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Vol. 42. Num. 6.August - September 2018
Pages e12-e16Pages 327-396
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Vol. 42. Num. 6.August - September 2018
Pages e12-e16Pages 327-396
Original
DOI: 10.1016/j.medin.2017.08.004
Risk factors and outcomes of severe acute respiratory failure requiring invasive mechanical ventilation in cancer patients: A retrospective cohort study
Factores de riesgo y resultados de la insuficiencia respiratoria grave que requiere ventilación mecánica invasiva en pacientes oncológicos: un estudio de cohortes retrospectivo
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F.D. Martos-Benítez
Corresponding author
fdmartos@infomed.sld.cu

Corresponding author.
, A. Gutiérrez-Noyola, M. Badal, N.A. Dietrich
Department of Intensive Care, Institute of Oncology and Radiobiology, 29 Street, Vedado, Havana, Cuba
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Table 1. Univariate analysis of factors associated with severe acute respiratory failure requiring invasive mechanical ventilation.
Table 2. Results of multivariate logistic regression analysisa of factors associated with severe acute respiratory failure requiring invasive mechanical ventilation.
Table 3. Outcomes of patients with severe acute respiratory failure requiring invasive mechanical ventilation.
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Abstract
Objectives

To determine the risk factors for severe acute respiratory failure requiring invasive mechanical ventilation (SARF-MV) and its effect upon clinical outcomes in critically ill cancer patients.

Design

A retrospective cohort study was carried out.

Setting

A 12-bed oncological intensive care unit (ICU) from January 2014 to December 2015.

Patients

A total of 878 consecutive cancer patients were included. Patients with an ICU stay of ≤1 day were excluded. The final sample size was 691 patients.

Interventions

None.

Variables

Clinical variables at ICU admission were extracted from the medical records. The primary outcome was SARF-MV. We also measured ICU and hospital mortality, as well as length of stay.

Results

The SARF-MV rate was 15.8%. The multivariate analysis identified brain tumour (OR 14.54; 95%CI 3.86–54.77; p<0.0001), stage IV cancer (OR 3.47; 95%CI 1.26–9.54; p=0.016), sepsis upon admission (OR 2.28; 95%CI 1.14–4.56; p=0.020) and an APACHE II score20 points (OR 5.38; 95%CI 1.92–15.05; p=0.001) as being independently associated to SARF-MV. Compared with the patients without SARF-MV, those with SARF-MV had a prolonged length of ICU stay (p<0.0001), a lower ICU survival rate (p<0.0001) and a lower hospital survival rate (p<0.0001).

Conclusions

A number of clinical factors are related to SARF-MV. In this regard, SARF-MV is a powerful factor independently correlated to poor outcomes. Future studies should investigate means for preventing SARF-MV in critically ill cancer patients, which may have an impact upon outcomes.

Keywords:
Acute respiratory failure
APACHE
Cancer
Critically ill cancer patient
Mortality
Mechanical ventilation
Sepsis
Resumen
Objetivos

Determinar los factores de riesgo para insuficiencia respiratoria grave que requiere ventilación mecánica (IRG-VM) y sus efectos sobre los resultados clínicos en pacientes críticos con cáncer.

Diseño

Estudio de cohorte retrospectivo.

Contexto

Desde enero de 2014 a diciembre de 2015 en una unidad de cuidados intensivos (UCI) oncológicos de 12 camas.

Pacientes

Se incluyeron consecutivamente 878 pacientes. Se excluyeron aquellos con una estancia en UCIun día. Finalmente la muestra fue de 691.

Intervenciones

Ninguna.

Variables

De los registros médicos se extrajeron las variables clínicas a la admisión en UCI. La variable de respuesta primaria fue la IRG-VM. También se analizó la mortalidad y estancia en UCI/hospitalaria.

Resultados

La tasa de IRG-VM fue del 15,8%. En el análisis multivariado el tumor cerebral (OR 14,54; IC 95% 3,86-54,77; p<0,0001), la etapa IV del cáncer (OR 3,47; IC 95% 1,26-9,54; p=0,016), la sepsis (OR 2,28; IC 95% 1,14-4,56; p=0,020) y la escala APACHE II20 puntos (OR 5,38; IC 95% 1,92-15,05; p=0,001) fueron factores de riesgo independientes de IRG-VM. La IRG-VM se asoció con una mayor estancia en la UCI (p<0,0001), así como con una menor tasa de supervivencia en UCI (p<0,0001) y hospitalaria (p<0,0001).

Conclusiones

Algunos factores clínicos se relacionan con la IRG-VM. Este trastorno es un factor que se relaciona poderosamente con un peor pronóstico. Se requieren estudios futuros que investiguen las formas de prevención de la IRG-VM en los pacientes oncológicos críticos, lo cual podría tener un impacto en los resultados.

Palabras clave:
Insuficiencia respiratoria aguda
APACHE
Cáncer
Paciente oncológico crítico
Mortalidad
Ventilación mecánica
Sepsis

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