Dataset Information

Admission of advanced lung cancer patients to intensive care unit: a retrospective study of 76 patients.

ABSTRACT:

Background

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

Methods

We 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.

Results

Of 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.

Conclusions

Patients 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.

SUBMITTER: Andrejak C

PROVIDER: S-EPMC3112156 | biostudies-literature | 2011 May

REPOSITORIES: biostudies-literature

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Publications

Admission of advanced lung cancer patients to intensive care unit: a retrospective study of 76 patients.

Andréjak Claire C Terzi Nicolas N Thielen Stéphanie S Bergot Emmanuel E Zalcman Gérard G Charbonneau Pierre P Jounieaux Vincent V

BMC cancer 20110502

<h4>Background</h4>Criteria for admitting patients with incurable diseases to the medical intensive care unit (MICU) remain unclear and have ethical implications.<h4>Methods</h4>We 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.<h4>Results</h4>Of 76 included patients, 49 had non-small cell lung cancer (stage IIIB n = 20; stage IV n = ...[more]

PMID: 21535895

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Project description:BACKGROUND:Admission to the intensive care unit (ICU) outside daytime hours has been shown to be variably associated with increased morbidity and mortality. We aimed to describe the characteristics and outcomes of patients admitted to the ICU afterhours (22:00-06:59 h) in a large Canadian health region. We further hypothesized that the association between afterhours admission and mortality would be modified by indicators of strained ICU capacity. METHODS:This is a population-based cohort study of 12,265 adults admitted to nine ICUs in Alberta from June 2012 to December 2014. We used a path-analysis modeling strategy and mixed-effects multivariate regression analysis to evaluate direct and integrated associations (mediated through Acute Physiology and Chronic Health Evaluation (APACHE) II score) between afterhours admission (22:00-06:59 h) and ICU mortality. Further analysis examined the effects of strained ICU capacity and varied definitions of afterhours and weekend admissions. ICU occupancy ? 90% or clustering of admissions (??0.15, defined as number of admissions 2 h before or after the index admission, divided by the number of ICU beds) were used as indicators of strained capacity. RESULTS:Of 12,265 admissions, 34.7% (n?=?4251) occurred afterhours. The proportion of afterhours admissions varied amongst ICUs (range 26.7-37.8%). Patients admitted afterhours were younger (median (IQR) 58 (44-70) vs 60 (47-70) years, p?<?0.0001), more likely to have a medical diagnosis (75.9% vs 72.1%, p?<?0.0001), and had higher APACHE II scores (20.9 (8.6) vs 19.9 (8.3), p?<?0.0001). Crude ICU mortality was greater for those admitted afterhours (15.9% vs 14.1%, p?=?0.007), but following multivariate adjustment there was no direct or integrated effect on ICU mortality (odds ratio (OR) 1.024; 95% confidence interval (CI) 0.923-1.135, p?=?0.658). Furthermore, direct and integrated analysis showed no association of afterhours admission and hospital mortality (p?=?0.90) or hospital length of stay (LOS) (p?=?0.27), although ICU LOS was shorter (p?=?0.049). Early-morning admission (00:00-06:59 h) with ICU occupancy ? 90% was associated with short-term (??7 days) and all-cause ICU mortality. CONCLUSIONS:One-third of critically ill patients are admitted to the ICU afterhours. Afterhours ICU admission was not associated with greater mortality risk in most circumstances but was sensitive to strained ICU capacity.

Dataset Information

Admission of advanced lung cancer patients to intensive care unit: a retrospective study of 76 patients.

Background

Methods

Results

Conclusions

Publications

Admission of advanced lung cancer patients to intensive care unit: a retrospective study of 76 patients.

Similar Datasets

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