title: Risk factors for noninvasive ventilation failure in cancer patients in the intensive care unit: A retrospective cohort study.
abstract: OBJECTIVE
  The purpose of the study is to identify risk factors for noninvasive ventilation (NIV) failure in cancer patients with acute respiratory failure (ARF).
  
  
  METHODS
  A retrospective cohort study of adult patients admitted to intensive care unit (ICU), who received NIV for treatment of ARF, was conducted. We conducted a chart review to estimate the NIV failure rate and used logistic regression to identify risk factors.
  
  
  RESULTS
  Of 2258 patients admitted to the ICU during the study period, 114 (5%) received NIV for ARF. Noninvasive ventilation was successful in 67 patients (59%) and failed for 47 (41%), of whom 36 were intubated and 11 were sedated for palliation. Factors associated with NIV failure were infection as the primary cause of ARF (odds ratio [OR], 4.90; 95% confidence interval [CI], 1.78-13.45; P = .002), male sex (OR, 2.58; 95% CI, 1.20-5.56; P = .015), and Simplified Acute Physiology Score 3 (OR, 1.04; 95% CI, 1.01-1.07; P = .006). Overall ICU mortality was 40%, and hospital mortality was 56%. Noninvasive ventilation failure was the only independent predictor of ICU mortality (OR, 16.6; 95% CI, 6.5-41.5; P < .001).
  
  
  CONCLUSIONS
  Noninvasive ventilation can avert ARF for most ICU cancer patients with ARF. For patients with pulmonary infections and high severity scores, NIV should be used with caution. Identifying risk factors for NIV failure using a comprehensive diagnostic approach and monitoring of NIV are paramount to improve outcomes.
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; AC Camargo Cancer Center, São Paulo, Brazil. Electronic address: juliana.ferreira@hc.fm.usp.br.
authors.forename: Juliana Carvalho
authors.initials: JC
authors.lastname: Ferreira
authors.affiliation: AC Camargo Cancer Center, São Paulo, Brazil. Electronic address: pedromedjr@yahoo.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Medeiros
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. Electronic address: francinni.mambrini@gmail.com.
authors.forename: Francinni Mambrini
authors.initials: FM
authors.lastname: Rego
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; AC Camargo Cancer Center, São Paulo, Brazil. Electronic address: pedro.caruso@hc.fm.usp.br.
authors.forename: Pedro
authors.initials: P
authors.lastname: Caruso
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D063087:Noninvasive Ventilation / Q000009:adverse effects* / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure
keywords: Artificial; Cancer care facilities; Intensive care; Neoplasms; Noninvasive ventilation; Respiration