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Prolonged Mechanical Ventilation in the Cancer Patient

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Mechanical Ventilation in Critically Ill Cancer Patients

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Abstract

Although acute respiratory failure remains a dangerous and frequent complication in the cancer patient, the mortality of these patients has declined in the intensive care unit (ICU). This is due to a combination of improved aggressive cancer therapies, earlier and more accurate diagnostic strategies, and an enhanced knowledge of supportive treatments in the critically ill. The improvement in mortality, however, has also led to an increase in the number of patients who remain dependent on the ventilator despite overcoming their acute illness. The definition of “prolonged mechanical ventilation (PMV)” has been set forth by a consensus statement by the former National Association for Medical Direction of Respiratory Care (NAMDRC) in 2004, and it is defined as the need for 21 or more days of mechanical ventilation for 6 or more hours per day [1]. Other authors describe the “chronically critically ill (CCI)” patient. Generally, the chronically critically ill population includes patients who require the ICU setting for weeks to months, typically due to the need for prolonged mechanical ventilation [2]. Definitions have been variable, however, and this is reflected in the heterogeneity of clinical, medicolegal, financial, and epidemiologic data collection. In this chapter, the terms PMV and CCI will be used interchangeably.

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References

  1. MacIntyre NR, Epstein SK, Carson S, et al. Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest. 2005;128:3937–54.

    Article  PubMed  Google Scholar 

  2. Carson SS, Bach PB. The epidemiology and costs of chronic critical illness. Crit Care Clin. 2002;18:461–76.

    Article  PubMed  Google Scholar 

  3. Lone NI, Walsh TS. Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit. Crit Care. 2011;15(2):R102.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Estenssoro E, Reina R, Canales H, et al. The distinct clinical profile of chronically critically ill patients: a cohort study. Crit Care. 2006;10:R89.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Jiang JR, Shih JY, Wang RM, et al. Small-cell lung cancer presenting with Lambert-Eaton myasthenic syndrome and respiratory failure. J Formos Med Assoc. 2002;101(12):871–4.

    PubMed  Google Scholar 

  6. Li X, Huang Y, Wu J, et al. Invasive ductal breast cancer associated polymyositis causing respiratory failure. Breast Cancer Res Treat. 2011;126(1):211–4.

    Article  PubMed  Google Scholar 

  7. Sereno M, Montoro FJ, Casanova C, et al. An unusual cause of respiratory failure in a colon cancer patient. Mol Clin Oncol. 2015;3(5):1152–4.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Murgu S, Langer S, Colt H. Bronchoscopic intervention obviates the need for continued mechanical ventilation in patients with airway obstruction and respiratory failure from inoperable non-small-cell lung cancer. Respiration. 2012;84:55–61.

    Article  PubMed  Google Scholar 

  9. Louie AV, Lane S, Palma DA, et al. Radiotherapy for intubated patients with malignant airway obstruction: futile or facilitating extubation? J Thorac Oncol. 2013;8:1365–70.

    Article  PubMed  Google Scholar 

  10. Mehta AB, Syeda SN, Bajpayee L, et al. Trends in tracheostomy for mechanically ventilated patients in the United States, 1993-2012. Am J Respir Crit Care Med. 2015;192(4):446–54.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sherlock ZV, Wilson JA, Exley C. Tracheostomy in the acute setting: Patient experience and information needs. J Crit Care. 2009;24:501–7.

    Article  PubMed  Google Scholar 

  12. Cox CE, Martinu T, Sathy S, et al. Expectations and outcomes of prolonged mechanical ventilation. Crit Care Med. 2009;37:2888–94.

    Article  PubMed  PubMed Central  Google Scholar 

  13. (MEDPAC), Medicare Payment Advisory Commision. Report to Congress: medicare payment policy: long-term care hospital services. Washington, DC: (MEDPAC), Medicare Payment Advisory Commision; 2008.

    Google Scholar 

  14. Kahn JM, Benson NM, Appleby D, et al. Long-term acute care hospital utilization after critical illness. JAMA. 2010;303(22):2253–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M. Liberation from prolonged mechanical ventilation. Crit Care Clin. 2002;18:569–95.

    Article  PubMed  Google Scholar 

  16. Schwebel CS, Clec’h C, Magne S, et al. Safety of intrahospital transport in ventilated critically ill patients: a multicenter cohort study. Crit Care Med. 2013;41:1919–28.

    Article  PubMed  Google Scholar 

  17. Beckmann U, Gillies DM, Berenholtz SM, et al. Incidents relating to the intra-hospital transfer of critically ill patients: an analysis of the reports submitted to the Australian incident monitoring study in intensive care. Intensive Care Med. 2004;30:1579–85.

