Etiology and prognosis of acute respiratory failure in patients with primary malignant brain tumors admitted to the intensive care unit
Acute respiratory failure (ARF) is common and potentially fatal in patients with primary malignant brain tumors (PMBT). However, few data are available regarding its precipitating factors and prognosis. We sought to: (1) compare the causes of ARF and the outcome between patients with PMBT and patients with other peripheral solid tumors (PST), (2) identify the factors influencing ICU survival in PMBT patients.
Two-center retrospective case-control study from March 1996 to May 2014. Primary central nervous system lymphomas were also included.
Eighty-four patients with PMBT and 133 patients with PST were included. Acute infectious pneumonia was more frequent in PMBT than PST patients (77 vs. 36%, p < 0.001). Pulmonary embolism was also more frequent in PMBT patients (13% vs. 5%, p = 0.042), while cardiogenic pulmonary edema and acute-on-chronic respiratory failure were more frequent in PST patients (37 vs. 10%, p < 0.001). Among acute infectious pneumonia, Pneumocystis pneumonia and aspiration pneumonia were more frequent in PMBT patients (19 vs. 2%, p < 0.001 and 19 vs. 8%, p < 0.001, respectively). ICU mortality was similar between PMBT and PST patients (24% vs. 24%, p = 0.966). In multivariate analysis, cancer progression (OR 7.25 95% CI 1.13–46.45, p = 0.034), need for intubation (OR 7.01 95% CI 1.29–38.54, p = 0.022), were independently associated with ICU mortality in PMBT patients.
The cause of ARF in patients with PMBT differs significantly than those with PST and up to 50% may have been prevented. Mortality did not differ between the two groups. These results suggest that PMBT alone is not a relevant criterion for ICU recusal.
KeywordsMalignant brain tumors Prognosis Intensive care unit Acute respiratory failure Pneumocystis pneumonia Critical care
We thank Anthony Saul for his help with English style and grammar
MD: methodology, data curation, conceptualization, validation, writing - original draft, and writing - review and editing. NW: data curation, conceptualization, validation, writing - original draft. CM: data curation, validation. LL: validation, software. MC: data curation, validation, KH-X: validation. HP: data curation, conceptualization, validation, IR: methodology, software, validation, writing - original draft. AI: supervision, validation, AD: methodology, data curation, supervision, conceptualization, validation, writing - original draft, and writing - review and editing, TS: supervision, validation, conceptualization, writing - original draft.
Compliance with ethical standards
Conflict of interest
Alexandre Demoule has signed research contracts with Covidien, Maquet, Philips and Ait Liquide Santé; he has also received personal fees from Covidien, Maquet and MSD. Ahmed Idbaih reports research funding from La Fondation ARC pour la recherche sur le Cancer, Carthera, Beta-Innov, and Intselchimos; travel funding from Hoffmann-La Roche; and personal fees from Novartis, La Lettre du Cancérologue, BMS, and Cipla unrelated to the submitted work. Nicolas Weiss has signed research contracts with Eumedica, BMS, MedDay pharmaceuticals; he has also received personal fees from Norgine and Alpha-Wasserman. Thomas Similowski has received grant research from Coviden, Philips, Pierre Fabre Médicaments, Air Liquide Medical Systems; he has also received personal fees from Takeda, Teva Pharma, Lungpacer Inc, Almirall France, Pierre Fabre Médicaments, Novartis, Mundipharma, Invacare, Astra Zeneca, Boehringer Ingelheim and GlaxoSmithKline. Hélène Prodanovic, Khê Hoang-Xuan, Clémence Marois, Isabelle Rivals, Marie Cantier, Léa Lemasle and Maxens Decavèle all declare that they have no conflict of interest.
Research involving human participants and/or animals and informed consent.
According to the French Public Health Code (L.1121-1 paragraph 1 and R1121-2,), informed consent is unnecessary for anonymous extraction and analysis of data from patients’ medical charts. The study was approved by the Institutional Review Board of the French Intensive Care Society.
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