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Management of superior vena cava syndrome in critically ill cancer patients

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Abstract

Purpose

The purpose of this study is to describe the management and outcome of critically ill cancer patients with Superior Vena Cava Syndrome (SVCS).

Methods

All cancer patients admitted to the medical intensive care unit (ICU) of the Saint-Louis University Hospital for a SVCS between January 2004 and December 2016 were included.

Results

Of the 50 patients included in the study, obstruction of the superior vena cava was partial in two-thirds of the cases and complete in one-third. Pleural effusion was reported in two-thirds of the patients, pulmonary atelectasis in 16 (32%), and pulmonary embolism in five (10%). Computed tomography of the chest showed upper airway compression in 18 (36%) cases, while echocardiography revealed 22 (44%) pericardial effusions. The causes of SVCS were diagnosed one (0–3) day after ICU admission, using interventional radiology procedures in 70% of the cases. Thirty (60%) patients had hematological malignancies, and 20 (40%) had solid tumors. Fifteen (30%) patients required invasive mechanical ventilation, seven (14%) received vasopressors, and renal replacement therapy was implemented in three (6%). ICU, in-hospital, and 6-month mortality rates were 20, 26, and 48%, respectively. The cause of SVCS was the only factor independently associated with day 180 mortality by multivariate analysis. Patients with hematological malignancies had a lower mortality than those with solid tumors (27 versus 80%) (odds ratio 0.12, 95% confidence interval (0.02–0.60), p < 0.01).

Conclusion

Airway obstruction and pleural and pericardial effusions contributed to the unstable condition of cancer patients with SVCS. The vital prognosis of SVCS was mainly related to the underlying diagnosis.

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Acknowledgements

We thank Victoria Mears for helping with English editing.

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Authors and Affiliations

  1. Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France

    Sarah Morin, Adeline Grateau, Danielle Reuter, Lara Zafrani, Benoit Schlemmer, Elie Azoulay & Emmanuel Canet

  2. Department of Radiology, Saint-Louis University Hospital, AP-HP, Paris, France

    Eric de Kerviler, Constance de Margerie-Mellon & Cédric de Bazelaire

  3. Paris Diderot University—Sorbonne Paris Cité, Paris, France

    Eric de Kerviler, Cédric de Bazelaire, Lara Zafrani, Benoit Schlemmer & Elie Azoulay

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  1. Sarah Morin
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Contributions

EC was the principal investigator and takes primary responsibility for the paper. SM, AG, DR, CDB, EDK, CDMM, LZ, and BS recruited the patients. EC and SM did the statistical analysis. EC and SM coordinated the research and wrote the paper.

Corresponding author

Correspondence to Emmanuel Canet.

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Financial support

This study did not have financial support.

Conflict of interest statements

SM, AG, DR, CDB, EDK, CDMM, LZ, BS, and EC declare that they have no competing interests. EA declares the following statements: board member for Gilead; lectures for Alexion, MSD, and Astellas; research grants from MSD, Fisher & Payckle, and Pfizer (2012).

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Morin, S., Grateau, A., Reuter, D. et al. Management of superior vena cava syndrome in critically ill cancer patients. Support Care Cancer 26, 521–528 (2018). https://doi.org/10.1007/s00520-017-3860-z

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  • DOI: https://doi.org/10.1007/s00520-017-3860-z

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