Original

Intensive Care Medicine

, Volume 40, Issue 8, pp 1106-1114

First online:

Acute respiratory distress syndrome in patients with malignancies

  • Elie AzoulayAffiliated withIntensive Care Unit of the Saint-Louis University HospitalSorbonne Paris-Cité, Medical School, AP-HP, Hôpital Saint-Louis, Medical ICU, Paris-Diderot University Email author 
  • , Virginie LemialeAffiliated withIntensive Care Unit of the Saint-Louis University Hospital
  • , Djamel MokartAffiliated withIntensive Care Unit of Institut Paoli Calmette
  • , Frédéric PèneAffiliated withIntensive Care Unit of Cochin University Hospital
  • , Achille KouatchetAffiliated withIntensive Care Unit of Angers University Hospital
  • , Pierre PerezAffiliated withIntensive Care Unit of Nancy University Hospital
  • , François VincentAffiliated withIntensive Care Unit of Bobigny University Hospital
  • , Julien MayauxAffiliated withIntensive Care Unit of Pitié-Salpêtrière University Hospital
  • , Dominique BenoitAffiliated withIntensive Care Unit of Ghent University Hospital
    • , Fabrice BruneelAffiliated withIntensive Care Unit of Versailles Hospital
    • , Anne-Pascale MeertAffiliated withIntensive Care Unit of Brussels University Hospital
    • , Martine NyungaAffiliated withIntensive Care Unit of Roubaix Hospital
    • , Antoine RabbatAffiliated withIntensive Care Unit of Cochin University Hospital
    • , Michael DarmonAffiliated withIntensive Care Unit of Saint-Etienne Teaching Hospital

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Abstract

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.

Keywords

Neutropenia Bronchoscopy Pneumonia Invasive aspergillosis Candidemia Pneumocystis