Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs*

Abstract

Objectives: To describe the characteristics of a large cohort of cancer patients receiving mechanical ventilation for >24 hrs and to identify clinical features predictive of in-hospital death. Design: Prospective cohort study. Setting: Ten-bed oncologic medical-surgical intensive care unit. Patients: A total of 463 consecutive patients were included over a 45-month period. Interventions: None. Measurements and Main Results: Data were collected on the day of admission to the intensive care unit. The intensive care unit and hospital mortality rates were 50% and 64%, respectively. There were 359 (78%) patients with solid tumors and 104 (22%) with hematologic malignancies; 35 (8%) patients had leukopenia. Sepsis (63%), coma (15%), invasion or compression by tumor (11%), pulmonary embolism (7%), and cardiopulmonary arrest (6%) were the main reasons for mechanical ventilation. The independent unfavorable risk factors for mortality were older age (odds ratio, 3.09; 95% confidence interval, 1.61–5.93, for patients 40–70 yrs old, and odds ratio, 9.26; 95% confidence interval, 4.16–20.58, for patients >70 yrs old); performance status 3–4 (odds ratio, 2.51; 95% confidence interval, 1.40–4.51); cancer recurrence/progression (odds ratio, 3.43; 95% confidence interval, 1.81–6.53); Pao₂/Fio₂ ratio <150 (odds ratio, 2.64; 95% confidence interval, 1.40–4.99); Sequential Organ Failure Assessment score (excluding respiratory domain, each 4 points; odds ratio, 2.34; 95% confidence interval, 1.70–3.24); and airway/pulmonary invasion or compression by tumor as a reason for mechanical ventilation (odds ratio, 5.73; 95% confidence interval, 1.92–17.08). Conclusions: Severity of acute organ failures, poor performance status, cancer status, and older age were the main determinants of mortality. The appropriate use of such easily available clinical characteristics may avoid forgoing intensive care for patients with a chance of survival.