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Acute respiratory distress syndrome in patients with malignancies

(2014) INTENSIVE CARE MEDICINE. 40(8). p.1106-1114
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Abstract
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. 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. 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. 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, INTENSIVE-CARE-UNIT, NONINVASIVE MECHANICAL VENTILATION, RANDOMIZED CONTROLLED-TRIAL, ACUTE MONOCYTIC LEUKEMIA, LONG-TERM OUTCOMES, ACUTE LUNG INJURY, CANCER-PATIENTS, BERLIN DEFINITION, SEPTIC SHOCK, NEUTROPENIC PATIENTS

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Citation

Please use this url to cite or link to this publication:

MLA
Azoulay, Elie, Virginie Lemiale, Djamel Mokart, et al. “Acute Respiratory Distress Syndrome in Patients with Malignancies.” INTENSIVE CARE MEDICINE 40.8 (2014): 1106–1114. Print.
APA
Azoulay, Elie, Lemiale, V., Mokart, D., Pene, F., Kouatchet, A., Perez, P., Vincent, F., et al. (2014). Acute respiratory distress syndrome in patients with malignancies. INTENSIVE CARE MEDICINE, 40(8), 1106–1114.
Chicago author-date
Azoulay, Elie, Virginie Lemiale, Djamel Mokart, Frederic Pene, Achille Kouatchet, Pierre Perez, François Vincent, et al. 2014. “Acute Respiratory Distress Syndrome in Patients with Malignancies.” Intensive Care Medicine 40 (8): 1106–1114.
Chicago author-date (all authors)
Azoulay, Elie, Virginie Lemiale, Djamel Mokart, Frederic Pene, Achille Kouatchet, Pierre Perez, François Vincent, Julien Mayaux, Dominique Benoit, Fabrice Bruneel, Anne-Pascale Meert, Martine Nyunga, Antoine Rabbat, and Michael Darmon. 2014. “Acute Respiratory Distress Syndrome in Patients with Malignancies.” Intensive Care Medicine 40 (8): 1106–1114.
Vancouver
1.
Azoulay E, Lemiale V, Mokart D, Pene F, Kouatchet A, Perez P, et al. Acute respiratory distress syndrome in patients with malignancies. INTENSIVE CARE MEDICINE. 2014;40(8):1106–14.
IEEE
[1]
E. Azoulay et al., “Acute respiratory distress syndrome in patients with malignancies,” INTENSIVE CARE MEDICINE, vol. 40, no. 8, pp. 1106–1114, 2014.
@article{5817991,
  abstract     = {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. 
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. 
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. 
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.},
  author       = {Azoulay, Elie and Lemiale, Virginie and Mokart, Djamel and Pene, Frederic and Kouatchet, Achille and Perez, Pierre and Vincent, François and Mayaux, Julien and Benoit, Dominique and Bruneel, Fabrice and Meert, Anne-Pascale and Nyunga, Martine and Rabbat, Antoine and Darmon, Michael},
  issn         = {0342-4642},
  journal      = {INTENSIVE CARE MEDICINE},
  keywords     = {Neutropenia,Bronchoscopy,Pneumonia,Invasive aspergillosis,Candidemia,Pneumocystis,INTENSIVE-CARE-UNIT,NONINVASIVE MECHANICAL VENTILATION,RANDOMIZED CONTROLLED-TRIAL,ACUTE MONOCYTIC LEUKEMIA,LONG-TERM OUTCOMES,ACUTE LUNG INJURY,CANCER-PATIENTS,BERLIN DEFINITION,SEPTIC SHOCK,NEUTROPENIC PATIENTS},
  language     = {eng},
  number       = {8},
  pages        = {1106--1114},
  title        = {Acute respiratory distress syndrome in patients with malignancies},
  url          = {http://dx.doi.org/10.1007/s00134-014-3354-0},
  volume       = {40},
  year         = {2014},
}

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