Weaning outcome of solid cancer patients requiring mechanical ventilation in the intensive care unit

Hsiue, Emily Han‐Chung; Lee, Pei-Lin; Chen, Yung-Hsuan; Wu, Tsan-Ming; Cheng, Colin C.J.; Cheng, Keng-Man; Yang, Pei‐Chi; Chen, Hsing-Wu; Lin, Pan; Chiang, Dai-Lung; Wu, Huey-Dong; Yang, James Chih‐Hsin; Yu, Chong‐Jen

doi:10.1016/j.jfma.2019.02.007

Cited by 8 publications

(4 citation statements)

References 35 publications

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“…Physicians may be hesitant to put cancer patients in mechanical ventilation or NIV as studies have demonstrated cancer patients were more likely to have slower recovery and more difficult to wean. 28,29 The underlying stages of malignancies and status of do-not-resuscitation order were not recorded in the present cohort. Despite this, vasopressors and a short trial of NIV were the routine first-line treatments in our center.…”

Section: Discussionmentioning

confidence: 89%

“…Patients with malignancy received less invasive mechanical ventilation (35.7% vs. 45.9%, p = 0.018). Physicians may be hesitant to put cancer patients in mechanical ventilation or NIV as studies have demonstrated cancer patients were more likely to have slower recovery and more difficult to wean 28,29 . The underlying stages of malignancies and status of do‐not‐resuscitation order were not recorded in the present cohort.…”

Section: Discussionmentioning

confidence: 95%

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Effect of the underlying malignancy on critically ill septic patient's outcome

Man

Shum

Lam

et al. 2021

Asia-Pac J Clncl Oncology

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Background: Sepsis is an important cause of mortality and morbidity among critically ill patients with underlying malignancy. Methods: Patients with sepsis admitted to the intensive care unit (ICU) of the Pamela Youde Nethersole Eastern Hospital from January 1, 2010 to April 30, 2019 were recruited. Demographics, laboratory parameter, and outcome were analyzed. Those with underlying malignancy were matched with those without malignancy based on their severity of organ failure (defined by the sequential organ failure assessment [SOFA] score) and septic source.Results: Two hundred sixty-three patients with underlying active malignancy were matched with 259 patients without malignancy. Those with malignancy had higher APACHE IV score (89 vs. 83), lower albumin (22.1 vs. 24.4), neutrophil count (6.0 vs. 9.3), hemoglobin (8.0 vs. 9.8), platelet count (113 vs. 133), less use of mechanical ventilation (35.7% vs. 45.9%), renal replacement therapy (22.1% vs. 28.2%) and vasopressor (66.2% vs. 74.9%), higher 30-day (34.2% vs. 24.3%) ICU (22.4% vs. 18.9%), and 1year (62.4% vs. 36.7%) mortality compared with those without malignancy. A higher APACHE IV score and pulmonary sepsis were predictors of 30-day mortality by Cox regression analysis. Conclusion:Disease severity and pulmonary sepsis, but not underlying malignancy, predicted short-term mortality among critically ill septic patients.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 95%

Effect of the underlying malignancy on critically ill septic patient's outcome

Man

Shum

Lam

et al. 2021

Asia-Pac J Clncl Oncology

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“…The presence of underlying active cancer and metastatic status are both important predictors for in-hospital mortality due to their immune-compromised status [14]. The effect of cancer on a patient's outcome has been proven in critical care [15,16]. However, whether patients have cancer with or without metastasis may provide little insight on the poor prognosis, and as high as 25% of terminal cancer patients receive vasopressors in the dying process [17].…”

Section: Discussionmentioning

confidence: 99%

Predicting in-hospital mortality for patients admitted from the emergency department: An initial alarm score for inpatient care

