The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients.
BACKGROUND
Delirium and coma are a frequent source of morbidity for ICU patients. Several factors are associated with the prognosis of mechanically ventilated (MV) cancer patients, but no studies evaluated delirium and coma (acute brain dysfunction). The present study evaluated the frequency and impact of acute brain dysfunction on mortality.


METHODS
The study was performed at National Cancer Institute, Rio de Janeiro, Brazil. We prospectively enrolled patients ventilated >48 h with a diagnosis of cancer. Acute brain dysfunction was assessed during the first 14 days of ICU using RASS/CAM-ICU. Patients were followed until hospital discharge. Univariate and multivariable analysis were performed to evaluate factors associated with hospital mortality.


RESULTS
170 patients were included. 73% had solid tumors, age 65 [53-72 (median, IQR 25%-75%)] years. SAPS II score was 54[46-63] points and SOFA score was (7 [6-9]) points. Median duration of MV was 13 (6-21) days and ICU stay was 14 (7.5-22) days. ICU mortality was 54% and hospital mortality was 66%. Acute brain dysfunction was diagnosed in 161 patients (95%). Survivors had more delirium/coma-free days [4(1,5-6) vs 1(0-2), p<0.001]. In multivariable analysis the number of days of delirium/coma-free days were associated with better outcomes as they were independent predictors of lower hospital mortality [0.771 (0.681 to 0.873), p<0.001].


CONCLUSIONS
Acute brain dysfunction in MV cancer patients is frequent and independently associated with increased hospital mortality. Future studies should investigate means of preventing or mitigating acute brain dysfunction as they may have a significant impact on clinical outcomes.
Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil.
Isabel C T
IC
Almeida
Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil ; D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil.
Márcio
M
Soares
D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil ; Intensive Care Lab, Instituto de Pesquisa Evandro Chagas, IPEC, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil.
Fernando A
FA
Bozza
Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil ; D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil.
Cassia Righy
CR
Shinotsuka
Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil.
Renata
R
Bujokas
Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil.
Vicente Cés
VC
Souza-Dantas
Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America ; Veteran's Affairs Tennessee Valley Geriatric Research Education Clinical Center (VA-GRECC), Nashville, Tennessee, United States of America.
E Wesley
EW
Ely
Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil ; D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil.
Jorge I F
JI
Salluh
D000208:Acute Disease; D000368:Aged; D001927:Brain Diseases / Q000175:diagnosis / Q000503:physiopathology*; D001938:Brazil; D003128:Coma / Q000175:diagnosis / Q000503:physiopathology*; D003693:Delirium / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*