RT Journal Article
SR Electronic
T1 Clinical assessment for identifying causes of acute respiratory failure in cancer patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 435
OP 443
DO 10.1183/09031936.00122512
VO 42
IS 2
A1 David Schnell
A1 Julien Mayaux
A1 Jérôme Lambert
A1 Antoine Roux
A1 Anne-Sophie Moreau
A1 Lara Zafrani
A1 Emmanuel Canet
A1 Virginie Lemiale
A1 Michael Darmon
A1 Élie Azoulay
YR 2013
UL http://erj.ersjournals.com/content/42/2/435.abstract
AB In cancer patients with acute respiratory failure (ARF), early adequate therapy is associated with better outcomes. We investigated the performance of the DIRECT approach, which uses criteria available at the bedside at admission to the intensive care unit (ICU), to identify causes of ARF in cancer patients. This cohort study included cancer patients with ARF of determined aetiology. Associations of aetiological groups with the selected criteria were evaluated using correspondence analysis. 424 cancer patients were included: 201 (47%) with bacterial pneumonia, 131 (31%) with opportunistic infections and 92 (22%) with noninfectious disorders. Mechanical ventilation (both invasive and noninvasive) was needed in 328 (77%) patients, treatment for shock in 217 (51%) patients and dialysis in 82 (19%) patients. 142 (34%) patients died in the ICU. Correspondence plots showed that bacterial pneumonia was associated with neutropenia, solid tumour, multiple myeloma, <3 days since symptom onset, shock, unilateral crackles and unilateral radiographic pattern. Opportunistic infections were associated with steroids, lymphoproliferative disorders and haematopoietic stem-cell transplantation, whereas noninfectious disorders were associated with acute leukaemia The selected criteria are strongly associated with causes of ARF in cancer patients and could be used to develop an algorithm for selecting first-line diagnostic investigations and empirical treatments.