir 2019; 36:333-341. [PMID: 30898468 DOI: 10.1016/j.rmr.2018.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 05/14/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION It has been demonstrated in unselected populations of cancer patients that prognosis in intensive care is essentially dependent on the extent of the acute physiological disturbance caused by the complication precipitating the admission. By contrast, the prognosis after hospital discharge remains dependent on the characteristics of the underlying neoplasm. The aim of our study was to confirm whether this general finding was the case in a specific population of lung cancer patients, since there are no data on this patient group in the literature. PATIENTS AND METHODS We conducted a retrospective study including all patients with lung cancer admitted to our ICU between September 1, 2008 and December 31, 2013. RESULTS During this period, 180 different patients with lung cancer were admitted into ICU. The simplified acute physiology score II (SAPS II) (OR 1.07 ; 95% CI 1.04-1.11), respiratory failure (OR 4.00; 95% CI 1.76-9.07) and the presence of therapeutic limitations were the 3 factors independently affecting hospital mortality in multivariate analysis. Considering only patients discharged alive from the hospital, the presence of metastases (HR 2.30; 95% CI 1.44-3.65) and limitations on therapy (HR 5,89; IC 95% 3,11-11,14) were the two statistically independent prognostic factors for overall survival. CONCLUSION In this population of lung cancer patients admitted into ICU, independent predictors of hospital mortality are determined by the physiological perturbations induced by the acute presenting complication. After recovery from this, prognosis is again determined by the characteristics of the underlying cancer.
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Affiliation(s)
- J Gorham
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique.
| | - L Ameye
- Data Centre, Institut Jules-Bordet, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - M Paesmans
- Data Centre, Institut Jules-Bordet, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - T Berghmans
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique
| | - J-P Sculier
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique
| | - A-P Meert
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique
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15
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Barth C, Soares M, Toffart AC, Timsit JF, Burghi G, Irrazabal C, Pattison N, Tobar E, Almeida BF, Silva UV, Azevedo LC, Rabbat A, Lamer C, Parrot A, Souza-Dantas VC, Wallet F, Blot F, Bourdin G, Piras C, Delemazure J, Durand M, Salluh J, Azoulay E, Lemiale V. Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs). Ann Intensive Care 2018; 8:80. [PMID: 30076547 PMCID: PMC6076209 DOI: 10.1186/s13613-018-0426-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. Methods A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013. Results Out of the 100 patients, 30 had small cell lung cancer (SCLC) and 70 had non-small cell lung cancer. (Thirty patients had already been treated with oncologic treatments.) Mechanical ventilation (MV) was performed for 81 patients. Seventeen patients received emergency chemotherapy during their ICU stay. ICU, hospital, 3- and 6-month mortality were, respectively, 47, 60, 67 and 71%. Hospital mortality was 60% when invasive MV was used alone, 71% when MV and vasopressors were needed and 83% when MV, vasopressors and hemodialysis were required. In multivariate analysis, hospital mortality was associated with metastatic disease (OR 4.22 [1.4–12.4]; p = 0.008), need for invasive MV (OR 4.20 [1.11–16.2]; p = 0.030), while chemotherapy in ICU was associated with survival (OR 0.23, [0.07–0.81]; p = 0.020). Conclusion This study shows that ICU management can be appropriate for selected newly diagnosed patients with advanced lung cancer, and chemotherapy might improve outcome for patients with SCLC admitted for cancer-related complications. Nevertheless, tumors’ characteristics, numbers and types of organ dysfunction should be taken into account in the decisional process before admitting these patients in ICU.
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Affiliation(s)
- C Barth
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - M Soares
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - A C Toffart
- Inserm, u 823, Institut A Bonniot, Grenoble, France
| | - J F Timsit
- Medical ICU, Hôpital Bichat-Claude Bernard, Paris, France
| | - G Burghi
- ICU, Hospital Maciel, Montevideo, Uruguay
| | - C Irrazabal
- ICU, Instituto Medico Especializado Alexander Fleming, Buenos Aires, Argentina
| | - N Pattison
- ICU, Royal Brompton NHS Foundation Trust, London ICU, Royal Marsden Hospital, London, UK
| | - E Tobar
- ICU, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - B F Almeida
- ICU, Hospital A. C. Camargo, São Paulo, Brazil
| | - U V Silva
- ICU, Fundação Pio XII-Hospital do Câncer de Barretos, Barretos, Brazil
| | - L C Azevedo
- ICU, Hospital Sírio Libanês, São Paulo, Brazil
| | - A Rabbat
- Thoracic ICU, Hôpital Cochin, Paris, France
| | - C Lamer
- ICU, Institut Mutualiste Montsouris, Paris, France
| | - A Parrot
- Medical ICU, Hôpital Tenon, Paris, France
| | - V C Souza-Dantas
- ICU, Instituto Nacional de Câncer-Hospital do Câncer I, Rio de Janeiro, Brazil
| | - F Wallet
- Medical-Surgical ICU, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France
| | - F Blot
- ICU, Institut Gustave Roussy, Villejuif, France
| | - G Bourdin
- Medical ICU, Hôpital de la Croix-Rousse, Lyon, France
| | - C Piras
- ICU, Vitória Apart Hospital, Vitória, Brazil
| | - J Delemazure
- Medical ICU, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - M Durand
- Surgical ICU, Hôpital A. Michallon Chu de Grenoble, Grenoble, France
| | - J Salluh