Hsieh¹,

Hsu²,

Lin³

et al. 2020

Preprint

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Background: The in-hospital mortality of patients admitted from the emergency department (ED) is high, but no appropriate initial alarm score is available. Methods: This prospective observational study enrolled ED-admitted patients in hospitalist-care wards and analyzed the predictors for seven-day in-hospital mortality from May 2010 to October 2016. Two-thirds were randomly assigned to a derivation cohort for development of the model and cross-validation was performed in the validation cohort. Results: During the study period, 8,649 patients were enrolled for analysis. The mean age was 71.05 years, and 51.91% were male. The most common admission diagnoses were pneumonia (36%) and urinary tract infection (20.05%). In the derivation cohort, multivariable Cox proportional hazard regression revealed that a low Barthel index score, triage level 1 at the ED, presence of cancer, metastasis, and admission diagnoses of pneumonia and sepsis were independently associated with seven-day in-hospital mortality. Based on the probability developed from the multivariable model, the area under the receiver operating characteristic curve in the derivation group was 0.81 [0.79–0.85]. The result in the validation cohort was comparable. The prediction score modified by the six independent factors had high sensitivity of 88.03% and a negative predictive value of 99.51% for a cutoff value of 4, whereas the specificity and positive predictive value were 89.61% and 10.55%, respectively, when the cutoff value was a score of 6. Conclusion: The seven-day in-hospital mortality in a hospitalist-care ward is 2.8%. The initial alarm score could help clinicians to prioritize or exclude patients who need urgent and intensive care.

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“…In patients with MV support, we found that noncancer patients had survive advantage at the point of 28-day and 90-day after ICU admission. Hsiue et al [25]compared 518 patients with solid cancers with 1362 non-cancer patients receiving MV admitted to ICU between 2012 and 2014. They found that the 28-day and 90-day mortality rates were higher in cancer patients than in noncancer patients (45.2% vs. 29.4%, and 65.6% vs. 37.7%, respectively, both P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

The Effect of the Underlying Malignancy on Short- and Medium-Term Survival of Critically Ill Patients Admitted to the Intensive Care Unit : A Retrospective Analysis Based on Propensity Score Matching

Yuan

Wang

Gao

et al. 2020

Preprint

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Background Advances in oncology led to a substantial increase in the number of patients requiring admission to the ICU. It is significant to confirm which cancer critical patients can benefit from the ICU care service like noncancer patients. Methods An observational retrospective cohort study using intensive care unit (ICU) admissions of Medical Information Mart for Intensive Care III from the Beth Israel Deaconess Medical Center in Boston, MA, USA between 2001 and 2012 was conducted. Propensity score matching was used to reduce the imbalance between two matched cohorts. ICU patients with cancer were compared with those without cancer in terms of patients’ characteristics and survival. Results There were 38,508 adult patients admitted to ICUs during the period. The median age was 65 years (IQR, 52-77) and 8,308 (21.8%) had an underlying malignancy diagnosis. The noncancer group had a significant survive advantage at the point of 28-day, 90-day, 365-day and 1095-day after ICU admission compared with cancer group (P < 0.001 for all) after PSM. Subgroup analysis showed that the diagnosis of malignancy didn’t decrease 28-day and 90-day survive when patients’ age ≥65-year, patients in surgical intensive care unit or cardiac surgery recovery unit or traumatic surgical intensive care unit, elective admission, patients with renal replacement therapy or vasopressor support (P > 0.05 for all). Conclusions Malignancy is a common diagnosis among ICU patients. Patients without cancer have a survive advantage compared with patients with cancer in the short- and medium-term. However, in selected groups, cancer critical patients can benefit from the ICU care service like noncancer patients in the short-term.

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Weaning outcome of solid cancer patients requiring mechanical ventilation in the intensive care unit

Cited by 8 publications

References 35 publications

Effect of the underlying malignancy on critically ill septic patient's outcome

Effect of the underlying malignancy on critically ill septic patient's outcome

Predicting in-hospital mortality for patients admitted from the emergency department: An initial alarm score for inpatient care

The Effect of the Underlying Malignancy on Short- and Medium-Term Survival of Critically Ill Patients Admitted to the Intensive Care Unit : A Retrospective Analysis Based on Propensity Score Matching

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