Impact of acute brain dysfunction on the outcomes of mechanically ventilated cancer patients
© Salluh et al; licensee BioMed Central Ltd. 2013
Published: 19 June 2013
Delirium and coma are a frequent source of morbidity for ICU patients. Several factors are associated with the prognosis of mechanically ventilated (MV) cancer patients, but no studies have evaluated delirium and coma (acute brain dysfunction). The present study evaluated the frequency and impact of acute brain dysfunction on hospital mortality.
The study was performed at the National Cancer Institute, Rio de Janeiro, Brazil. We prospectively enrolled patients ventilated >48 hours with a diagnosis of cancer. The presence of acute brain dysfunction was assessed daily during the first 14 days of ICU care using the CAM-ICU. Patients were followed until hospital discharge. Univariate and multivariate analysis were performed to evaluate factors associated with hospital mortality.
A total 170 patients were included. Seventy-three percent had solid tumors, age 65 (53 to 72 (median, IQR 25 to 75%)) years. Admission SAPS II score was 54 (46 to 63) points and SOFA score was (7 (6 to 9)) points. Median duration of MV was 13 (6 to 21) days and ICU stay was 14 (7.5 to 22) days. ICU mortality was 54% and hospital mortality was 66%. Acute brain dysfunction was diagnosed in 161 patients (95%). Nonsurvivors had a higher frequency of acute brain dysfunction (110 (97.3%) vs. 51 (89.4%), P = 0.06). Survivors had more delirium/coma-free days (4 (1.5 to 6) vs. 1 (0 to 2), P = 0.771 (0.681 to 0.873), P < 0.001).
Acute brain dysfunction in MV cancer patients is frequent and independently predictive of increased hospital mortality. Future studies should investigate means of preventing or mitigating acute brain dysfunction as they may have a significant impact on clinical outcomes.
Supported by the National Cancer Institute, CNPq and FAPERJ.
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