Prolonged mechanical ventilation in the cancer patient

Abstract

Although acute respiratory failure remains a dangerous and frequent complication in the cancer patient, the mortality of these patients has declined in the intensive care unit (ICU). This is due to a combination of improved aggressive cancer therapies, earlier and more accurate diagnostic strategies, and an enhanced knowledge of supportive treatments in the critically ill. The improvement in mortality, however, has also led to an increase in the number of patients who remain dependent on the ventilator despite overcoming their acute illness. The definition of “prolonged mechanical ventilation (PMV)" has been set forth by a consensus statement by the former National Association for Medical Direction of Respiratory Care (NAMDRC) in 2004, and it is defined as the need for 21 or more days of mechanical ventilation for 6 or more hours per day [1]. Other authors describe the “chronically critically ill (CCI)" patient. Generally, the chronically critically ill population includes patients who require the ICU setting for weeks to months, typically due to the need for prolonged mechanical ventilation [2]. Definitions have been variable, however, and this is reflected in the heterogeneity of clinical, medicolegal, financial, and epidemiologic data collection. In this chapter, the terms PMV and CCI will be used interchangeably.