title: Invasive mechanical ventilation in cancer patients. Prior non invasive ventilation is a poor prognostic factor.
abstract: OBJECTIVE
  Prior non invasive ventilation (NIV) is associated with an increased mortality in patients with haematological malignancies and acute respiratory failure treated by invasive mechanical ventilation (IMV). We have assessed whether NIV failure is an independent prognostic factor for hospital discharge in a general cancer population treated by IMV.
  
  
  METHODS
  106 patients with solid tumors and 58 patients with haematological malignancies were eligible for this retrospective study; 41 were treated by NIV before IMV.
  
  
  RESULTS
  The main indications for mechanical ventilation were sepsis/shock (35%), acute respiratory failure (33%), cardiopulmonary resuscitation (16%) and neurologic disease (10%). Respectively, 35%, 28% and 24% of the patients were extubated, discharged from the intensive care unit (ICU) and from the hospital. For patients treated with NIV prior to IMV, the rates were 22%, 17% and 10%, respectively. In multivariate analysis, 3 variables were independently associated with a decreased probability of being discharged from the hospital: NIV use before IMV (odds ratio/OR=0.30, 95% confidence interval/CI: 0.09-0.95; p=0.04); leukopenia (OR=0.21, 95% CI: 0.06-0.77; p=0.02) and serum bilirubin >1.1 mg/dl (OR=0.38, 95% CI: 0.16-0.94; p=0.04).
  
  
  CONCLUSIONS
  NIV failure before IMV is an independent poor prognostic factor in cancer patients treated by IMV.
authors.affiliation: Département de Soins Intensifs et Oncologie Thoracique et Data Centre, Institut Jules Bordet, Centre des tumeurs de l'Université Libre de Bruxelles (ULB), Bruxelles, Belgium. ap.meert@bordet.be
authors.forename: A P
authors.initials: AP
authors.lastname: Meert
authors.forename: T
authors.initials: T
authors.lastname: Berghmans
authors.forename: E
authors.initials: E
authors.lastname: Markiewicz
authors.forename: M
authors.initials: M
authors.lastname: Hardy
authors.forename: N
authors.initials: N
authors.lastname: Nayer
authors.forename: M
authors.initials: M
authors.lastname: Paesmans
authors.forename: J P
authors.initials: JP
authors.lastname: Sculier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D007970:Leukopenia / Q000150:complications; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D011379:Prognosis; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D001663:Bilirubin