Authors: Élie Azoulay Benoît Schlemmer
Publish Date: 2006/04/29
Volume: 32, Issue: 6, Pages: 808-822
Abstract
Nearly 15 of cancer patients experience acute respiratory failure ARF requiring admission to the intensive care unit where their mortality is about 50 This review focuses on ARF in cancer patients The most recent literature is reviewed and emphasis is placed on current controversies most notably the risk/benefit ratio of fiberoptic bronchoscopy and BAL in patients with severe hypoxemiaFiberoptic bronchoscopy with bronchoalveolar lavage BAL is the cornerstone of the causal diagnosis However the low diagnostic yield of about 50 related to the widespread use of broadspectrum antimicrobial therapy in cancer patients has generated interest in highresolution computed tomography HRCT and primary surgical lung biopsy In patients with hypoxemia bronchoscopy and BAL may trigger a need for invasive mechanical ventilation thus considerably decreasing the chances of survivalThe place for recently developed effective noninvasive diagnostic tools tests on sputum blood urine and nasopharyngeal aspirates needs to be determined The prognosis is not markedly influenced by cancer characteristics it is determined chiefly by the cause of ARF need for mechanical ventilation and presence of other organ failures Although noninvasive ventilation reduces the need for endotracheal intubation and diminishes mortality rate its prolonged use in patients with severe disease may preclude optimal diagnostic and therapeutic management The appropriateness of switching to endotracheal mechanical ventilation in patients who fail noninvasive ventilation warrants evaluationThis review discusses risks and benefits from invasive and non invasive diagnostic and therapeutic strategies in critically ill cancer patients with acute respiratory failure Avenues for research are also suggested in order to improve survival in these very high risk patientsThe electronic reference of this article is http//dxdoiorg/101007/s0013400601292 The online fulltext version of this article includes electronic supplementary material This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured fulltext article To cite or link to this article you can use the above reference
Keywords: