Factors associated with non-invasive ventilation failure and mortality in oncologic patients outside the intensive care unit
DOI:
https://doi.org/10.33448/rsd-v10i11.19625Keywords:
Noninvasive ventilation; Cancer; Mortality.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.
References
Adda M, Coquet I, Darmon M, Thiery G, Schlemmer B, & Azoulay E (2008). Predictors of non-invasive ventilation failure in patients with hematologic malignancy and acute respiratory failure. Crit Care Med 36:2766–72. http://dx.doi.org/10.1097/CCM.0b013e31818699f6.
Al-Rajhi A, Murad A1, Li P Z, et al (2018). Outcomes and predictors of failure of non-invasive ventilation in patients with community acquired pneumonia in the ED. Am J Emerg Med. 36(3):347-351. doi: https://doi. org/10.1016/j.ajem.2017.08.016
Araujo B P, Faria EM, Silva L M, Bizzo LV, Quintão M M P, Bergmann A, et al (2019). Fatores preditores para a falha da ventilação não invasiva em pacientes hospitalizados com câncer. Revista Brasileira de Cancerologia. 65(1): e-10322. https://doi.org/10.32635/2176-9745.RBC.2019v65n1.322.
Aygencel G, Turkoglu M, Turkoz Sucak G, & Benekli M (2014). Prognostic factors in critically ill cancer patients admitted to the intensive care unit. J Crit Care 29:618–26. http://dx.doi.org/10.1016/j.jcrc.2014.01.014.
Azevedo L C P, Caruso P, Silva U V A, Torelly A P, Silva E, Rezende E, et al (2014). Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest 146:257–66. http://dx.doi.org/10.1378/chest.13-1870.
Azevedo L C, Park M, Salluh J I, Rea-Neto A, Souza-Dantas V C, Varaschin P, et al (2013). Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care 17:R63. http://dx.doi.org/10.1186/cc12594.
Azoulay E, Mokart D, Lambert J, Lemiale V, Rabbat A, Kouatchet A, et al (2010). Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 182:1038–46. http://dx.doi.org/10.1164/rccm.201001-0018OC.).
Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B (2011). Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care 1:5. http://dx.doi.org/10.1186/2110-5820-1-5.
Azoulay E, Thiery G, Chevret S, Moreau D, Darmon M, Bergeron A, et al (2004). The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 2004;83:360–70. http://dx.doi.org/10.1097/01.md.0000145370.6367 6.fb.
Bray F, Ferlay J, Soerjomataramet I, Siegel, R. L., Torre, L. A., & Jemal, A (2018). Global câncer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancer in 185 countries. CA Cancer J Clin. 68(6):394-424. https://doi.org/10.3322/caac.21492.
Briones Claudett K H, Briones Claudett M H, Esquinas A M, et al. Determinants of immediate failure of noninvasive mechanical ventilation outside the intensive care unit. Anaesthesiol Intensive Ther. 2017; 49(4):252- 258. doi: https://doi.org/10.5603/AIT.a2017.0054 .
Czeszyńska M B, & Sontowska A (2020). SpO2, heart rate, and arterial blood pressure during successful or failed application of non-invasive ventilation after delivery - a single-centre study. Anaesthesiol Intensive Ther. 52(4):304-311. doi:10.5114/ait.2020.100574.
Corrêa T D, Sanches P R, de Morais L C, Scarin F C, Silva E, Barbas C S, et al (2011). Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study. BMC Pulm Med. 15:144. https://doi.org/10.1186/s12890-015-0139-3.
Ferreira J C, Medeiros P Jr, Rego F M, et al (2015). Risk factors for noninvasive ventilation failure in cancer patients in the intensive care unit: a retrospective cohort study. J Crit Care. 30(5):1003-1007. doi: https://doi.org/10.1016/j.jcrc.2015.04.121.
Gristina G R, Antonelli M, Conti G, Ciarlone A, Rogante S, Rossi C, et al (2011). Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. Crit Care Med 39:2232–9. http://dx.doi.org/10.1097/CCM.0b013e3182227a27.
Hayek A J, Scott V, Yau P, Zolfaghari K, Goldwater M, Almquist J, et al (2020). Bedside risk stratification for mortality in patients with acute respiratory failure treated with noninvasive ventilation. Proc (Bayl Univ Med Cent). 33(2):172-177. doi: 10.1080/08998280.2020.1729612.
Instituto Nacional de Câncer José Alencar Gomes da Silva (2017). Estimativa 2020: incidência de câncer no Brasil. Rio de Janeiro: INCA.
Keenan S P, Sinuff T, Burns K E A, Muscedere J, Kutsogiannis J, Mehta S, et al (2011). Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and non-invasive continuous positive airway pressure in the acute care setting. CMAJ 183:E195–214. http://dx.doi.org/10.1503/cmaj.100071.
Neuschwander A, Lemiale V, Darmon M, et al (2017). Noninvasive ventilation during acute respiratory distress syndrome in patients with cancer: trends in use and outcome. J Crit Care. 38:295-299. doi: https:// doi.org/10.1016/j.jcrc.2016.11.042.
Ozsancak Ugurlu A, Sidhom S S, Khodabandeh A, et al (2015). Where is noninvasive ventilation actually delivered for acute respiratory failure? Lung. 193(5):779-788. doi: https://doi.org/10.1007/s00408-015-9766-yDe
Rathi N K, Haque S A, Nates R, et al (2017). Noninvasivepositive pressure ventilation vsinvasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure in cancer patients. J Crit Care. 39:56-61. doi: https://doi.org/10.1016/j.jcrc.2017.01.007
Saillard C, Mokart D, Lemiale V, & Azoulay E (2014). Mechanical ventilation in cancer patients. Minerva Anestesiol 80:712–25.
Schnell D, Mayaux J, Lambert J, Roux A, Moreau A-S, Zafrani L, et al (2013). Clinical assessment for identifying causes of acute respiratory failure in cancer patients. Eur Respir J 42:435–43. http://dx.doi.org/10.1183/09031936.00122512.
Soares M, Caruso P, Silva E, Teles J M, Lobo S M, Friedman G, et al (2010). Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med 38:9-15. http://dx.doi.org/10.1097/CCM.0b013e3181c0349e.
Soubani A O, Shehada E, Chen W, Smith D (2014). The outcome of cancer patients with acute respiratory distress syndrome. J Crit Care 29:183.e7–183.e12. http://dx.doi.org/10.1016/j.jcrc.2013.10.011.
Walkey A J, & Wiener R S (2013). Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: a population-based study. Ann Am Thorac Soc 10:10–7. http://dx.doi.org/10.1513/AnnalsATS.201206-034OC.
Yeo C D, Kim J W, Kim S C, Kim Y K, Kim K H, Kim H J, et al (2012). Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive careunit. J Crit Care 27:739.e1–6. http://dx.doi.org/10.1016/j.jcrc.2012.07. 014.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Gustavo Telles Silva; Bianca Paraiso Araujo; Eduarda Martins Faria; Camila Martins de Bessa; Anke Bergmann; Luiz Claudio Santos Thuler
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