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - E Azoulay
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Virginie Lemiale
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
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16
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Lai CC, Ho CH, Chen CM, Chiang SR, Chao CM, Liu WL, Wang JJ, Yang CC, Cheng KC. Risk factors and mortality of adults with lung cancer admitted to the intensive care unit. J Thorac Dis 2018; 10:4118-4126. [PMID: 30174856 DOI: 10.21037/jtd.2018.06.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background This study aims to investigate lung cancer patients' risk factors for: intensive care unit (ICU) admission, infectious complications and organ dysfunction in the ICU, and prognosis after ICU admission. Methods The records of all patients with lung-cancer catastrophic-illness cards admitted to the ICU between 2003 and 2012 were reviewed. The primary endpoint was 1-year mortality. Results We finally analyzed the records of index-date-, age-, and sex-matched ICU-admitted (ICU+) lung cancer patients (n=17,687) and ICU-non-admitted (ICU-) lung cancer patients (n=35,374). The overall 1-year mortality rate was significantly (P<0.0001) higher for ICU+ patients (49.91%) than for ICU- patients (44.86%). Most ICU+ patients (56.16%) had infectious complications and organ dysfunction (52.33%), and overall, 6,893 (38.97%) had sepsis. Independent mortality risk factors were age (≥75 years) [adjusted hazard ratio (AHR), 1.22; 95% confidence interval (CI), 1.16-1.29], male sex: (AHR, 1.18; 95% CI, 1.13-1.23), recent radiotherapy (AHR, 1.09; 95% CI, 1.04-1.15), infectious complications (AHR: 1.23; 95% CI: 1.17-1.29), organ dysfunction (AHR, 1.57; 95% CI, 1.50-1.65), and hospital level (regional hospital: AHR, 1.11; 95% CI, 1.06-1.16; local hospital: AHR, 1.28; 95% CI, 1.18-1.37). Conclusions ICU admission for lung cancer patients is associated with higher mortality. Several risk factors of mortality for ICU+ patients should help physicians provide patients personalized and better-informed lung cancer therapy decisions.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan.,Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan
| | - Chin-Ming Chen
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan.,Chia Nan University of Pharmacy and Science, Tainan
| | - Shyh-Ren Chiang
- Chia Nan University of Pharmacy and Science, Tainan.,Internal Medicine, Chi Mei Medical Center, Tainan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying
| | - Wei-Lun Liu
- Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, New Taipei
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan
| | - Ching-Chieh Yang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung.,Department of Biotechnology, Chia-Nan University of Pharmacy and Science, Tainan
| | - Kuo-Chen Cheng
- Internal Medicine, Chi Mei Medical Center, Tainan.,Department of Safety, Health, and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan
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17
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Chen YF, Lin JW, Ho CC, Yang CY, Chang CH, Huang TM, Chen CY, Chen KY, Shih JY, Yu CJ. Outcomes of cancer therapy administered to treatment-naïve lung cancer patients in the intensive care unit. J Cancer 2017; 8:1995-2003. [PMID: 28819399 PMCID: PMC5559960 DOI: 10.7150/jca.18178] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/03/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives: Therapy outcomes for newly diagnosed, critically ill lung cancer patients have seldom been evaluated. This study evaluated therapy outcomes for treatment-naïve lung cancer patients in the intensive care unit (ICU). Materials and Methods: Patients were excluded if they had previously received lung cancer treatment, such as systemic chemotherapy, targeted therapy, radiotherapy, or surgical lung resection before ICU admission. The therapeutic strategies for the treatment-naïve patients were determined while they were in the ICU. The patients' demographic data, clinical outcomes, and treatment-related toxicities were analyzed. Results: Newly diagnosed lung cancer patients (n = 72) who did not receive any anticancer treatment before ICU admission were included. Most patients had locally advanced disease, and 61 (84.7%) required intensive care due to cancer-related events. In the ICU, 24 (33.3%) patients received chemotherapy, 24 (33.3%) received epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy and 24 (33.3%) received best supportive care (BSC). Patients receiving chemotherapy or EGFR-TKIs in the ICU demonstrated better ICU (p = 0.011) and in-hospital (p = 0.034) survival than those receiving BSC only. Among patients requiring mechanical ventilation, those receiving chemotherapy had higher weaning rates than those receiving EGFR-TKIs or BSC (p = 0.002). In multivariate analysis, receipt of chemotherapy (hazard ratio [HR], 0.443; p = 0.083) and mechanical ventilation (HR, 0.270; p = 0.022) were significantly associated with longer ICU survival after adjusting for clinical factors. Conclusions: Anticancer therapy in the ICU might provide better short-term ICU survival for treatment-naïve, critically ill lung cancer patients.
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Affiliation(s)
- Yen-Fu Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan (R.O.C.)
| | - Jou-Wei Lin
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan (R.O.C.)
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
| | - Ching-Yao Yang
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
| | - Chia-Hao Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd., Hsinchu City 30059, Taiwan (R.O.C.)
| | - Tao-Min Huang
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan (R.O.C.)
| | - Chung-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan (R.O.C.)
