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BACKGROUND The probability of weaning and of long-term survival of chronically mechanically ventilated cancer patients is unknown, with incomplete information available to guide therapeutic decisions. We sought to determine the probability of weaning and overall survival of cancer patients requiring long-term mechanical ventilation in a specialized weaning unit. METHODS A single-institution retrospective review of patients requiring mechanical ventilation outside of a critical care setting from 2008 to 2012 and from January 1 to December 31, 2018, was performed. Demographic and clinical data were recorded, including cancer specifics, comorbidities, treatments, and outcomes. Overall survival was determined using the Kaplan-Meier approach. Time to weaning was analyzed using the cumulative incidence function, with death considered a competing risk. Prognostic factors were evaluated for use in prospective evaluations of weaning protocols. RESULTS Between 2008 and 2012, 122 patients required mechanical ventilation outside of a critical care setting with weaning as a goal of care. The cumulative incidence of weaning after discharge from the intensive care unit was 42% at 21 days, 49% at 30 days, 58% at 60 days, 61% at 90 days, and 61% at 120 days. The median survival was 0.16 years (95% CI, 0.12 to 0.33) for those not weaned and 1.05 years (95% CI, 0.60 to 1.34) for those weaned. Overall survival at 1 year and 2 years was 52 and 32% among those weaned and 16 and 9% among those not weaned. During 2018, 36 patients at our institution required mechanical ventilation outside of a critical care setting, with weaning as a goal of care. Overall, with a median follow-up of 140 days (range, 0-425 days; average, 141 days), 25% of patients requiring long-term mechanical ventilation (9 of 36) are alive. CONCLUSIONS Cancer patients can be weaned from long-term mechanical ventilation, even after prolonged periods of support. Implementation of a resource-intensive weaning program did not improve rates of successful weaning. No clear time on mechanical ventilation could be identified beyond which weaning was unprecedented. Short-term overall survival for these patients is poor.
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
March 2017,
Annals of the American Thoracic Society,
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
June 2019,
American journal of respiratory and critical care medicine,
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
November 2019,
American journal of critical care : an official publication, American Association of Critical-Care Nurses,
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
January 1987,
Scandinavian journal of plastic and reconstructive surgery and hand surgery,
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
January 1984,
Pride Institute journal of long term home health care,
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
December 2016,
Clinics in chest medicine,
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
July 2019,
Deutsche medizinische Wochenschrift (1946),
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
June 2021,
Pneumologie (Stuttgart, Germany),
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
January 1989,
The Medical journal of Australia,
Kelly Haviland, and
Kay See Tan, and
Nadja Schwenk, and
Manju V Pillai, and
Diane E Stover, and
Robert J Downey
January 2008,
Lung,
