Characteristics and outcomes of lung cancer patients requiring ventilatory support: results from a multinational study

Introduction

The aim was to evaluate clinical characteristics and outcomes of patients with lung cancer requiring ventilatory support.

Methods

Secondary analysis of a prospective multicenter study including patients requiring either invasive (IMV) or non-invasive (NIV) mechanical ventilation for >24 hours admitted to 22 ICUs in six countries from Europe and South America during 2011. We used shared frailty models to identify factors associated with 6-month survival.

Results

Out of 449 patients admitted to the ICUs, 239 (small-cell (SCLC) = 34; non-SCLC = 205)) required ventilatory support (NIV = 104; IMV = 135). Out of NIV patients, 31 (30%) were subsequently intubated for IMV. Main reasons for ventilatory support were sepsis (n = 119; among them, 102 patients had pneumonia), airway involvement by tumor (n = 79), ARDS (n = 47) and coma (n = 18). Mean SAPS II score was 54 ± 20 and median SOFA score was 7 (4 to 12) points. Hospital and 6-month mortality rates were 55% and 67%; 94 (39%) patients received treatment limitations in the ICU. Mortality according to ventilatory strategy was 56% for NIV only, 77% for NIV followed by IMV, and 70% for IMV only. In the multilevel model, adjusting for the hospital size, presence of step-down units, type of admission and treatment limitation, performance status (PS) 3 to 4 (HR = 2.25 (95% CI, 1.52 to 3.34)), metastasis (HR = 1.66 (1.18 to 2.33)) and the ventilatory strategy compared with NIV only (HR = 1.73 (1.02 to 2.92), for NIV followed by IMV; HR = 2.25 (1.51 to 3.35), for IMV only) were associated with increased mortality. Conversely, patients with sepsis had higher survival (HR = 0.67 (0.46 to 0.96)).

Conclusion

In a multinational study, 6-month survival in lung cancer patients requiring ventilatory support is better than perceived a priori. Palliative care should be preferred in patients with poor PS.