Identifying Cancer Subjects With Acute Respiratory Failure at High Risk for Intubation and Mechanical Ventilation.
BACKGROUND: We sought to identify risk factors for mechanical ventilation in patients with malignancies and acute respiratory failure (ARF). METHODS: We analyzed data from a previous randomized controlled trial in which nonintubated oncology and hematology subjects with ARF were randomized to early...
| Published in: | Respiratory Care Vol. 59; no. 10; pp. 1517 - 1524 |
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| Main Authors: | , , , , , , , , , , , |
| Format: | research tables/charts randomized controlled trial Journal Article |
| Published: |
Mary Ann Liebert, Inc.
Oct2014
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103899550&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103899550 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Oct2014 vid: 59 iid: 10 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 103899550 98592364 10.4187/respcare.02693 NLM25233383 103899550 ppf: 1517 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Identifying Cancer Subjects With Acute Respiratory Failure at High Risk for Intubation and Mechanical Ventilation. aug: au: Lemiale, Virginie Lambert, Jérôome Canet, Emmanuel Mokart, Djamel Pène, Frederic Rabbat, Antoine Kouatchet, Achille Vincent, François Bruneel, Fabrice Gruson, Didier Chevret, Sylvie Azoulay, Elie affil: ICU, Saint Louis Teaching Hospital, Paris, France sug: subj: Cancer Patients Respiratory Failure Risk Assessment Respiration, Artificial Intubation Noninvasive Procedures Immunosuppression Human France Descriptive Statistics Multivariate Analysis Funding Source Post Hoc Analysis Multicenter Studies Randomized Controlled Trials Wilcoxon Rank Sum Test Fisher's Exact Test Logistic Regression Odds Ratio Confidence Intervals Data Analysis Software Female Male Middle Age Aged Middle Aged: 45-64 years Aged: 65+ years Female Male ab: BACKGROUND: We sought to identify risk factors for mechanical ventilation in patients with malignancies and acute respiratory failure (ARF). METHODS: We analyzed data from a previous randomized controlled trial in which nonintubated oncology and hematology subjects with ARF were randomized to early bronchoalveolar lavage or routine care in 16 ICUs in France. Consecutive patients with malignancies were admitted to the ICU for ARF in 2005 and 2006 with no intervention. RESULTS: During the study period, 219 patients were admitted to the ICU for ARF, and 8 patients were not included due to a nonintubation order. Data on the underlying disease, pulmonary involvement, and extrapulmonary organ dysfunctions were recorded at admission in the 211 remaining subjects. Ventilatory support included oxygen only (49 subjects), noninvasive ventilation (NIV) only (81 subjects), NIV followed by invasive mechanical ventilation (49 subjects), and first-line invasive mechanical ventilation (32 subjects). The 81 subjects who required invasive mechanical ventilation were compared with the 130 subjects who remained on oxygen or NIV. Factors associated with invasive mechanical ventilation by multivariate analysis were the oxygen flow required at ICU admission, the number of quadrants involved on chest x-ray, and hemodynamic dysfunction. Mortality rates for subjects who had NIV failure were 65.3% compared with 50% for subjects who were First-line intubated (P = .34). CONCLUSIONS: In cancer patients with ARF, hypoxemia, extent of pulmonary infiltration on chest x-ray, or hemodynamic dysfunction are risk factors for invasive mechanical ventilation. Mortality was not significantly different between NIV failure and first-line intubation. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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