Journal Article

Acute respiratory distress syndrome in patients with malignancies

Meert, Anne-Pascale, Darmon, Michael, Pène, Frédéric, Mayaux, Julien, Mokart, Djamel, Bruneel, Fabrice, Nyunga, Martine, Rabbat, Antoine, Perez, Pierre, Lemiale, Virginie, Kouatchet, Achille, Benoit, Dominique, Azoulay, Elie, Vincent, François

2014

Overview

Purpose Little attention has been given to ARDS in cancer patients, despite their high risk for pulmonary complications. We sought to describe outcomes in cancer patients with ARDS meeting the Berlin definition. Methods Data from a cohort of patients admitted to 14 ICUs between 1990 and 2011 were used for a multivariable analysis of risk factors for hospital mortality. Results Of 1,004 included patients (86 % with hematological malignancies and 14 % with solid tumors), 444 (44.2 %) had neutropenia. Admission SOFA score was 12 (10–13). Etiological categories were primary infection-related ARDS ( n  = 662, 65.9 %; 385 bacterial infections, 213 invasive aspergillosis, 64 Pneumocystis pneumonia); extrapulmonary septic shock-related ARDS ( n  = 225, 22.4 %; 33 % candidemia); noninfectious ARDS ( n  = 76, 7.6 %); and undetermined cause ( n  = 41, 4.1 %). Of 387 (38.6 %) patients given noninvasive ventilation (NIV), 276 (71 %) subsequently required endotracheal ventilation. Hospital mortality was 64 % overall. According to the Berlin definition, 252 (25.1 %) patients had mild, 426 (42.4 %) moderate and 326 (32.5 %) severe ARDS; mortality was 59, 63 and 68.5 %, respectively ( p  = 0.06). Mortality dropped from 89 % in 1990–1995 to 52 % in 2006–2011 ( p  < 0.0001). Solid tumors, primary ARDS, and later admission period were associated with lower mortality. Risk factors for higher mortality were allogeneic bone-marrow transplantation, modified SOFA, NIV failure, severe ARDS, and invasive fungal infection. Conclusions In cancer patients, 90 % of ARDS cases are infection-related, including one-third due to invasive fungal infections. Mortality has decreased over time. NIV failure is associated with increased mortality. The high mortality associated with invasive fungal infections warrants specific studies of early treatment strategies.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Acute respiratory distress syndrome / Aged / Analysis / Anesthesiology / Aspergillus / Bacterial infections / Bacterial pneumonia / Bone marrow / Bone Marrow Transplantation - adverse effects / Cancer / Cancer patients / Care and treatment / Complications and side effects / Critical Care Medicine / Emergency Medicine / Female / France / Fungal infections / Germany / Hematology / Hospital patients / Humans / Intensive / Intensive care / Intensive Care Units / Leukemia - complications / Lung Diseases - complications / Lymphoma - complications / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Mortality / Mycoses - complications / Neoplasms - complications / Neutropenia / Neutropenia - complications / Original / Pain Medicine / Pediatrics / Pneumocystis / Pneumology/Respiratory System / Pneumonia / Respiratory distress syndrome / Respiratory Distress Syndrome, Adult - etiology / Respiratory Distress Syndrome, Adult - mortality / Risk Factors / Sepsis / Septic shock / Transplantation / Tumors / United Kingdom / Ventilators / Viral infections