| | - Kuan-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC)
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18
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Auclin E, Charles-Nelson A, Abbar B, Guérot E, Oudard S, Hauw-Berlemont C, Thibault C, Monnier A, Diehl JL, Katsahian S, Fagon JY, Taieb J, Aissaoui N. Outcomes in elderly patients admitted to the intensive care unit with solid tumors. Ann Intensive Care 2017; 7:26. [PMID: 28265980 PMCID: PMC5339259 DOI: 10.1186/s13613-017-0250-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/23/2017] [Indexed: 12/28/2022] Open
Abstract
Background As the population ages and cancer therapies improve, there is an increased call for elderly cancer patients to be admitted to the intensive care unit (ICU). This study aimed to assess short-term survival and prognostic factors in critically ill patients with solid tumors aged ≥65 years. Methods We conducted a retrospective study. The primary endpoint was ICU mortality. Resumption of anticancer therapy in patients who survived the ICU stay and 90-day mortality were secondary endpoints. All patients aged ≥65 years admitted to the ICU of Georges Pompidou Hospital (Paris, France) between 2009 and 2014 were eligible. Results Of 2327 eligible elderly patients (EP), 262 (75.0 ± 6.7 years) with solid tumors were analyzed. These patients were extremely critically ill (SAPS 2 61.9 ± 22.5), and 60.3% had metastatic disease. Gastrointestinal, lung and genitourinary cancers were the most common types of tumors. Mechanical ventilation was required in 51.5% of patients, inotropes in 48.1% and dialysis in 12.6%. Most patients (66.7%) were admitted for reasons unrelated to cancer, including sepsis (30.5%), acute respiratory failure (28.2%) and neurological problems (8.0%). ICU mortality in patients with cancer was 33.6 versus 32.6% among patients without cancer (p = 0.75). Among the cancer EP, the 90-day mortality was 51.9% (n = 136). In multivariate analysis, increased SAPS 2 score and primary tumor site were associated with 90-day death, whereas previous anticancer therapies and poor performance status were not. Among survivor patients from ICU with anti-tumoral treatment indication, 77 (52.7%) had resumption of anticancer treatment. Conclusions Elderly solid tumor patients admitted to the ICU had a mortality rate similar to EP without cancer. Prognostic factors for 90-day mortality were more related to severity of clinical status at admission than the presence or stage of cancer, suggesting that early admission of EP with cancer to the ICU is appropriate. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0250-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edouard Auclin
- Gastrointestinal Oncology Department, European Georges Pompidou Hospital, Paris, France. .,Intensive Care Unit, European Georges Pompidou Hospital, Paris, France. .,Oncology Department, European Georges Pompidou Hospital, Paris, France. .,Université Paris Descartes, Paris, France.
| | | | - Baptiste Abbar
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France
| | - Emmanuel Guérot
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France
| | - Stéphane Oudard
- Oncology Department, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Caroline Hauw-Berlemont
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Constance Thibault
- Oncology Department, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Alexandra Monnier
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Jean-Luc Diehl
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Sandrine Katsahian
- Université Paris Descartes, Paris, France.,Clinical Research Unit, European Georges Pompidou Hospital, Paris, France
| | - Jean-Yves Fagon
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Julien Taieb
- Gastrointestinal Oncology Department, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Nadia Aissaoui
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
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Abstract
Advances in cancer treatment and patient survival are associated with increasing number of these patients requiring intensive care. Over the last 2 decades, there has been a steady improvement in the outcomes of critically ill patients with cancer. This review provides data on the use of the intensive care unit (ICU) and short and long-term outcomes of critically ill patients with cancer, the ICU system practices that influence patients outcomes, and the role of the different clinical variables in predicting the prognosis of these patients.
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Affiliation(s)
- Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R- 3 Hudson, Detroit, MI 48201, USA.
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20
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Shimabukuro-Vornhagen A, Böll B, Kochanek M, Azoulay É, von Bergwelt-Baildon MS. Critical care of patients with cancer. CA Cancer J Clin 2016; 66:496-517. [PMID: 27348695 DOI: 10.3322/caac.21351] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Answer questions and earn CME/CNE The increasing prevalence of patients living with cancer in conjunction with the rapid progress in cancer therapy will lead to a growing number of patients with cancer who will require intensive care treatment. Fortunately, the development of more effective oncologic therapies, advances in critical care, and improvements in patient selection have led to an increased survival of critically ill patients with cancer. As a consequence, critical care has become an important cornerstone in the continuum of modern cancer care. Although, in many aspects, critical care for patients with cancer does not differ from intensive care for other seriously ill patients, there are several challenging issues that are unique to this patient population and require special knowledge and skills. The optimal management of critically ill patients with cancer necessitates expertise in oncology, critical care, and palliative medicine. Cancer specialists therefore have to be familiar with key principles of intensive care for critically ill patients with cancer. This review provides an overview of the state-of-the-art in the individualized management of critically ill patients with cancer. CA Cancer J Clin 2016;66:496-517. © 2016 American Cancer Society.
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Affiliation(s)
- Alexander Shimabukuro-Vornhagen
- Consultant, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Boris Böll
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Head of Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Program Director, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Éli Azoulay
- Director, Medical Intensive Care Unit, St. Louis Hospital, Paris, France
- Professor of Medicine, Teaching and Research Unit, Department of Medicine, Paris Diderot University, Paris, France
- Chair, Study Group for Respiratory Intensive Care in Malignancies, St. Louis Hospital, Paris, France
| | - Michael S von Bergwelt-Baildon
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Program Director, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Professor, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
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21
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Sakhri L, Saint-Raymond C, Quetant S, Pison C, Lagrange E, Hamidfar Roy R, Janssens JP, Maindet-Dominici C, Garrouste-Orgeas M, Levy-Soussan M, Terzi N, Toffart AC. [Limitations of active therapeutic and palliative care in chronic respiratory disease]. Rev Mal Respir 2016; 34:102-120. [PMID: 27639947 DOI: 10.1016/j.rmr.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/29/2016] [Indexed: 11/16/2022]
Abstract
The issue of intensive and palliative care in patients with chronic disease frequently arises. This review aims to describe the prognostic factors of chronic respiratory diseases in stable and in acute situations in order to improve the management of these complex situations. The various laws on patients' rights provide a legal framework and define the concept of unreasonable obstinacy. For patients with chronic obstructive pulmonary disease, the most robust decision factors are good knowledge of the respiratory disease, the comorbidities, the history of previous exacerbations and patient preferences. In the case of idiopathic pulmonary fibrosis, it is necessary to know if there is a prospect of transplantation and to assess the reversibility of the respiratory distress. In the case of amyotrophic lateral sclerosis, treatment decisions depend on the presence of advance directives about the use of intubation and tracheostomy. For lung cancer patients, general condition, cancer history and the tumor treatment plan are important factors. A multidisciplinary discussion that takes into account the patient's medical history, wishes and the current state of knowledge permits the taking of a coherent decision.
