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01-08-2014 | Original

Acute respiratory distress syndrome in patients with malignancies

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

Published in: Intensive Care Medicine | Issue 8/2014

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.

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Title: Acute respiratory distress syndrome in patients with malignancies
Authors: Elie Azoulay
Virginie Lemiale
Djamel Mokart
Frédéric Pène
Achille Kouatchet
Pierre Perez
François Vincent
Julien Mayaux
Dominique Benoit
Fabrice Bruneel
Anne-Pascale Meert
Martine Nyunga
Antoine Rabbat
Michael Darmon
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 8/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3354-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acute respiratory distress syndrome in patients with malignancies

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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