Abstract
Studies about prognostic assessment in cancer patients requiring prolonged mechanical ventilation (PMV) for post-intensive care are scarce. We retrospectively enrolled 112 cancer patients requiring PMV support who were admitted to the respiratory care center (RCC), a specialized post-intensive care weaning facility, from November 2009 through September 2013. The weaning success rate was 44.6%, and mortality rates at hospital discharge and after 1 year were 43.8% and 76.9%, respectively. Multivariate logistic regression showed that weaning failure, in addition to underlying cancer status, was significantly associated with an increased 1-year mortality (odds ratio, 6.269; 95% confidence interval, 1.800–21.834; P = 0.004). Patients who had controlled non-hematologic cancers and successful weaning had the longest median survival, while those with other cancers who failed weaning had the worst. Patients with low maximal inspiratory pressure, anemia, and poor oxygenation at RCC admission had an increased risk of weaning failure. In conclusion, cancer status and weaning outcome were the most important determinants associated with long-term mortality in cancer patients requiring PMV. We suggest palliative care for those patients with clinical features associated with worse outcomes. It is unknown whether survival in this specific patient population could be improved by modifying the risk of weaning failure.
Highlights
Several prognostic factors, including organ failure, performance and cancer status, have been reported for mechanically ventilated cancer patients[8, 9]
Clinical and laboratory data were not included in the analyses performed by Shih et al Potential clinical prognostic factors reported for general PMV patients, including disease severity, hemodialysis, and weaning status, may be important for prognostic assessment in cancer patients requiring PMV, they were neglected in Shih’s study based on a nationwide database[10,11,12,13]
Among 331 patients requiring PMV support who were subsequently transferred to the respiratory care center (RCC), 112 (33.8%) had diagnoses of malignancies and constituted the study population
Summary
Several prognostic factors, including organ failure, performance and cancer status, have been reported for mechanically ventilated cancer patients[8, 9]. Studies regarding prognostic assessment in cancer patients requiring PMV support are rare. Using data from the National Health Insurance Research Database in Taiwan, Shih et al reported that patients with hepatic or pulmonary cancers or distant metastases show a worse survival, www.nature.com/scientificreports/. Clinical and laboratory data were not included in the analyses performed by Shih et al Potential clinical prognostic factors reported for general PMV patients, including disease severity, hemodialysis, and weaning status, may be important for prognostic assessment in cancer patients requiring PMV, they were neglected in Shih’s study based on a nationwide database[10,11,12,13]. This study aimed to report the short- and long-term mortality rates of cancer patients requiring PMV in post-ICU settings, and to explore clinical factors significantly associated with weaning outcome and long-term mortality
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