Abstract
In cancer patients with acute respiratory failure (ARF), early adequate therapy is associated with better outcomes. We investigate the performance of the DIRECT approach that used criteria available at the bedside at ICU admission to identify causes of ARF in cancer patients.
Cohort study of cancer patients with ARF of determined aetiology. Associations of aetiological groups with the selected criteria were evaluated using correspondence analysis.
Four hundred twenty-four cancer patients were included: 201 (47%) with bacterial pneumonia, 131 (31%) with opportunistic infections, and 92 (22%) with non-infectious disorders. Mechanical ventilation (both invasive and non-invasive) was needed in 328 (77%) patients, treatment for shock in 217 (51%), and dialysis in 82 (19%). One hundred forty-two patients (34%) died in the ICU. Correspondence plots showed that bacterial pneumonia was associated with neutropenia, solid tumour, multiple myeloma, time since symptom onset <3 days, shock, unilateral crackles, and unilateral radiographic pattern. Opportunistic infections were associated with steroids, lymphoproliferative disorders, and hematopoietic stem-cell transplantation, whereas non-infectious disorders were associated with acute leukaemia
The selected criteria are strongly associated with causes of ARF in cancer patients and could be used to develop an algorithm for selecting first-line diagnostic investigations and empirical treatments.
- Acute respiratory failure
- bronchoalveolar lavage
- cancer
- fiberoptic bronchoscopy
- infectious diseases/pneumonia
- mechanically ventilated patients.
- ERS