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Affiliation(s)
- L Sakhri
- Institut de cancérologie Daniel-Hollard, groupe hospitalier Mutualiste, 38000 Grenoble, France
| | - C Saint-Raymond
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - S Quetant
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - C Pison
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Laboratoire de bioénergétique fondamentale et appliquée, Inserm 1055, 38400 Saint-Martin-d'Hères, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France
| | - E Lagrange
- Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France
| | - R Hamidfar Roy
- Pôle urgences médecine aiguë, clinique de réanimation médicale, CHU de Grenoble, 38000 Grenoble, France
| | - J-P Janssens
- Service de pneumologie, hôpital Cantonal universitaire, Genève, Suisse
| | - C Maindet-Dominici
- Pôle anesthésie réanimation, centre de la douleur, CHU de Grenoble, 38000 Grenoble, France
| | - M Garrouste-Orgeas
- Service de médecine intensive et de réanimation, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - M Levy-Soussan
- Unité mobile d'accompagnement et de soins palliatifs, hôpital universitaire Pitié-Salpêtrière, 75006 Paris, France
| | - N Terzi
- Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France; Inserm U1042, université Grenoble Alpes, HP2, CHU de Grenoble, 38000 Grenoble, France
| | - A-C Toffart
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Institut pour l'avancée des biosciences, centre de recherche UGA, Inserm U 1209, CNRS UMR 5309, 38000 Grenoble, France.
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22
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Gupta R, Heshami N, Jay C, Ramesh N, Song J, Lei X, Rose EJ, Carter K, Araujo DM, Benjamin RS, Patel S, Nates JL, Ravi V. Predictors of survival in patients with sarcoma admitted to the intensive care unit. Clin Sarcoma Res 2016; 6:12. [PMID: 27437097 PMCID: PMC4950117 DOI: 10.1186/s13569-016-0051-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advances in treatment of sarcoma patients has prolonged survival but has led to increased disease- or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU). Survival and long-term outcome information about such critically ill patients with sarcoma is unknown. METHODS The primary objective of the study was to determine the ICU and post-ICU survival rates of critically ill sarcoma patients. Secondary objectives included determining the modifiable and non-modifiable predictors of poor survival. We performed a retrospective chart review of sarcoma patients admitted to the ICU at The University of Texas MD Anderson Cancer Center between January 1, 2005, and December 31, 2012. Main outcome measures were ICU mortality, in-hospital mortality and 1, 2, and 6-month survival rates. Covariates such as histological diagnosis, disease characteristics, chemotherapy use, Charlson comorbidity index, Sequential Organ Failure Assessment (SOFA) scores, and clinical findings leading to ICU admission were analyzed for their effects on survival. RESULTS We identified 172 admissions over the 8-year study period hat met our inclusion criteria. The study population was 45.9 % males with a median age of 52 years. The most common sarcoma subgroups were high-grade unclassified sarcoma (25 %) and bone tumors (17.4 %). The ICU mortality rate was 23.3 % (95 % confidence interval [CI], 16.9-29.6 %), and an additional 6.4 % of patients died before hospital discharge (95 % CI, 22.9-37.1 %). 6-month OS rates were 41 %. The median SOFA scores on admission were 6 (inter quartile range (IQR), 3.5-9) in ICU survivors and 10 (IQR, 6.5-14) in ICU non-survivors. Increase in SOFA scores ≥6 led to poor outcomes (ICU survival 13.3 %, OS 6.7 %). Charlson comorbidity index (HR 1.139, 95 % CI 1.023-1.268, p = 0.02) and discharge SOFA scores (HR 1.210, 95 % CI 1.141-1.283, p < 0.0001) correlated with overall survival. CONCLUSIONS Our results suggest that patients that are admitted to the ICU for respiratory failure, cardiac arrest, septic shock, acute renal failure or acidosis and also have a high SOFA score with subsequent worsening in the ICU have poor prognosis. Based on the retrospective data which needs further validation we can recommend that judicious approach should be taken in patients with predictors of poor survival before subjecting them to aggressive treatment.
