Outcome of invasive mechanical ventilation in cancer patients: Intubate or not to intubate a patient with cancer


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Abstract

Purpose:The outcome of cancer patients who undergo mechanical ventilation has been grim. However, it has lately become more promising, creating hesitation when approaching the decision to intubate a cancer patient. Therefore, the main goal was to find some factors that could predict mortality.Material and methods:Studies were selected on the basis of their information wholeness, the year done, patients' number, participating country, underlying hematological or nonhematological malignancies, ventilation duration, ICU survival, hospital survival, long term survival, disease activity, and other contributing factors.Results:Twenty-two studies were included which accrued 3115 patients. The average ICU survival was 32.4%, and long-term survival was 10.2%. Over the years, the outcome of cancer patients undergoing mechanical ventilation has improved. The most important predicting factors are: The respiratory failure etiology, the performance status, the disease activity, and the SOFA score.Conclusions:The aforementioned predicting factors could be used when approaching the decision to intubate. When in doubt, we should give the benefit to the patient, proceed to intubate and reevaluate progress daily and in doing so, we would suggest to use the trends in SOFA score and weaning index to assess success or failure of invasive mechanical ventilation.HIGHLIGHTSCancer patients are living longer nowadays.They develop complications that lead to the need for mechanical ventilation.The mortality from mechanical ventilation in cancer patients is quite high.Factors that predict mortality are: Old age, bad performance, advanced disease, neoplastic airway involvement, aspergillosis, need for vasopressors.Factors that predict survival are: Young age, good performance status, low SOFA score, pulmonary edema, hemodynamic stability.

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