Outcome for Cancer Patients Requiring Mechanical Ventilation

Abstract

This model can be used to estimate the probability of hospital survival for classes of adult cancer patients who require mechanical ventilation and can help to guide physicians, patients, and families in deciding goals and direction of treatment. Prospective independent validation in different medical settings is warranted.

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…67,70,71 The need for ventilatory support ranges from 28 to 76% in recent studies, 13,16,21,24,25,[27][28][29][30][31][32][33][34][35] and ICU mortality varies from 63 to 85% (Table 3). These results are far worse than the respective 70% and 62% ICU and hospital survival rates reported in a large observational study of unselected ICU patients requiring MV.…”

“…Indeed, the survival rate of patients requiring MV within the engraftment period is acceptable and similar to the rates reported in cohorts of cancer patients. 13,70 Third, NIV is increasingly used and frequently successful in 61%. 30 Moreover, NIV failure was not associated with poor prognosis.…”

General Prognostic Scores in Outcome Prediction for Cancer Patients Admitted to the Intensive Care Unit

“…These improvements come at the cost of an escalating number of patients who experience cancer-related complications and/or treatment-related adverse events 3 and thus need specialized intensive care. Fortunately, since the 1980s, the mortality rate of critically ill cancer patients admitted to the ICU has decreased, 4 including mortality among those who are recipients of hematopoietic stem cell transplants 5 and those who require life-sustaining therapies for the management of acute respiratory failure, [6][7][8] acute renal failure, 9 or septic shock. 10,11 This decrease in mortality has been attributed to a better understanding of the pathophysiology of certain cancer-related complications and the development of effective targeted treatments (eg, rasburicase for tumor lysis syndrome 12 ).…”

Outcome in critically ill cancer patients: past and present

“…Even ICU physicians often dealing with such patients fail to discriminate well between survivors and non-survivors 46 . Nevertheless, a number of prognostic indicators have been identified to guide physicians in their decisionmaking 15,16,[27][28][29][30][31]44 . Of course beside these prognostic indicators, the patient's perceived quality of life and the wishes of the patient and/or the relatives should also be taken into account.…”

“…The high mortality of more than 80% in patients requiring mechanical ventilation (Table 1) [8][9][10][11][12][13][14][15] , increasing to more than 90% to 95% in patients developing multiple organ failure or who require renal replacement therapy during ICU stay 12,[16][17][18] , particularly in the transplant setting [19][20][21] , together with the severe emotional burden endured by these patients and their relatives, and the considerable costs of advanced and prolonged life-supporting therapy 13 resulted in a general reluctance to admit such patients to the ICU 2,6,7 . However, over the past few years, several centres throughout the world have been reporting on increasingly improving survival in critically ill patients with hematological malignancies and solid tumors [22][23][24][25][26][27][28][29][30][31] , approaching survival rates reported in general ICU patients 32 .…”