title: Use of intensive care in patients with nonresectable lung cancer.
abstract: 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.
authors.affiliation: Clinique de Pneumologie, Pôle Médecine Aiguë Communautaire, Centre Hospitalier Universitaire de Grenoble, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Toffart
authors.forename: Clémence
authors.initials: C
authors.lastname: Minet
authors.forename: Bruno
authors.initials: B
authors.lastname: Raynard
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hamidfar-Roy
authors.forename: Samia
authors.initials: S
authors.lastname: Diab
authors.forename: Sébastien
authors.initials: S
authors.lastname: Quetant
authors.forename: Denis
authors.initials: D
authors.lastname: Moro-Sibilot
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000368:Aged; D000075202:Contraindications; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate