Weaning outcome of solid cancer patients requiring mechanical ventilation in the intensive care unit

Emily Han-Chung Hsiue; Pei-Lin Lee; Yung-Hsuan Chen; Ting-Hui Wu; Chiao-Feng Cheng; Keng-Man Cheng; Po-Chun Yang; Hsing-Wu Chen; Pei-Yu Lin; Dai-Lung Chiang; Huey-Dong Wu; James Chih-Hsin Yang; Chong-Jen Yu

doi:10.1016/j.jfma.2019.02.007

Weaning outcome of solid cancer patients requiring mechanical ventilation in the intensive care unit

J Formos Med Assoc. 2019 Jun;118(6):995-1004. doi: 10.1016/j.jfma.2019.02.007. Epub 2019 Mar 8.

Authors

Affiliations

¹ Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Cellular and Molecular Medicine Program, Johns Hopkins School of Medicine, Suite 2-103, 1830 East Monument St, Baltimore, MD, 21205, USA.
² Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Center for Electronics Technology Integration, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. Electronic address: leepeilin@ntu.edu.tw.
³ Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
⁴ Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
⁵ Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
⁶ Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, No.1, Sec.4, Roosevelt Road, Taipei, Taiwan.
⁷ Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
⁸ Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren-Ai Rd, 100, Taipei, Taiwan; National Taiwan University Cancer Center, No. 1, Sec. 1, Ren-Ai Rd, Taipei, 100, Taiwan.
⁹ Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.

PMID: 30857753
DOI: 10.1016/j.jfma.2019.02.007

Abstract

Background: Whether the weaning outcome of solid cancer patients receiving mechanical ventilation (MV) in the intensive care unit (ICU) is comparable to that in non-cancer patients is unknown. The aim of this study was to compare the weaning outcomes between non-cancer patients and patients with different types of cancer.

Methods: We studied patients requiring MV during ICU stay for medical reasons between 2012 and 2014. Cancer patients were grouped into those with lung cancer (LC), head and neck cancer (HNC), hepatocellular carcinoma (HCC), and other cancers (OC). The primary endpoint was successful weaning at day 90 after the initiation of MV, and the main secondary endpoints were 28-day and 90-day mortality after ICU admission.

Results: Five hundred and eighteen patients with solid cancers and 1362 non-cancer patients were recruited. The rate of successful weaning at day 90 was 57.9% in cancer patients, which was lower than 68.9% in non-cancer patients (p < 0.001). Compared to non-cancer patients, LC was associated with a lower probability of weaning at day 90 (hazard ratio 0.565, 95% CI 0.446 to 0.715), while HNC, HCC, and OC had similar probabilities. The 28-day and 90-day mortality rates were higher in cancer patients than in non-cancer patients (45.2% vs. 29.4%, and 65.6% vs. 37.7%, respectively, both p < 0.001).

Conclusion: Among mechanically ventilated patients in the ICU, those with LC were associated with a lower probability of weaning at day 90 compared to non-cancer patients.

Keywords: Cancer; Intensive care unit; Mechanical ventilation; Weaning.

MeSH terms

Aged
Aged, 80 and over
Carcinoma, Hepatocellular / complications*
Carcinoma, Hepatocellular / mortality
Female
Hospital Mortality
Humans
Intensive Care Units
Liver Neoplasms / complications*
Liver Neoplasms / mortality
Male
Middle Aged
Respiratory Insufficiency / etiology
Respiratory Insufficiency / therapy*
Retrospective Studies
Survival Analysis
Taiwan / epidemiology
Time Factors
Treatment Failure
Ventilator Weaning*