title: Admission of advanced lung cancer patients to intensive care unit: a retrospective study of 76 patients.
abstract: BACKGROUND
  Criteria for admitting patients with incurable diseases to the medical intensive care unit (MICU) remain unclear and have ethical implications.
  
  
  METHODS
  We retrospectively evaluated MICU outcomes and identified risk factors for MICU mortality in consecutive patients with advanced lung cancer admitted to two university-hospital MICUs in France between 1996 and 2006.
  
  
  RESULTS
  Of 76 included patients, 49 had non-small cell lung cancer (stage IIIB n = 20; stage IV n = 29). In 60 patients, MICU admission was directly related to the lung cancer (complication of cancer management, n = 30; cancer progression, n = 14; and lung-cancer-induced diseases, n = 17). Mechanical ventilation was required during the MICU stay in 57 patients. Thirty-six (47.4%) patients died in the MICU. Three factors were independently associated with MICU mortality: use of vasoactive agents (odds ratio [OR] 6.81 95% confidence interval [95%CI] [1.77-26.26], p = 0.005), mechanical ventilation (OR 6.61 95%CI [1.44-30.5], p = 0.015) and thrombocytopenia (OR 5.13; 95%CI [1.17-22.5], p = 0.030). In contrast, mortality was lower in patients admitted for a complication of cancer management (OR 0.206; 95%CI [0.058-0.738], p = 0.015). Of the 27 patients who returned home, four received specific lung cancer treatment after the MICU stay.
  
  
  CONCLUSIONS
  Patients with acute complications of treatment for advanced lung cancer may benefit from MCIU admission. Further studies are necessary to assess outcomes such as quality of life after MICU discharge.
authors.affiliation: Service de Pneumologie et Réanimation, Centre Hospitalier Universitaire, Amiens, France. clandrejak@gmail.com
authors.forename: Claire
authors.initials: C
authors.lastname: Andréjak
authors.forename: Nicolas
authors.initials: N
authors.lastname: Terzi
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Thielen
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bergot
authors.forename: Gérard
authors.initials: G
authors.lastname: Zalcman
authors.forename: Pierre
authors.initials: P
authors.lastname: Charbonneau
authors.forename: Vincent
authors.initials: V
authors.lastname: Jounieaux
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome