title: Selection criteria for intensive care unit referral of lung cancer patients: a pilot study.
abstract: The decision-making process for the intensity of care delivered to patients with lung cancer and organ failure is poorly understood, and does not always involve intensivists. Our objective was to describe the potential suitability for intensive care unit (ICU) referral of lung cancer in-patients with organ failures. We prospectively included consecutive lung cancer patients with failure of at least one organ admitted to the teaching hospital in Grenoble, France, between December 2010 and October 2012. Of 140 patients, 121 (86%) were evaluated by an oncologist and 49 (35%) were referred for ICU admission, with subsequent admission for 36 (73%) out of those 49. Factors independently associated with ICU referral were performance status ⩽2 (OR 10.07, 95% CI 3.85-26.32), nonprogressive malignancy (OR 7.00, 95% CI 2.24-21.80), and no explicit refusal of ICU admission by the patient and/or family (OR 7.95, 95% CI 2.39-26.37). Factors independently associated with ICU admission were the initial ward being other than the lung cancer unit (OR 6.02, 95% CI 1.11-32.80) and an available medical ICU bed (OR 8.19, 95% CI 1.48-45.35). Only one-third of lung cancer patients with organ failures were referred for ICU admission. The decision not to consider ICU admission was often taken by a non-intensivist, with advice from an oncologist rather than an intensivist.
authors.affiliation: Grenoble 1 University, U 823, A. Bonniot Institute, J. Fourier University, Grenoble, France Thoracic Oncology Unit, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire A. Michallon, Grenoble, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Toffart
authors.affiliation: Traumatology-Orthopedic Unit, Pôle Tête et Cou, Centre Hospitalier Universitaire A. Michallon, Grenoble, France.
authors.forename: Carola Alegria
authors.initials: CA
authors.lastname: Pizarro
authors.affiliation: Medical Intensive Care Unit, Pôle Urgences Médecine Aiguë, Centre Hospitalier Universitaire A. Michallon, Grenoble, France Grenoble 1 J. Fourier University, Laboratoires des Pharmaceutiques Biocliniques, U 1039, Grenoble, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.affiliation: Thoracic Oncology Unit, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire A. Michallon, Grenoble, France.
authors.forename: Linda
authors.initials: L
authors.lastname: Sakhri
authors.affiliation: Medical Intensive Care Unit, Pôle Urgences Médecine Aiguë, Centre Hospitalier Universitaire A. Michallon, Grenoble, France.
authors.forename: Clemence
authors.initials: C
authors.lastname: Minet
authors.affiliation: Thoracic Oncology Unit, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire A. Michallon, Grenoble, France Equipe de Recherche 2, "Interactions des cellules tumorales et leur environnement et résistance aux agents anticancéreux", GRC Université Paris 6 Pierre et Marie Curie Theranoscan, Hôpital Tenon - APHP, Paris, France.
authors.forename: Michaël
authors.initials: M
authors.lastname: Duruisseaux
authors.affiliation: Intensive Care Unit, Hôpital Saint Louis, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Grenoble 1 University, U 823, A. Bonniot Institute, J. Fourier University, Grenoble, France Thoracic Oncology Unit, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire A. Michallon, Grenoble, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Moro-Sibilot
authors.affiliation: Grenoble 1 University, U 823, A. Bonniot Institute, J. Fourier University, Grenoble, France INSERM, IAME, UMR 1137, Paris, France Paris Diderot University, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France AP-HP, Hôpital Bichat, Service de Réanimation Médicale et Infectieuse, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000368:Aged; D003422:Critical Care / Q000458:organization & administration*; D003657:Decision Making; D018450:Disease Progression; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008495:Medical Oncology / Q000458:organization & administration; D008875:Middle Aged; D010343:Patient Admission; D018579:Patient Selection; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation; D013997:Time Factors