Elsevier

Critical Care Clinics

Volume 26, Issue 1, January 2010, Pages 41-58
Critical Care Clinics

Mechanical Ventilation in Cancer Patients: Clinical Characteristics and Outcomes

https://doi.org/10.1016/j.ccc.2009.09.005Get rights and content

Section snippets

Epidemiology

Information on the incidence of ARF and need for ventilatory support in patients with malignancies is still limited, but it seems to vary largely depending on the studied population. Approximately 5% of patients with solid tumors will experience ARF during the course of their disease,1, 2 but the incidence may be higher in patients with lung and head and neck cancers. In hematology patients, the incidence is variable, running from 4% to almost half of the population.1, 2, 3, 4, 5 In the study

Reasons for mechanical ventilation

Besides infectious complications and decompensation of concurrent respiratory and cardiovascular diseases, the main reasons for MV in cancer patients include direct involvement of the respiratory system by malignancy, cancer-related medical disorders, and respiratory distress associated with anticancer therapies.2, 26 Outcomes vary largely regarding the underlying reason for MV. For instance, patients with respiratory failure secondary to cardiogenic pulmonary edema are more likely to survive,1

Short-Term Outcomes

ARF with the need for ventilatory support is usually associated with high mortality and morbidity. Until the 1990s, the outcome for these patients was considered very poor, with several studies reporting mortality rates greater than 80%.40, 41, 42, 43, 44, 45 Fortunately, studies from the past decade have documented improved survival rates in patients with diverse malignancies requiring MV. Nonetheless, the need for invasive MV remains a major outcome predictor in critically ill patients with

Triage for intensive care unit admission

In the authors' opinion, cancer patients who develop ARF requiring ventilatory support are appropriate candidates for ICU admission. As previously discussed, improvements in survival have been demonstrated in different centers and the knowledge on patients' outcomes has expanded significantly over the past several years. However, the decision to admit a patient with cancer requiring ventilatory support to the ICU remains complex, involving multidimensional domains, and is still a matter of

Invasive and noninvasive mechanical ventilatory support in acute respiratory failure

Whereas the ultimate outcome of ARF depends on the reversibility of the underlying cause, correction of hypoxemia and oxygen delivery as well as hypercapnic acidosis is pivotal to ensure patient survival while the underlying cause is identified and treated. Positive pressure ventilation can be delivered through endotracheal intubation (ie, IPPV) or through a nasal or facial mask, or a helmet (ie, NIPPV). In contrast to IPPV, NIPPV preserves the integrity of the upper airway functions and

Summary

Survival of patients with malignancies admitted to the ICU in need of MV has improved over the last decade. This improvement can be ascribable to advances in patient management in hematology and oncology and in critical care, but certainly also to a better selection of patients for ICU admission. The current scenario of better outcomes coupled with imprecision in patient selection criteria and broadening of ICU admission policies should prompt clinicians to offer initial “full-code” management

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    Conflicts of interest: none.

    Financial support: Dr Soares is supported in part by an individual research grant from CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazil).

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