    Article  PubMed  Google Scholar 

  18. Quenot JP, Milesi C, Cravoisy A, et al. Intrahospital transport of critically ill patients (excluding newborns) recommendations of the Societe de Reanimation de Langue Francaise (SRLF), the Societe Francaise d’Anesthesie et de Reanimation (SFAR), and the Societe Francaise de Medecine d’Urgence. Ann Intensive Care. 2012;2(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Guidelines for the transfer of critically ill patients. Guidelines Committee of the American College of Critical Care Medicine, Society of Critical Care Medicine and American Association of Critical-Care Nurses Transfer Guidelines Task Force. Crit Care Med. 1993;21(6):931–7.

    Google Scholar 

  20. AARC Clinical Practice Guideline. Long-term invasive mechanical ventilation in the home—2007 revision and update. Respir Care. 2007;52(1):1056–62.

    Google Scholar 

  21. Cairo JM. Mechanical ventilation: physiological and clinical applications. 5th ed. St. Louis: Mosby; 2012. p. 428–58.

    Google Scholar 

  22. Cox CE, Wysham NG, Walton B, Jones D, Cass B, Tobin M, Jonsson M, Kahn JM, White DB, Hough CL, Lewis CL, Carson SS. Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation. Ann Intensive Care. 2015;5:6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M, et al. Outcomes in post-ICU mechanical ventilation: a therapist-implemented weaning protocol. Chest. 2001;119:236–42.

    Article  CAS  PubMed  Google Scholar 

  24. Jubran A, Grant BJ, Duffner LA, et al. Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation. JAMA. 2013;309(7):671–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Vitacca M, Vianello A, Colombo D, et al. Comparison of two methods for weaning patietns with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days. Am J Respir Crit Care Med. 2001;164:225–30.

    Article  CAS  PubMed  Google Scholar 

  26. Marchese S, Corrado A, Scala R, et al. Tracheostomy in patients with long-term mechanical ventilation: A survey. Respir Care. 2010;104:749–53.

    Google Scholar 

  27. Scheinhorn DE, Stearn-Hassenpflug M, Votto JJ, et al. Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study. Chest. 131:85–93.

    Google Scholar 

  28. Dasta JF, McLaughlin TP, Mody SH, et al. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266–71.

    Article  PubMed  Google Scholar 

  29. Cox CE, Carson SS, Lindquist JH, et al. Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Crit Care. 2007;11:R9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hung MC, Lai WW, Chen HH, Lee JC, Lin YJ, Hsiao JR, Cheng YM, Shan YS, Su WC, Wang JD. Cost effectiveness of cancer treatment in Taiwan. J Formos Med Assoc. 2016;115(8):609–18.

    Article  PubMed  Google Scholar 

  31. Shih CY, Hung MC, Lu HM, et al. Incidence, life expectancy, and prognostic factors in cancer patients under prolonged mechanical ventilation: a nationwide analysis of 5,138 cases during 1998-2007. Crit Care. 2013;17:R144.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Azevedo LC, Caruso P, Silva UV, et al. Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest. 2014;146(2):257–66.

    Article  PubMed  Google Scholar 

  33. Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M. Impact of renal dysfunction on weaning from prolonged mechanical ventilation. Crit Care. 1997;1(3):101–4.

    Article  CAS  PubMed  Google Scholar 

  34. Gracey DR, Naessens JM, Krishan I, et al. Hospital and posthospital survival in patients mechanically ventilated for more than 29 days. Chest. 1992;101:211–4.

    Article  CAS  PubMed  Google Scholar 

  35. Carson SS, Garrett J, Hanson L, et al. A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation. Crit Care Med. 2008;36(7):2061–9.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, USA

    Jennifer Kaya M.D. & Ayman O. Soubani M.D.

Authors
  1. Jennifer Kaya M.D.
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  2. Ayman O. Soubani M.D.
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Correspondence to Ayman O. Soubani M.D. .

Editor information

Editors and Affiliations

  1. Intensive Care and Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain

    Antonio M. Esquinas

  2. Division of Anesthesiology and Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    S. Egbert Pravinkumar

  3. Wayne State University School of Medicine, Detroit, Michigan, USA

    AYMAN O. SOUBANI

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Kaya, J., Soubani, A.O. (2018). Prolonged Mechanical Ventilation in the Cancer Patient. In: Esquinas, A., Pravinkumar, S., SOUBANI, A. (eds) Mechanical Ventilation in Critically Ill Cancer Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-49256-8_27

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  • DOI: https://doi.org/10.1007/978-3-319-49256-8_27

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-49255-1

  • Online ISBN: 978-3-319-49256-8

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