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Affiliation(s)
- Rohan Gupta
- The University of Texas at Houston Internal Medicine Residency Program, Houston, TX USA
| | - Neda Heshami
- The University of Texas at Houston Internal Medicine Residency Program, Houston, TX USA
| | - Chouhan Jay
- The University of Texas at Houston Internal Medicine Residency Program, Houston, TX USA
| | - Naveen Ramesh
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX USA
| | - Juhee Song
- Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Xiudong Lei
- Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Erfe Jean Rose
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Kristen Carter
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
| | - Dejka M Araujo
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
| | - Robert S Benjamin
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
| | - Joseph L Nates
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
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23
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Kerrigan K, Shoben A, Otterson G. Treatment of Lung Cancer Patients With Actionable Mutations in the Intensive Care Unit. Clin Lung Cancer 2016; 17:523-527. [PMID: 27256487 DOI: 10.1016/j.cllc.2016.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients with advanced-stage non-small-cell lung cancer (NSCLC) have high mortality rates in the intensive care unit (ICU). Although the benefit of chemotherapy for hematologic malignancies in the ICU has previously been explored, few data exist regarding the use of targeted therapy for NSCLC in such settings. The primary objective of the present study was to report our experience with the use of targeted therapy in patients with NSCLC in the ICU. MATERIALS AND METHODS We performed a single-institution, retrospective medical record review. The eligibility criteria included patients with NSCLC with targetable mutations who had received tyrosine kinase inhibitors (TKIs) in the ICU. Cases were identified by queries of our institution's information warehouse database and pharmacy dispensary records from 2010 to 2015. RESULTS All 9 patients who had received TKIs in the ICU had acute respiratory failure. Three patients were successfully extubated after initiating TKI therapy, although 1 required later tracheostomy. TKI therapy stabilized another patient's refractory disseminated intravascular coagulation. The remaining 5 patients showed no measurable clinical improvement and were transitioned to comfort care. The overall ICU mortality rate was 56%. CONCLUSION Patients with metastatic NSCLC requiring mechanical ventilation have high mortality rates. Cytotoxic chemotherapy is generally contraindicated for poor performance status patients. However, targeted TKI therapy should be considered, given its proven efficacy and few systemic side effects. We recommend the empiric use of targeted therapy for NSCLC patients with suspected and/or known actionable mutations presenting with multifactorial respiratory failure to the ICU, with aggressive determination of the mutation status if not known.
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Affiliation(s)
- Kathleen Kerrigan
- Department of Internal Medicine, The Ohio State University, Columbus, OH.
| | - Abigail Shoben
- Department of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH
| | - Gregory Otterson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
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24
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Xia R, Wang D. Intensive care unit prognostic factors in critically ill patients with advanced solid tumors: a 3-year retrospective study. BMC Cancer 2016; 16:188. [PMID: 26946297 PMCID: PMC4779224 DOI: 10.1186/s12885-016-2242-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 03/01/2016] [Indexed: 12/15/2022] Open
Abstract
Background The objective of this study was to identify risk factors predicting prognosis of critically ill medical patients with advanced solid tumors in the intensive care unit (ICU). Methods We retrospectively analyzed all ICU unplanned medical admissions to the ICU of patients with advanced solid cancer in Tianjin Medical University Cancer Institute and Hospital between October 1, 2012 and March 1, 2015. Approval was obtained from the Ethical Commission of Tianjin Medical University Cancer Institute and Hospital to review and publish information from patients’ records. Results One hundred and forty-one patients with full code status met the criteria for inclusion from among 813 ICU admissions. ICU mortality was 14.9 % and in-hospital mortality was 29.8 %. The major reasons for unplanned ICU admission were respiratory failure (38.3 %) and severe sepsis or septic shock (27.7 %). The ICU mortality in patients who required vasopressors, mechanical ventilation or renal replacement therapy for >24 h was 25, 25.9 and 40 %, respectively. The mean overall survival was 28.6 months. After adjusting for hypertension, type of solid cancer, intervention time, need for mechanical ventilation and Acute Physiology and Chronic Health Evaluation II score, only Sepsis-related Organ Failure Assessment (SOFA) score on day 7 of ICU treatment remained a significant predictor of ICU mortality (adjusted odds ratio 1.612, 95 % confidence interval 1.137–2.285, P = 0.007). Conclusions We suggest broadening the criteria for ICU admission. The patients should be allowed an ICU trial consisting of unlimited ICU support, including invasive hemodynamic monitoring, mechanical ventilation and renal replacement therapy. An interdisciplinary meeting, including an ethics consultation, should be held to make end-of-life decisions if the SOFA score on day 7 shows clinical deterioration with no available therapeutic options.
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Affiliation(s)
- Rui Xia
- Key Laboratory of Cancer Prevention and Therapy, Intensive Care Unit, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, China.
| | - Donghao Wang
- Key Laboratory of Cancer Prevention and Therapy, Intensive Care Unit, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, China
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25
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Toffart AC, Duruisseaux M, Sakhri L, Giaj Levra M, Moro-Sibilot D, Timsit JF. Indications de réanimation en oncologie thoracique. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/s1877-1203(16)30039-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Integrating early palliative care (EPC) in the management of lung cancer: The role of the thoracic oncologist. Lung Cancer 2015; 90:135-8. [PMID: 26341958 DOI: 10.1016/j.lungcan.2015.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/06/2015] [Accepted: 08/24/2015] [Indexed: 12/25/2022]
Abstract
Early introduction of palliative care in the management of patients with metastatic lung cancer is recommended since it improves quality of life and improves survival rates. In many hospitals the focus of palliative teams is often on terminal care due to limited resources. How is Early palliative care (EPC) in this setting implemented in daily oncologic care? It seems obvious that thoracic oncologists will have to become involved in EPC for lung cancer patients. In this review we want to determine the assignments for the thoracic oncologist in EPC and to give some practical tools how we started EPC in collaboration with the palliative team.
