Abstract
Introduction: New treatments have been introduced with the objective to increase the survival rate of oncologic patients. As a result of these approaches, there was an increase in the number of cases of toxicity and complications, which can lead to acute respiratory failure (ARF). One of the most frequent ways to treat ARF is non-invasive ventilation (NIV). Despite the proven benefits in several clinical conditions, NIV results in cancer patients are controversial. Objective: To evaluate risk factors associated with NIV failure and hospital mortality in oncologic patients. Methods: Retrospective cohort study including patients with solid tumors and hematological neoplasms admitted for hospitalization at National Cancer Institute between January 1, 2017 and December 31, 2019, who underwent NIV. The association between the variables of exposure and the outcome was performed by gross and adjusted logistic regression. The Kaplan-Meier method was used to analyze the length of hospital stay. Results: Sixty-three patients who underwent NIV in hospitalization were evaluated, and 26 failed NIV. The patients had a mean age of 58.5 years (±15.6), most were male (57.1%), under 60 years old (58.7%) and had comorbidities (55.5%). The patients with pulmonary infection (OR 6.53; 95% CI 1.21-35.12; p=0.02) had a higher risk of failure in NIV. In relation to hospital mortality, patients older than 60 years (OR 6.90; 95% CI, 2.12-22.45; p=0.001) had a higher risk. Conclusion: Patients who presented pulmonary infection were more likely to fail in NIV. Higher hospital mortality was observed among elderly patients.
Highlights
New treatments have been introduced with the objective to increase the survival rate of oncologic patients
The 12-month survival rates were 11.5% for the patients who failed in the non-invasive ventilation (NIV) and 25.4% for patients who not failed in the NIV. In this retrospective cohort of patients diagnosed with hematological neoplasms and solid tumors with acute respiratory failure (ARF) admitted to wards, it was observed/ that NIV was not effective for reversing ARF in 49% of patients for any cause
The risk factors associated with NIV failure was pulmonary infection as the cause of ARF, while the risk factor associated with mortality was age
Summary
New treatments have been introduced with the objective to increase the survival rate of oncologic patients. An increase in the survival rate of cancer patients in recent decades has been associated with advances in antineoplastic treatment and early diagnosis (Azoulay et al 2010; Azoulay et al 2011; Avgencel et al 2014). These survival gains have increased the number of cases of toxicity and complications, resulting in a higher number of cancer patients admitted to intensive care units (ICU) (Azoulay et al 2004; Soares et al 2010). ARF has a high mortality rate in cancer patients of up to 50% and even higher in patients who need invasive ventilation (Azoulay et al 2004; Azevedo et al 2014; Yeo et al 2012; Soubani et al 2014)
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