title: Identifying cancer subjects with acute respiratory failure at high risk for intubation and mechanical ventilation.
abstract: BACKGROUND
  We sought to identify risk factors for mechanical ventilation in patients with malignancies and acute respiratory failure (ARF).
  
  
  METHODS
  We analyzed data from a previous randomized controlled trial in which nonintubated oncology and hematology subjects with ARF were randomized to early bronchoalveolar lavage or routine care in 16 ICUs in France. Consecutive patients with malignancies were admitted to the ICU for ARF in 2005 and 2006 with no intervention.
  
  
  RESULTS
  During the study period, 219 patients were admitted to the ICU for ARF, and 8 patients were not included due to a nonintubation order. Data on the underlying disease, pulmonary involvement, and extrapulmonary organ dysfunctions were recorded at admission in the 211 remaining subjects. Ventilatory support included oxygen only (49 subjects), noninvasive ventilation (NIV) only (81 subjects), NIV followed by invasive mechanical ventilation (49 subjects), and first-line invasive mechanical ventilation (32 subjects). The 81 subjects who required invasive mechanical ventilation were compared with the 130 subjects who remained on oxygen or NIV. Factors associated with invasive mechanical ventilation by multivariate analysis were the oxygen flow required at ICU admission, the number of quadrants involved on chest x-ray, and hemodynamic dysfunction. Mortality rates for subjects who had NIV failure were 65.3% compared with 50% for subjects who were first-line intubated (P = .34).
  
  
  CONCLUSIONS
  In cancer patients with ARF, hypoxemia, extent of pulmonary infiltration on chest x-ray, or hemodynamic dysfunction are risk factors for invasive mechanical ventilation. Mortality was not significantly different between NIV failure and first-line intubation.
authors.affiliation: ICU virginie.lemiale@sls.aphp.fr.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.affiliation: Biostatistics Department, Saint Louis Teaching Hospital, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lambert
authors.affiliation: ICU.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.affiliation: ICU, Institut Paoli Calmettes, Marseilles, France.
authors.forename: Djamel
authors.initials: D
authors.lastname: Mokart
authors.affiliation: ICU, Cochin Teaching Hospital, Paris, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Pène
authors.affiliation: ICU, Hotel Dieu Teaching Hospital, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.affiliation: ICU, Angers Teaching Hospital, Angers, France.
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.affiliation: ICU, Avicenne Teaching Hospital, Bobigny, France.
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.affiliation: ICU, Mignot Hospital, Versailles, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.affiliation: Pellegrin Teaching Hospital, Bordeaux, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
authors.affiliation: Biostatistics Department, Saint Louis Teaching Hospital, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.affiliation: ICU.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000368:Aged; D018893:Bronchoalveolar Lavage; D005260:Female; D005602:France; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011859:Radiography; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors
keywords: cancer mechanical ventilation; immunosuppression; noninvasive ventilation; outcome; respiratory failure