Chest
Original ResearchCritical CareUse of Intensive Care in Patients With Nonresectable Lung Cancer
Section snippets
Study Design
We conducted a retrospective review of the medical charts of patients with lung cancer admitted to three tertiary-level hospital ICUs in France that manage large numbers of patients with cancer. In these three ICUs, patients with cancer are admitted only if they are eligible for potentially lifespan-extending anticancer treatment. The study was approved by the appropriate ethics committee (Comité d'éthique des Centres d'Investigation Clinique de l'inter-région Rhône-Alpes-Auvergne), which
Patient Characteristics
We included 105 patients; only two patients were excluded because of missing data. Table 1 reports the main characteristics of the remaining 103 patients. Median follow-up in survivors was 109 days (IQR, 33-227 days). At 3 months, 7 (7%) patients were lost to follow-up.
At referral for ICU admission, 32 (31%) patients were from the ED, eight (8%) were transported to the hospital from home by an emergency mobile unit, and 63 (61%) were from the hospital wards. Most of the patients had squamous
Discussion
Although our patients with nonresectable lung cancer had acceptable rates of ICU and in-hospital survival (69% and 52%, respectively), survival rates were substantially lower after 90 days and 1 year (37% and 12%, respectively). Patients with lung cancer who had a poor ECOG-PS at baseline or who developed multiorgan failure early after ICU admission had significantly higher mortality rates.
Nevertheless, our data suggest that ICU admission may produce meaningful benefits in some patients.
Conclusions
In a select population of patients with nonresectable lung cancer, ICU admission was followed by a 37% 90-day survival rate. This survival rate is similar to that reported in ICU patients with any type of malignant disease. Factors associated with survival were an ECOG-PS > 2, nonmetastatic disease, and an admission LOD score ≤ 3. ECOG-PS was the main prognostic factor, except when the acute disease was very severe. This study provides the first data on the course of organ dysfunction over the
Acknowledgments
Author contributions: Dr Toffart: contributed to the planning, writing, and editing of the manuscript.
Dr Minet: contributed to the planning, writing, and editing of the manuscript.
Dr Raynard: contributed to the planning, writing, and editing of the manuscript.
Dr Schwebel: contributed to the planning, writing, and editing of the manuscript.
Dr Hamidfar-Roy: contributed to the planning, writing, and editing of the manuscript.
Dr Diab: contributed to the planning, writing, and editing of the
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