Expert Consensus on Acute Respiratory Failure in Critically Ill Cancer Patients (2023)

Hai-Jun Wang; Wei Chen; Hong-Zhi Wang; He-Ling Zhao; Dong-Hao Wang; Yun Long; Xue-Zhong Xing; on behalf of the Critical Care Medicine Committee of Beijing Association of Oncology (CCMBAO)

doi:10.24920/004203

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Expert Consensus on Acute Respiratory Failure in Critically Ill Cancer Patients (2023)

Chinese Medical Sciences Journal Vol. 38, Issue 3, Pages: 163-177(2023)

Guideline & Consensus | Updated：2024-11-26

- Expert Consensus on Acute Respiratory Failure in Critically Ill Cancer Patients (2023)
- Affiliations：
  
  1. 1Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  2. 2Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  3. 3Department of Intensive Care Unit, Peking University Cancer Hospital, Beijing 100142, China
  4. 4Department of Intensive Care Unit, Hebei General Hospital, Shijiazhuang 050057, China
  5. 5Department of Intensive Care Unit, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
  6. 6Department of Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Author bio：
- Funds：
- DOI：10.24920/004203
  CLC：
- Received：27 December 2022，
  
  Accepted：2022-5-6，
  
  Published Online：21 September 2023，
  
  Published：30 September 2023
- Accepted：
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Hai-Jun Wang, Wei Chen, Hong-Zhi Wang, et al. Expert Consensus on Acute Respiratory Failure in Critically Ill Cancer Patients (2023)[J]. Chinese medical sciences journal, 2023, 38(3): 163-177.
DOI：

Hai-Jun Wang, Wei Chen, Hong-Zhi Wang, et al. Expert Consensus on Acute Respiratory Failure in Critically Ill Cancer Patients (2023)[J]. Chinese medical sciences journal, 2023, 38(3): 163-177. DOI： 10.24920/004203.

摘要

目的

本共识的制定旨在为肿瘤重症患者合并呼吸衰竭的临床处理中常见问题提供基于临床证据的推荐意见。

方法

采用人群、干预、比较和预后（Population

Intervention

Comparison

and Outcome，PICO）原则对肿瘤重症患者呼吸衰竭的诊断和处理提出6个重要临床问题，基于文献检索和证据整合形成推荐意见。采用推荐意见分级评价、制定与评估（Grading of Recommendation Assessment

Development and Evaluation，GRADE）的方法讨论每个问题并经专家组讨论后形成共识意见。

结果

共识专家组形成了如下推荐意见。强推荐：⑴宏基因组二代测序可能有助于临床医师快速诊断合并呼吸衰竭的肿瘤重症患者的肺部感染；⑵体外膜肺（Extracorporeal Membrane Oxygenation，ECMO）不作为合并急性呼吸窘迫综合征的肿瘤重症患者常规挽救方案，多学科会诊后高选择性患者可能受益于ECMO治疗；⑶与标准化疗相比，免疫检查点抑制剂治疗增加肿瘤患者肺毒性的发生率；⑷接受机械通气的肿瘤患者如预计通气时间超过14天，早期气管切开可能使患者获益；⑸高流量氧疗和无创通气可以作为肿瘤合并呼吸衰竭的重症患者的一线氧疗方案。弱推荐：⑹对于癌肿压迫所致呼吸衰竭的肿瘤重症患者，如多学科会诊后考虑肿瘤对于药物潜在敏感，可采用紧急化疗作为挽救治疗。

结论

基于已有证据形成的推荐意见可指导肿瘤合并呼吸衰竭患者的诊断和治疗并改善预后。

Abstract

Objective

This consensus aims to provide evidence-based recommendations on common questions in the diagnosis and treatment of acute respiratory failure (ARF) for critically ill cancer patients.

Methods

We developed six clinical questions using the PICO (Population

Intervention

Comparison

and Outcome) principle in diagnosis and treatment for critical ill cancer patients with ARF. Based on literature searching and meta-analyses

recommendations were devised. The GRADE (Grading of Recommendation Assessment

Development and Evaluation) method was applied to each question to reach consensus in the expert panel.

Results

The panel makes strong recommendations in favor of (1) metagenomic next-generation sequencing (mNGS) tests may aid clinicians in rapid diagnosis in critically ill cancer patients suspected of pulmonary infections; (2) extracorporeal membrane oxygenation (ECMO) therapy should not be used as a routine rescue therapy for acute respiratory distress syndrome in critically ill cancer patients but may benefit highly selected patients after multi-disciplinary consultations; (3) cancer patients who have received immune checkpoint inhibitor therapy have an increased incidence of pneumonitis compared with standard chemotherapy; (4) critically ill cancer patients who are on invasive mechanical ventilation and estimated to be extubated after 14 days may benefit from early tracheotomy; and (5) high-flow nasal oxygen and noninvasive ventilation therapy can be used as a first-line oxygen strategy for critically ill cancer patients with ARFs. A weak recommendation is: (6) for critically ill cancer patients with ARF caused by tumor compression

urgent chemotherapy may be considered as a rescue therapy only in patients determined to be potentially sensitive to the anticancer therapy after multidisciplinary consultations.

Conclusions

The recommendations based on the available evidence can guide diagnosis and treatment in critically ill cancer patients with acute respiratory failure and improve outcomes.

关键词

Keywords

references

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