• Sébastien Roques, Antoine Parrot, Armelle Lavole, Pierre-Yves Ancel, Valérie Gounant, Michel Djibre, and Muriel Fartoukh.
• Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020 Paris, France. broques1@yahoo.com
• Intensive Care Med. 2009 Dec 1; 35 (12): 2044-50.

BackgroundIntensive care unit (ICU) admission of patients with lung cancer remains debated because of the poor short-term prognosis. However, ICU admission of such patients should also be assessed on the possibility to administer specific anticancer treatment and the long-term outcome thereafter.ObjectivesTo identify predictive factors of hospital and 6-month mortality in critically ill lung-cancer patients.Design And SettingRetrospective study conducted in the ICU of a university hospital.PatientsOne hundred five consecutive lung-cancer patients included between 1 January 1997 and 31 December 2006.InterventionsNone.ResultsOf the 105 patients (mean age 64.8 years), 87 (83%) had a non-small cell lung cancer (NSCLC). Extensive disease was diagnosed in 85 patients (83%) (NSCLC stages IIIB and IV or disseminated small cell lung cancer). The main reasons for ICU admission were acute respiratory failure (59%) and/or hemoptysis (45%). Forty-three patients (41%) needed mechanical ventilation (MV). The ICU, hospital and 6-month mortality rates were 43, 54 and 73%, respectively. A performance status (PS) >or=2 [odds ratio OR = 3.6 (95% confidence interval CI (1.5-8.7)] and acute respiratory failure [OR = 3.5 (95% CI (1.5-8.4)] predicted hospital mortality. In a multivariate Cox model, the cancer progression [hazard ratio HR = 6.1 (95% CI 2.2-17)] and the need for MV [HR = 3.6 (95% CI 1.35-9.4)] were independently associated with 6-month mortality. Two-thirds of the ICU survivors were able to receive anticancer treatment.ConclusionsICU admission should be considered in selected patients with lung cancer (PS <2, no cancer disease progression).

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