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27
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Müller AM, Gazzana MB, Silva DR. Outcomes for patients with lung cancer admitted to intensive care units. Rev Bras Ter Intensiva 2015; 25:12-6. [PMID: 23887754 PMCID: PMC4031862 DOI: 10.1590/s0103-507x2013000100004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/28/2013] [Indexed: 12/15/2022] Open
Abstract
Objective This study aimed to evaluate the outcomes for patients with lung cancer admitted
to intensive care units and assess their clinical and demographic profiles. Methods Retrospective, analytical, observational study, wherein the outcomes for patients
diagnosed with lung cancer admitted to the intensive care unit of university
hospital from January 2010 until February 2011 were evaluated. Results Thirty-four patients' medical records were included. Twenty-six (76.5%) patients
received some type of ventilatory support, of whom 21 (61.8%) used invasive
mechanical ventilation and 11 (32.4%) used noninvasive ventilation at some point
during their stay at the intensive care unit. Regarding mortality, 12 (35.3%)
patients died during hospitalization at the intensive care unit, totaling 15
(44.1%) deaths during the entire hospitalization period; 19 (55.9%) patients were
discharged from the hospital. The analysis of the variables showed that the
patients who died had remained on invasive mechanical ventilation for a longer
period 5.0 (0.25 to 15.0) days than the survivors (1.0 (0 to 1.0) days) (p=0.033)
and underwent dialysis during their stay at the intensive care unit (p=0.014).
Conclusions The mortality of patients with lung cancer admitted to the intensive care unit is
associated with the time spent on invasive mechanical ventilation and the need for
dialysis.
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28
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Prediction of short- and long-term survival for advanced cancer patients after ICU admission. Support Care Cancer 2014; 23:1647-55. [DOI: 10.1007/s00520-014-2519-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/10/2014] [Indexed: 12/12/2022]
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29
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Meert AP, Berghmans T, Sculier JP. [The patient with lung cancer in intensive care]. Rev Mal Respir 2014; 31:961-74. [PMID: 25496791 DOI: 10.1016/j.rmr.2014.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 04/28/2014] [Indexed: 12/17/2022]
Abstract
In Western countries, lung cancer (LC) is the most common cause of cancer death. It is present in 15-20% of patients admitted to the ICU with a neoplastic condition. The purpose of this article is to review the causes of admission to ICU of patients with LC, their prognosis and the results of different life-support techniques. Most studies include mixed populations of non-small cell (NSCLC) and small-cell lung cancers (SCLC). However, there is preponderance of NSCLC (70%) and LC of advanced or metastatic stages, reflecting the distribution in the general population of LC. The cause of admission of LC patients to ICU is most often of respiratory origin. The ICU mortality rate currently ranges from 13 to 47% and the hospital mortality rate from 24 to 65%. The predictors of in-hospital mortality are mainly severity scores, organ dysfunction, general condition (performance status), respiratory distress and the need for mechanical ventilation or vasopressor drugs. When considering the long-term mortality, it is the features of the cancer (presence of metastases, cancer progression) that are important predictive factors.
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Affiliation(s)
- A-P Meert
- Service des soins intensifs et urgences oncologiques et oncologie thoracique, université libre de Bruxelles (ULB), institut Jules-Bordet, 1, rue Heger-Bordet, 1000 Brussel, Belgique.
| | - T Berghmans
- Service des soins intensifs et urgences oncologiques et oncologie thoracique, université libre de Bruxelles (ULB), institut Jules-Bordet, 1, rue Heger-Bordet, 1000 Brussel, Belgique
| | - J-P Sculier
- Service des soins intensifs et urgences oncologiques et oncologie thoracique, université libre de Bruxelles (ULB), institut Jules-Bordet, 1, rue Heger-Bordet, 1000 Brussel, Belgique
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Toffart AC, Pizarro CA, Schwebel C, Sakhri L, Minet C, Duruisseaux M, Azoulay E, Moro-Sibilot D, Timsit JF. Selection criteria for intensive care unit referral of lung cancer patients: a pilot study. Eur Respir J 2014; 45:491-500. [DOI: 10.1183/09031936.00118114] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The decision-making process for the intensity of care delivered to patients with lung cancer and organ failure is poorly understood, and does not always involve intensivists. Our objective was to describe the potential suitability for intensive care unit (ICU) referral of lung cancer in-patients with organ failures.We prospectively included consecutive lung cancer patients with failure of at least one organ admitted to the teaching hospital in Grenoble, France, between December 2010 and October 2012.Of 140 patients, 121 (86%) were evaluated by an oncologist and 49 (35%) were referred for ICU admission, with subsequent admission for 36 (73%) out of those 49. Factors independently associated with ICU referral were performance status ⩽2 (OR 10.07, 95% CI 3.85–26.32), nonprogressive malignancy (OR 7.00, 95% CI 2.24–21.80), and no explicit refusal of ICU admission by the patient and/or family (OR 7.95, 95% CI 2.39–26.37). Factors independently associated with ICU admission were the initial ward being other than the lung cancer unit (OR 6.02, 95% CI 1.11–32.80) and an available medical ICU bed (OR 8.19, 95% CI 1.48–45.35).Only one-third of lung cancer patients with organ failures were referred for ICU admission. The decision not to consider ICU admission was often taken by a non-intensivist, with advice from an oncologist rather than an intensivist.
