Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon, Gangwon-do, Republic of Korea.
Support Care Cancer. 2013 Jun;21(6):1647-53. doi: 10.1007/s00520-012-1709-z. Epub 2013 Jan 12.
Acute respiratory failure that requires invasive mechanical ventilation is a leading cause of death in critically ill cancer patients. The aim of this study was to evaluate the outcome and prognostic factors of patients requiring invasive mechanical ventilator for acute respiratory failure, within 1 month of ambulatory chemotherapy for solid cancer.
A retrospective observational study of patients who underwent ambulatory chemotherapy at Samsung Medical Center, between January of 2007 and April of 2009, was employed for this study.
A total of 51 patients met the inclusion criteria and were included in the study. The median age was 65 years (25-87) and the majority of the patients were male (n = 38, 74.5%). There were 42 patients (82.3%) with lung cancer. The most common cause of acute respiratory failure was pneumonia (n = 24, 47.1%), followed by acute respiratory failure due to extra-pulmonary infection, drug-induced pneumonitis, alveolar hemorrhage, and cancer progression. The intensive care unit (ICU) mortality was 68.6% and the most common cause of death in the ICU was uncorrected cause of acute respiratory failure. Before adjustment for others factors, prechemotherapy Eastern Cooperative Oncology Group (ECOG) Performance Scale (PS) (P = 0.03), Sequential Organ Failure Assessment score (P = 0.01), and anemia (P = 0.04) were significantly associated with ICU mortality. However, when adjusted for age, sex, and Acute Physiologic and Chronic Health Evaluation II score, only poor ECOG PS (≥2) was significantly associated with ICU mortality [OR 6.36 (95% CI (1.02-39.5))].
The outcome of patients with acute respiratory failure needing invasive mechanical ventilation during ambulatory chemotherapy for solid cancer is poor. Prechemotherapy performance status is an independent predictor of mortality.
需要有创机械通气的急性呼吸衰竭是危重症癌症患者死亡的主要原因。本研究旨在评估在实体瘤门诊化疗后 1 个月内因急性呼吸衰竭需要有创机械通气的患者的预后和预后因素。
本研究采用回顾性观察性研究，纳入 2007 年 1 月至 2009 年 4 月期间在三星医疗中心接受门诊化疗的患者。
共有 51 名患者符合纳入标准并纳入研究。中位年龄为 65 岁（25-87 岁），大多数为男性（n=38，74.5%）。42 名患者（82.3%）患有肺癌。急性呼吸衰竭最常见的原因是肺炎（n=24，47.1%），其次是肺外感染、药物性肺炎、肺泡出血和肿瘤进展引起的急性呼吸衰竭。重症监护病房（ICU）死亡率为 68.6%，ICU 死亡的最常见原因是急性呼吸衰竭的原因未得到纠正。在调整其他因素之前，化疗前东部合作肿瘤组（ECOG）表现状态（PS）（P=0.03）、序贯器官衰竭评估评分（P=0.01）和贫血（P=0.04）与 ICU 死亡率显著相关。然而，在校正年龄、性别和急性生理和慢性健康评估 II 评分后，只有较差的 ECOG PS（≥2）与 ICU 死亡率显著相关[比值比 6.36（95%置信区间 1.02-39.5）]。
在实体瘤门诊化疗期间因急性呼吸衰竭需要有创机械通气的患者预后较差。化疗前的体能状态是死亡率的独立预测因素。
