Azoulay Élie, Thiéry Guillaume, Chevret Sylvie, Moreau Delphine, Darmon Michaël, Bergeron Anne, Yang Kun, Meignin Véronique, Ciroldi Magali, Le Gall Jean-Roger, Tazi Abdellatif, Schlemmer Benoît
From Medical Intensive Care Unit, Biostatistics Department, Respiratory Department, Department of Pathology, Saint-Louis Hospital and Paris 7 University. Assistance Publique, Hôpitaux de Paris, France.
Medicine (Baltimore). 2004 Nov;83(6):360-370. doi: 10.1097/01.md.0000145370.63676.fb.
Acute respiratory failure (ARF) in patients with cancer is frequently a fatal event. To identify factors associated with survival of cancer patients admitted to an intensive care unit (ICU) for ARF, we conducted a prospective 5-year observational study in a medical ICU in a teaching hospital in Paris, France. The patients were 203 cancer patients with ARF mainly due to infectious pneumonia (58%), but also noninfectious pneumonia (9%), congestive heart failure (12%), and no identifiable cause (21%). We measured clinical characteristics and ICU and hospital mortality rates.ICU mortality was 44.8% and hospital mortality was 47.8%. Noninvasive mechanical ventilation was used in 79 (39%) patients and conventional mechanical ventilation in 114 (56%), the mortality rates being 48.1% and 75.4%, respectively. Among the 14 patients with late noninvasive mechanical ventilation failure (>48 hours), only 1 survived. The mortality rate was 100% in the 19 noncardiac patients in whom conventional mechanical ventilation was started after 72 hours. By multivariable analysis, factors associated with increased mortality were documented invasive aspergillosis (odds ratio [OR], 2.13; 95% confidence intervals [CI], 1.05-14.74), no definite diagnosis (OR, 3.85; 95% CI, 1.26-11.70), vasopressors (OR, 3.19; 95% CI, 1.28-7.95), first-line conventional mechanical ventilation (OR, 8.75; 95% CI, 2.35-35.24), conventional mechanical ventilation after noninvasive mechanical ventilation failure (OR, 17.46; 95% CI, 5.04-60.52), and late noninvasive mechanical ventilation failure (OR, 10.64; 95% CI, 1.05-107.83). Hospital mortality was lower in patients with cardiac pulmonary edema (OR, 0.16; 95% CI, 0.03-0.72). Survival gains achieved in critically ill cancer patients in recent years extend to patients requiring ventilatory assistance. The impact of conventional mechanical ventilation on survival depends on the time from ICU admission to conventional mechanical ventilation and on the patient's response to noninvasive mechanical ventilation.
癌症患者的急性呼吸衰竭（ARF）往往是致命事件。为了确定入住重症监护病房（ICU）治疗ARF的癌症患者的生存相关因素，我们在法国巴黎一家教学医院的内科ICU进行了一项为期5年的前瞻性观察研究。患者为203例患有ARF的癌症患者，主要病因是感染性肺炎（58%），但也有非感染性肺炎（9%）、充血性心力衰竭（12%）以及病因不明（21%）。我们测量了临床特征以及ICU和医院死亡率。ICU死亡率为44.8%，医院死亡率为47.8%。79例（39%）患者使用了无创机械通气，114例（56%）患者使用了传统机械通气，死亡率分别为48.1%和75.4%。在14例无创机械通气失败较晚（>48小时）的患者中，仅1例存活。在19例非心脏疾病患者中，72小时后开始使用传统机械通气，死亡率为100%。通过多变量分析，与死亡率增加相关的因素包括确诊的侵袭性曲霉病（比值比[OR]，2.13；95%置信区间[CI]，1.05 - 14.74）、未明确诊断（OR，3.85；95% CI，1.26 - 11.70）、使用血管活性药物（OR，3.19；95% CI，1.28 - 7.95）、一线使用传统机械通气（OR，8.75；95% CI，2.35 - 35.24）、无创机械通气失败后使用传统机械通气（OR，17.46；95% CI，5.04 - 60.52）以及无创机械通气失败较晚（OR，10.64；95% CI，1.05 - 107.83）。心源性肺水肿患者的医院死亡率较低（OR，0.16；95% CI，0.03 - 0.72）。近年来危重症癌症患者生存率的提高也适用于需要通气支持的患者。传统机械通气对生存的影响取决于从入住ICU到开始使用传统机械通气的时间以及患者对无创机械通气的反应。