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31
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El paciente con cáncer en la unidad de vigilancia intensiva. Nuevas perspectivas. Rev Clin Esp 2014; 214:403-9. [DOI: 10.1016/j.rce.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/08/2014] [Accepted: 03/10/2014] [Indexed: 11/20/2022]
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32
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Kostakou E, Rovina N, Kyriakopoulou M, Koulouris NG, Koutsoukou A. Critically ill cancer patient in intensive care unit: Issues that arise. J Crit Care 2014; 29:817-22. [DOI: 10.1016/j.jcrc.2014.04.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 03/01/2014] [Accepted: 04/16/2014] [Indexed: 12/15/2022]
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Puxty K, McLoone P, Quasim T, Kinsella J, Morrison D. Survival in solid cancer patients following intensive care unit admission. Intensive Care Med 2014; 40:1409-28. [PMID: 25223853 DOI: 10.1007/s00134-014-3471-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 08/26/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE One in seven patients admitted to intensive care units (ICU) has a cancer diagnosis but evidence on their expected outcomes after admission has not been synthesised. METHODS Systematic literature review of solid cancer adult patients admitted to ICU from 2000 onwards using EMBASE and MEDLINE electronic databases. RESULTS There were 48 papers identified that reported survival in ICU patients with solid cancers. ICU mortality was reported in 35 studies comprising a total sample of 25,339 patients and ranging from 4.5 to 85 %. The average mortality of the distribution of reported mortality rates within ICU was 31.2 % (95 % CI 24.0-39.0 %). Hospital mortality was reported in 31 studies across a total sample of 74,061 patients. The average hospital mortality was 38.2 % (33.8-42.7 %) and ranged from 4.6 to 76.8 %. Poorer physiological score, invasive mechanical ventilation and poor functional status were associated with higher mortality. CONCLUSIONS Several factors have been associated with poor survival in ICU cancer patients; however, primary research is still needed to describe outcomes in cancer patients with sufficient case mix and treatment details to be of prognostic value to clinicians.
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Affiliation(s)
- Kathryn Puxty
- NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK,
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34
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Prieto del Portillo I, Polo Zarzuela M, Pujol Varela I. Patients with cancer in the intensive monitoring unit. New perspectives. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hsia TC, Tu CY, Chen HJ. The impact of rescue or maintenance therapy with EGFR TKIs for Stage IIIb-IV non-squamous non-small-cell lung cancer patients requiring mechanical ventilation. BMC Anesthesiol 2014; 14:55. [PMID: 25050082 PMCID: PMC4105103 DOI: 10.1186/1471-2253-14-55] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/09/2014] [Indexed: 11/12/2022] Open
Abstract
Background The toxicity of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is less than that of cytotoxic agents. The reports of dramatic response and improvement in performance status with the use of EGFR TKIs may influence a physician’s decision-making for patients with non-squamous non-small cell lung cancer (NSCLC) and life-threatening respiratory distress. The aim of this study was to evaluate the outcome of rescue or maintenance therapy with EGFR TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation. Methods Eighty-three Asian patients with stage IIIb-IV non-squamous NSCLC and who required mechanical ventilation between June 2005 and January 2010 were evaluated. Results Of the 83 patients, 16 (19%) were successfully weaned from the ventilator. The use of EGFR TKI as rescue or maintenance therapy during respiratory failure did not improve the rate of successful weaning (standard care 18% vs. with EGFR TKI, 22%; p = 0.81) in univariate and multivariate analyses. Conclusions Rescue or maintenance therapy with EGFR TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation was not associated with better outcome. An end-of-life discussion should be an important aspect in the care of this group of patients, since only 19% were successfully weaned from mechanical ventilation.
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Affiliation(s)
- Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Hung-Jen Chen
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
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Zarogoulidis P, Pataka A, Terzi E, Hohenforst-Schmidt W, Machairiotis N, Huang H, Tsakiridis K, Katsikogiannis N, Kougioumtzi I, Mpakas A, Zarogoulidis K. Intensive care unit and lung cancer: when should we intubate? J Thorac Dis 2014; 5 Suppl 4:S407-12. [PMID: 24102014 DOI: 10.3978/j.issn.2072-1439.2013.08.15] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 08/09/2013] [Indexed: 12/20/2022]
Abstract
Lung cancer still remains the leading cause of cancer death among males. Several new methodologies are being used in the everyday practise for diagnosis and staging. Novel targeted therapies are being used and others are being investigated. However; early diagnosis still remains the cornerstone for efficient treatment and disease management. Lung cancer patients requires in many situations intensive care unit (ICU) admission, either due to the necessity for supportive care until efficient disease symptom control (respiratory distress due to malignant pleural effusion) or disease adverse effect management (massive pulmonary embolism). In any case guidelines indicating the patient that has to be intubated have not yet been issued. In the current review we will present current data and finally present an algorithm based on the current published information for lung cancer patients that will probably benefit from admission to the ICU.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Saft HL, Richman PS, Berman AR, Mularski RA, Kvale PA, Ray DE, Selecky P, Ford DW, Asch SM. Impact of critical care medicine training programs' palliative care education and bedside tools on ICU use at the end of life. J Grad Med Educ 2014; 6:44-9. [PMID: 24701309 PMCID: PMC3963793 DOI: 10.4300/jgme-06-01-38] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/17/2013] [Accepted: 07/30/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Intensive care unit (ICU) use at the end of life is rising. Little research has focused on associations among critical care fellows' training, institutional support, and bedside tools with ICU use at the end of life. OBJECTIVE We evaluated whether hospital and critical care medicine program interventions were associated with ICU use in the last 6 months of life for patients with chronic illness. METHODS Our observational, retrospective study explored associations between results from a survey of critical care program directors and hospital-level Medicare data on ICU use in the last 6 months of life. Program directors evaluated quality of palliative care education in their critical care fellowships and reported on the number of bedside tools and the presence or absence of an inpatient palliative care consultation service. RESULTS For the 89 hospitals and 71 affiliated training programs analyzed, there were statistically significant relationships between 2 of the explanatory variables-the quality of palliative care education and the number of bedside tools-in ICU use. Each level of increased educational quality (1-5 Likert scale) was associated with a 0.57-day decrease in ICU days, whereas, for each additional, evidence-based bedside tool, there was a 0.31-day decrease. The presence of an inpatient palliative care program was not a significant predictor of ICU use. CONCLUSIONS We found that the quality of palliative care training in critical care medicine programs and the use of bedside tools were independently associated with reduced ICU use at the end of life.
