Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study.
BACKGROUND
This study was undertaken to evaluate the clinical characteristics and outcomes of patients with cancer requiring nonpalliative ventilatory support.


METHODS
This was a secondary analysis of a prospective cohort study conducted in 28 Brazilian ICUs evaluating adult patients with cancer requiring invasive mechanical ventilation (MV) or noninvasive ventilation (NIV) during the first 48 h of their ICU stay. We used logistic regression to identify the variables associated with hospital mortality.


RESULTS
Of 717 patients, 263 (37%) (solid tumors = 227; hematologic malignancies = 36) received ventilatory support. NIV was initially used in 85 patients (32%), and 178 (68%) received MV. Additionally, NIV followed by MV occurred in 45 patients (53%). Hospital mortality rates were 67% in all patients, 40% in patients receiving NIV only, 69% when NIV was followed by MV, and 73% in patients receiving MV only (P < .001). Adjusting for the type of admission, newly diagnosed malignancy (OR, 3.59; 95% CI, 1.28-10.10), recurrent or progressive malignancy (OR, 3.67; 95% CI, 1.25-10.81), tumoral airway involvement (OR, 4.04; 95% CI, 1.30-12.56), performance status (PS) 2 to 4 (OR, 2.39; 95% CI, 1.24-4.59), NIV followed by MV (OR, 3.00; 95% CI, 1.09-8.18), MV as initial ventilatory strategy (OR, 3.53; 95% CI, 1.45-8.60), and Sequential Organ Failure Assessment score (each point except the respiratory domain) (OR, 1.15; 95% CI, 1.03-1.29) were associated with hospital mortality. Hospital survival in patients with good PS and nonprogressive malignancy and without tumoral airway involvement was 53%. Conversely, patients with poor functional capacity and cancer progression had unfavorable outcomes.


CONCLUSIONS
Patients with cancer with good PS and nonprogressive disease requiring ventilatory support should receive full intensive care, because one-half of these patients survive. On the other hand, provision of palliative care should be considered the main goal for patients with poor PS and progressive underlying malignancy.
ICU, Hospital Sirio-Libanes, Criciúma, Brazil; Programa de Pós-Graduação em Oncologia, Criciúma, Brazil.
Luciano C P
LCP
Azevedo
ICU, Hospital A. C. Camargo, Criciúma, Brazil.
Pedro
P
Caruso
ICU, Universidade Federal do Rio Grande do Sul, Porto Alegre, Criciúma, Brazil.
Ulysses V A
UVA
Silva
ICU, Santa Casa de Misericórdia de Porto Alegre, Criciúma, Brazil.
André P
AP
Torelly
ICU, Hospital Israelita Albert Einstein, Criciúma, Brazil; ICU, Fundação Pio XII, Hospital do Câncer de Barretos, Barretos, Criciúma, Brazil.
Eliézer
E
Silva
ICU, Hospital do Servidor Público Estadual, São Paulo, Criciúma, Brazil.
Ederlon
E
Rezende
ICU, Instituto Nacional de Câncer, Hospital do Câncer II, Criciúma, Brazil.
José J
JJ
Netto
ICU, Vitória Apart Hospital, Vitória, Criciúma, Brazil.
Claudio
C
Piras
Division of Critical Care Medicine, Department of Internal Medicine, Medical School and Hospital de Base, São José do Rio Preto, Criciúma, Brazil.
Suzana M A
SMA
Lobo
ICU, Hospital São Lucas, Criciúma, Brazil. Electronic address: marciosoaresms@gmail.com.
Marcos F
MF
Knibel
ICU, Hospital Português, Salvador, Criciúma, Brazil.
José M
JM
Teles
ICU, Hospital Samaritano, Criciúma, Brazil.
Ricardo A
RA
Lima
Hospital Pasteur, Criciúma, Brazil.
Bruno S
BS
Ferreira
ICU, Universidade Federal do Rio Grande do Sul, Porto Alegre, Criciúma, Brazil.
Gilberto
G
Friedman
ICU, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Criciúma, Brazil.
Alvaro
A
Rea-Neto
Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil.
Felipe
F
Dal-Pizzol
D'Or Institute for Research and Education, Rio de Janeiro, Criciúma, Brazil.
Fernando A
FA
Bozza
Programa de Pós-Graduação em Oncologia, Criciúma, Brazil.
Jorge I F
JIF
Salluh
Programa de Pós-Graduação em Oncologia, Criciúma, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Criciúma, Brazil.
Márcio
M
Soares
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D063087:Noninvasive Ventilation / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome