Invasive Mechanical Ventilation (IMV) in Cancer Patients - Long Term Follow-up and Clinical Outcomes

Berner-Wygoda Y, Zarbiv Y, Rubin L, Sviri S, Breuer S and Popovtzer A

Sharett Institute of Oncology, Hadassah Medical Center, Jerusalem, Israel
The Hebrew University of Jerusalem, Jerusalem, Israel
Department of Internal Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
Allergy and Clinical Immunology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
Medical Intensive Care, Hebrew University and Hadassah University Medical Center, Jerusalem, Israel
These authors Contributed Equally to this work

^*Correspondance to: Yael Berner-Wygoda 

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Abstract:

Background: Recent developments in oncology have caused a positive shift both in prognosis and quality of life for patients with solid malignancies. In the past the concept of “futility” was generally accepted regarding invasive procedure including intubation and mechanical ventilation. This concept has been challenged in recent years; however, very little long term survival outcomes
have been published.
Methods: We identified patients with solid tumors who underwent Invasive Mechanical Ventilation (IMV) and were admitted to the Intensive Care Unit (ICU), treated at our institution between 2016-2020 using the institutional Electronic Medical Record System. We report clinical indications for IMV, clinical and laboratory parameters as well as long term survival outcomes.
Results: We identified a total of 46 patients who fit these criteria. We then divided the cohort to patients who died while on IMV and patients who underwent successful extubation. Indication for IMV, clinical and laboratory parameters were not found to be statistically significant in predicting outcome, except positive blood cultures (bacteremia). The average overall survival of patients
successfully extubated was 66 days, with a subgroup of long-term survivors in whom median survival was 176 days.
Conclusion: We performed a retrospective analysis of cancer patients undergoing IMV and report long term survival in the group of patients who were successfully extubated. We were unable to identify prognostic markers that could help identify patients who may benefit most. We conclude that in a selected group of patients, intensive care and mechanical ventilation is both appropriate and necessary. We propose that the most important determinant for long term survival is the indication for IMV. Patients who suffered an acute insult not necessarily related to cancer progression, fared best. Clinical prudence is required in selecting these patients.

Keywords:

End of life care; Solid tumors; Invasive mechanical ventilation; Cancer survivorship

Cite the Article:

Berner-Wygoda Y, Zarbiv Y, Rubin L, Sviri S, Breuer S, Popovtzer A. Invasive Mechanical Ventilation (IMV) in Cancer Patients - Long Term Follow-up and Clinical Outcomes. Clin Oncol. 2023;8:1985..