title: Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs.
abstract: OBJECTIVE
  To describe the characteristics of a large cohort of cancer patients receiving mechanical ventilation for >24 hrs and to identify clinical features predictive of in-hospital death.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Ten-bed oncologic medical-surgical intensive care unit.
  
  
  METHODS
  A total of 463 consecutive patients were included over a 45-month period.
  
  
  METHODS
  None.
  
  
  RESULTS
  Data were collected on the day of admission to the intensive care unit. The intensive care unit and hospital mortality rates were 50% and 64%, respectively. There were 359 (78%) patients with solid tumors and 104 (22%) with hematologic malignancies; 35 (8%) patients had leukopenia. Sepsis (63%), coma (15%), invasion or compression by tumor (11%), pulmonary embolism (7%), and cardiopulmonary arrest (6%) were the main reasons for mechanical ventilation. The independent unfavorable risk factors for mortality were older age (odds ratio, 3.09; 95% confidence interval, 1.61-5.93, for patients 40-70 yrs old, and odds ratio, 9.26; 95% confidence interval, 4.16-20.58, for patients >70 yrs old); performance status 3-4 (odds ratio, 2.51; 95% confidence interval, 1.40-4.51); cancer recurrence/progression (odds ratio, 3.43; 95% confidence interval, 1.81-6.53); Pao2/Fio2 ratio <150 (odds ratio, 2.64; 95% confidence interval, 1.40-4.99); Sequential Organ Failure Assessment score (excluding respiratory domain, each 4 points; odds ratio, 2.34; 95% confidence interval, 1.70-3.24); and airway/pulmonary invasion or compression by tumor as a reason for mechanical ventilation (odds ratio, 5.73; 95% confidence interval, 1.92-17.08).
  
  
  CONCLUSIONS
  Severity of acute organ failures, poor performance status, cancer status, and older age were the main determinants of mortality. The appropriate use of such easily available clinical characteristics may avoid forgoing intensive care for patients with a chance of survival.
authors.affiliation: Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. marciosoaresms@yahoo.com.br
authors.forename: Márcio
authors.initials: M
authors.lastname: Soares
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh
authors.forename: Nelson
authors.initials: N
authors.lastname: Spector
authors.forename: José R
authors.initials: JR
authors.lastname: Rocco
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001938:Brazil / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D016896:Treatment Outcome