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Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB–IV lung cancer patients. Med Oncol 2014; 31:847. [DOI: 10.1007/s12032-014-0847-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 01/15/2014] [Indexed: 01/02/2023]
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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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Hwang KE, Seol CH, Hwang YR, Jo HG, Park SH, Yoon KH, Park DS, Jeong ET, Kim HR. The prognosis of patients with lung cancer admitted to the medical intensive care unit. Asia Pac J Clin Oncol 2013; 12:e118-24. [PMID: 24289233 DOI: 10.1111/ajco.12157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS Lung cancer remains the leading cause of cancer mortality worldwide. Despite their poor prognosis, patients with lung cancer are increasingly being admitted to the medical intensive care unit (MICU) for treatment of critical illnesses. The aim of this study was to assess the outcome of patients with lung cancer who are admitted to an MICU and to identify the measurable predictors of their MICU outcome. METHODS We conducted retrospective analysis on 97 patients with lung cancer admitted to the MICU between 2007 and 2011. RESULTS The mean age ± standard deviation was 71.8 ± 6.8 years. Of the 97 patients (82 male), 73 patients (75%) had non-small cell lung cancer stage IIIB, IV and 24 patients (25%) had small cell lung cancer. The intensive care unit mortality and in-hospital mortality rates were 53.6 and 61.8%. The main reasons for MICU admission were pneumonia (n = 51) and complication of cancer management (n = 45). The predictors of poor MICU outcome were history of diabetes mellitus (P = 0.028), Acute Physiology and Chronic Health Evaluation II score (P = 0.018), need for mechanical ventilation (P = 0.014), use of vasoactive agents (P < 0.0001), the presence of acute renal failure (P < 0.0001) and presence of multiorgan failure (P < 0.0001). CONCLUSIONS We found that in-hospital mortality was not influenced by age, sex or performance status score of patients with lung cancer but increased with the severity of organ failure at MICU admission.
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Affiliation(s)
- Ki-Eun Hwang
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.,Department of Medicine, Graduate School, Chosun University, Gwangju, Korea
| | - Chang-Hwan Seol
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yu-Ri Hwang
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Hoon-Gil Jo
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Seong-Hoon Park
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Korea
| | - Kwon-Ha Yoon
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Korea
| | - Do-Sim Park
- Department of Laboratory Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun-Taik Jeong
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Hak-Ryul Kim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
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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, 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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Slatore CG, Wiener RS, Cooke CR. Reply to F. Vincent et al and S.M.H. Alibhai. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.45.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christopher G. Slatore
- Portland Veterans Affairs Medical Center; Oregon Health and Science University, Portland, OR
| | - Renda Soylemez Wiener
- Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford; The Pulmonary Center, Boston University School of Medicine, Boston, MA
| | - Colin R. Cooke
- University of Michigan Health System; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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Bonomi MR, Smith CB, Mhango G, Wisnivesky JP. Outcomes of elderly patients with stage IIIB–IV non-small cell lung cancer admitted to the intensive care unit. Lung Cancer 2012; 77:600-4. [DOI: 10.1016/j.lungcan.2012.05.103] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 05/15/2012] [Accepted: 05/17/2012] [Indexed: 11/26/2022]
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Survival and functional outcomes after cardiopulmonary resuscitation in the intensive care unit. J Crit Care 2012; 27:421.e9-17. [DOI: 10.1016/j.jcrc.2011.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/27/2011] [Accepted: 11/03/2011] [Indexed: 11/22/2022]
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Boyd M, Rubio E. The utility of interventional pulmonary procedures in liberating patients with malignancy-associated central airway obstruction from mechanical ventilation. Lung 2012; 190:471-6. [PMID: 22644069 DOI: 10.1007/s00408-012-9394-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 05/08/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE Utilization of intensive care services by patients with malignancy has risen during the past several decades. Newer cancer therapies have improved overall survival and outcomes. Patients with respiratory failure from central airway obstruction related to tumor growth were previously viewed as inappropriate candidates for ventilator support. However, an increasing number of reports suggest that interventional pulmonary (IP) procedures may benefit such patients. METHODS We reviewed the literature for case reports or case series from the past 20 years regarding the use of IP procedures for the treatment of respiratory failure from malignancy-associated central airway obstruction. RESULTS As a whole, IP procedures were greater than 60 % successful in liberating patients from mechanical ventilation. Moreover, IP procedures served to palliate respiratory symptoms, prolong overall survival, allow for additional cancer treatments, and reduce hospitalization costs. Nevertheless, it remains unclear who may benefit the most from these procedures. CONCLUSIONS Although data are limited, IP procedures are generally safe and should be considered for appropriate patients with respiratory failure from malignancy-associated central airway obstruction as a potential means of liberation from mechanical ventilation.
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Affiliation(s)
- Michael Boyd
- Virginia Tech Carilion School of Medicine, Section of Pulmonary, Critical Care, Environmental, and Sleep Medicine, Carilion Clinic, 1906 Belleview Avenue, Roanoke, VA 24014, USA.
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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: 65] [Impact Index Per Article: 5.4] [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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