Respiratory support in oncology ward setting: a prospective descriptive study.
BACKGROUND
Mechanical ventilation in cancer patients is a critical issue The present prospective descriptive study was designed (1) to assess the patient population needing respirator support in ward setting at a premier state-run oncology institute in India, (2) to observe and analyze the course of their disease while on respirator, and (3) to coordinate better quality of life measures in cancer patients at the institute based on the present study's outcomes.


METHODS
Beginning from March 2005 to March 2006, all cancer patients who were connected to respirator in the wards were enrolled in the current study. Our anesthesiology department at the cancer institute also has primary responsibility for airway management and mechanical ventilation in high dependency units of oncology wards. Preventilation variables in cancer patients were assessed to judge the futility of mechanical ventilation in ward setting. Subsequently, patients were observed for disease course while on respirator. Final outcome with its etio-pathogenesis was correlated with predicted futility of mechanical ventilation.


RESULTS
Over a period of 1 year, 132 (46 men and 86 women) cancer patients with median age 40 years (range 1-75 years) were connected to respirator in oncology wards. Based on the preventilation variables and indications for respirator support, right prediction of medical futility and hospital discharge was made in 77% of patients. Underestimation and overestimation of survival to hospital discharge was made in 10% cases and 13% cases, respectively.


CONCLUSIONS
Based on preventilation variables, prediction of outcome in cancer patients needing respirator support can be made in 77% cases. This high probability of prediction can be used to educate patients, and their families and primary physicians, for well-informed and documented advance directives, formulated and regularly revised DNAR policies, and judicious use of respirator support for better quality-of-life outcomes.
Mishra
Seema
S
Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. mseema17@ yahoo.co.in
Bhatnagar
Sushma
S
Gupta
Deepak
D
Goyal
Gaurav Nirvani
GN
Agrawal
Ravi
R
Jain
Roopesh
R
Chauhan
Himanshu
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D015996:Survival Rate; D016312:Treatment Refusal / Q000706:statistics & numerical data; D055815:Young Adult