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BMC Cancer

, 11:159

Epidemiology, prevention and public health

Abstract

BackgroundCriteria for admitting patients with incurable diseases to the medical intensive care unit MICU remain unclear and have ethical implications.

MethodsWe retrospectively evaluated MICU outcomes and identified risk factors for MICU mortality in consecutive patients with advanced lung cancer admitted to two university-hospital MICUs in France between 1996 and 2006.

ResultsOf 76 included patients, 49 had non-small cell lung cancer stage IIIB n = 20; stage IV n = 29. In 60 patients, MICU admission was directly related to the lung cancer complication of cancer management, n = 30; cancer progression, n = 14; and lung-cancer-induced diseases, n = 17. Mechanical ventilation was required during the MICU stay in 57 patients. Thirty-six 47.4% patients died in the MICU. Three factors were independently associated with MICU mortality: use of vasoactive agents odds ratio OR 6.81 95% confidence interval 95%CI 1.77-26.26, p = 0.005, mechanical ventilation OR 6.61 95%CI 1.44-30.5, p = 0.015 and thrombocytopenia OR 5.13; 95%CI 1.17-22.5, p = 0.030. In contrast, mortality was lower in patients admitted for a complication of cancer management OR 0.206; 95%CI 0.058-0.738, p = 0.015. Of the 27 patients who returned home, four received specific lung cancer treatment after the MICU stay.

ConclusionsPatients with acute complications of treatment for advanced lung cancer may benefit from MCIU admission. Further studies are necessary to assess outcomes such as quality of life after MICU discharge.

AbbreviationsAPACHE IIAcute Physiology and Chronic Health Evaluation

CCICharlson Co-morbidity Index

CI 95%Confidence Interval 95%

MICUMedical Intensive Care Unit

NIVNon-Invasive Ventilation

NSCLCNon-Small Cell Lung Cancer

OROdds Ratio

SAPS IISimplified Acute Physiology Score

SCLCSmall Cell Lung Cancer

WHO performance statusWorld Health Organization performance status.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-11-159 contains supplementary material, which is available to authorized users.

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Autor: Claire Andréjak - Nicolas Terzi - Stéphanie Thielen - Emmanuel Bergot - Gérard Zalcman - Pierre Charbonneau - Vincent Jo

Fuente: https://link.springer.com/







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