Improved survival in cancer patients requiring mechanical ventilatory support: Impact of noninvasive mechanical ventilatory support
Improved survival in cancer patients requiring mechanical ventilatory support: Impact of noninvasive mechanical ventilatory support
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DOI：
10.1097/00003246-200103000-00009
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发表时间：
2001-03-01
影响因子：
8.8
通讯作者：
Schlemmer, B
中科院分区：
文献类型：
--
作者：
Azoulay, E;Alberti, C;Schlemmer, B
目的：当癌症患者病情危重时，机械通气（MV）通常被认为是徒劳的。然而，最近的研究发现，危重癌症患者的预后多年来一直在改善，高死亡率的经典预测因素已经失去了相关性。 设计：我们回顾性地确定了 237 名入住重症监护病房 (ICU) 的机械通气癌症患者的 30 天死亡率的结果和预测因素。 患者：将 1990 年至 1995 年间入院的 132 名患者 (55.7%) 与 105 名患者进行了比较(44.3%) 患者于 1996 年至 1998 年间入院。其中 119 例 (50.3%) 患者的恶性肿瘤为白血病/淋巴瘤，50 例 (21%) 患者为骨髓瘤，68 例 (28.7%) 患者为实体瘤。 42 例（17.7%）患者接受了骨髓移植，91 例（38.4%）患者出现中性粒细胞减少症。简化急性生理学评分 II (SAPS II) 中位数为 58（范围：40-75）。 MV 的原因为急性低氧血症性呼吸衰竭 148 例（62.5%），昏迷 54 例（22.8%），心源性肺水肿 35 例（14.7%）。 189 名 (79.8%) 患者首先使用传统 MV，48 名 (20.2%) 患者使用无创 MV (NIMV)。总体死亡率为 72.5%（172 例死亡）。 结果：Logistic 回归确定了与死亡率相关的三个变量：1996 年至 1998 年期间入住 ICU（比值比 [OR]，0.24；95% 置信区间 [Ct]，0.12-0.50）和 NIMV 的使用（OR，0.34；95% Gf，0.16-0.73）保护性，SAPS II 加重（68，每点 1.04；95% GI，1.02-1.06）。为了更好地定义 NIMV 的影响，我们进行了成对匹配的暴露-未暴露分析。将 48 名接受 NIMV 作为第一种通气方法的患者和 48 名未接受 NIMV 的患者进行了 SAPS II、恶性肿瘤类型和 ICU 入住时间的匹配。暴露患者和对照组的 ICU 粗死亡率分别为 43.7% 和 70.8%。在调整匹配变量后，NIMV 仍能降低死亡率（OR，0.31；95% GI，0.12-0.82）。结论：我们的结果证实，在过去十年中，危重癌症患者（甚至需要 MV 的患者）的死亡率有所改善，并表明这可能部分是由于 NIMV 的保护作用。
Objective: When a cancer patient becomes critically ill, mechanical Ventilation (MV) is often considered futile. However, recent studies have found that outcomes of critically ill cancer patients have been improving over the years and that classic predictors of high mortality have lost their relevance.Design: We retrospectively determined outcomes and predictors of 30-day mortality in 237 mechanically-ventilated cancer patients admitted to the intensive care unit (ICU).Patients: The 132 (55.7%) patients who were admitted between 1990 and 1995 were compared with 105 (44.3%) patients who were admitted between 1996 and 1998. The malignancy was leukemia/lymphoma in 119 (50.3%) patients, myeloma in 50 (21%), and a solid tumor in 68 (28.7%). Forty-two (17.7%) patients had bone marrow transplantation, and 91 (38.4%) were neutropenic. Median Simplified Acute Physiology Score II (SAPS II) was 58 (range, 40-75). Reasons for MV were acute hypoxemic respiratory failure in 148 (62.5%) patients, coma in 54 (22.8%), and cardiogenic pulmonary edema in 35 (14.7%). Conventional MV was used first in 189 (79.8%) patients, and noninvasive MV (NIMV) was used in 48 (20.2%). Overall mortality rate was 72.5% (172 deaths).Results: Logistic regression identified three variables associated with mortality: ICU admission between 1996 and 1998 (odds ratio [OR], 0.24; 95% confidence interval [Ct], 0.12-0.50) and the use of NIMV (OR, 0.34; 95% Gf, 0.16-0.73) were protective, and the SAPS II was aggravating (68, 1.04 per point; 95% GI, 1.02-1.06). To better define the impact of NIMV, we performed a pairwise-matched exposed-unexposed analysis. Forty-eight patients who did and 48 who did not receive NIMV as the first ventilation method were matched for SAPS II, type of malignancy, and period of ICU admission. Crude ICU mortality rates from exposed patients and controls were 43.7% and 70.8%, respectively. NIMV remained protective from mortality after adjustment for matching variables (OR, 0.31; 95% GI, 0.12-0.82).Conclusion: Our results confirm that mortality has improved over the past decade in critically ill cancer patients, even those who require MV, and suggest that this may be, in part, because of a protective effect of NIMV.