Medical intensive care for lung cancer patients: better than we thought?

Intensive care unit and lung cancer: when should we intubate?

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.

Outcomes and prognostic factors of patients with lung cancer and pneumonia-induced respiratory failure in a medical intensive care unit: a single-center study

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.

Prognosis and Resuscitation Status of Critically Ill Patients with Lung Cancer Admitted to the Intensive Care Unit

The aims of the study were to assess the intensive care unit (ICU) outcome for critically ill patients with lung cancer, to determine the risk factors for mortality and to examine the resuscitation status on admission and during their ICU course. Data was collected from May 1999 to March 2009 for patients with lung cancer admitted to the ICU. During the study period, 51 patients with lung cancer were admitted to our ICU. The ICU and hospital mortality rates were 49 and 60%, respectively. The majority of patients were full resuscitation on admission to ICU. The resuscitation status was changed in 56% of patients during the ICU course. It is suggested that end-of-life decisions should be addressed earlier in these patients’ illnesses.

Use of intensive care in patients with nonresectable lung cancer

BACKGROUND

Admission of patients with lung cancer to the ICU has been criticized. We evaluated whether ICU admission improved 3-month survival in patients with nonresectable lung cancer. Factors associated with survival were identified.

METHODS

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

RESULTS

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

CONCLUSIONS

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