Benefit of critical care in patients with inoperable lung cancer

Purpose: The initiation of mechanical ventilation in patients with inoperable lung cancer is often considered an inappropriate use of scarce and expensive resources. The purpose of this study is to identify those patients who can benefit from critical care management and mechanical ventilation based on hospital survival. Methods: 544 consecutive admissions to the M.D. Anderson Cancer Center Medical Intensive Care Unit (MICU) from August 1994 to July 1995 were prospectively analyzed for type of malignancy, extent of disease, prior cancer therapy, etiology of admission, the use of mechanical ventilation, cause of respiratory failure, and MICU outcome. Results: Forty-two (8%) patients were admitted with the diagnosis of lung cancer. Fifteen (36%) patients with lung cancer required mechanical ventilation and four (27%) were subsequently able to be weaned from the ventilator and discharged from the MICU. Respiratory failure in the survivors was due to exacerbation of COPD in one patient, bronchospasm in two patients, and spontaneous pneumothorax in the remaining patient. Eleven (63%) lung cancer patients that received mechanical ventilation died in the MICU. The causes of respiratory failure in these patients were cardiopulmonary arrest (45%), progressive disease (45%), and sepsis (10%). There was no significant difference in the extent of disease or prior therapy among survivors and those that died in the MICU. Conclusions: The percentage of patients with lung cancer admitted to the MICU and placed on mechanical ventilation is low (3%). Patients who were able to be weaned from mechanical ventilation were those intubated for etiologies other than overwhelming sepsis, progressive disease, and status post cardiopulmonary arrest. Clinical Implications: Mechanical ventilation in patients with lung cancer can be justifiable in a select group of patients with reversible causes of respiratory failure. Objective admission criteria to the MICU is essential to promote cost effective and quality patient care.