Impacts of Airway Self-expandable Metallic Stent on Ventilator Weaning and Survival of Mechanically Ventilated Patients with Esophageal Cancer and Cental Airway Invasion

自張性氣道金屬支架對使用機械式呼吸器的食道癌併中央呼吸道侵犯患者其呼吸器脫離和生存的影響

李忠恕(Chung-Shu Lee) ； 鍾福財(Fu-Tsai Chung)

《內科學誌》 28卷4期 (2017/08) Pp. 243-251

https://doi.org/10.6314/JIMT.2017.28(4).07

摘要

Objective: This study describes the clinical effects of airway Ultraflex stenting as an alternative method for mechanically ventilated patients with esophageal cancer and central airway invasion. Although these patients have poor prognosis, this method may increase successful weaning to be able to receive the following cancer treatment. Design: Retrospective study. Setting: Medical intensive care unit (ICU), university hospital. Patients and interventions: Sixteen esophageal cancer patients with mechanical ventilation and central airway invasion were admitted to our ICU from 2001 to 2009. They received intervention therapy with Ultraflex stenting for central airway invasion. Main results: The mean ventilator day and length of intensive care unit stay of these sixteen patients were 14.4 (range, 1-59) and 16.4 (range, 5-61) days, respectively. Most patients (11/16, 68.7%) were successfully liberated from the ventilator after airway Ultraflex stent implantation. Five patients were finally discharged from hospital and received further treatment including concurrent chemoradiotherapy (3/16, 18.7%) or palliative radiotherapy (2/16, 12.5%). Although six patients were weaned from mechanical ventilator, they died during their hospitalization because of tumor progression or a new development of sepsis and recurrent respiratory failure. Five patients without weaning from the ventilator died due to severe pneumonia. The mean hospital stay was 36.1 days (range, 5-113) and the mean survival time was 56.1 days (range, 5-183). The ICU survival (10/11, 91% vs. 0/5, 0%; p ＜0.01) and overall survival (mean: 75.3 days vs. 13.8 days, p ＜0.01) of patients who were successfully weaned were significantly better than those who were not weaned from their ventilators. Conclusions: Airway Ultraflex stenting makes successful withdrawal from mechanical ventilation possible, and can therefore extend survival in critically ill esophageal cancer patients with airway invasion and mechanical ventilation.

關鍵字

Ultraflex stents ； Esophageal cancer ； Airway invasion ； Respiratory failure ； Outcomes

並列摘要

目標：此研究描述在食道癌併中央氣道侵犯且使用機械式呼吸器的患者中，接受氣道極彎支架(Ultraflex stent)置放這種替代性方式有其臨床效果。雖然此族群患者預後不佳，但此方法能讓病人增加脫離呼吸器的機會而接著後續食道癌的治療。設計：回溯性研究。設置及配備：內科加護病房(Intensive care unit, ICU)，大學附屬醫院級。病患和介入性方法：從2001年至2009年間住進加護病房的十六個食道癌併中央氣道侵犯且使用機械式呼吸器的患者，他們因氣道侵犯而接受氣道極彎支架置放。主要結果：十六位患者平均使用呼吸器的時間和加護病房天數分別為14.4天(range, 1-59) 和16.4天(range, 5-61)。大部分患者(11/16, 68.7%)在氣道極彎支架置放後，能成功脫離機械式呼吸器。其中五個病人最後順利出院而且接受了後續進一步的治療，包含三個接受同步化療及放射線治療(concurrent chemo-radiotherapy)(3/16, 18.7%)和二個接受姑息性放射線治療(palliative radiotherapy) (2/16, 12.5%)；六個病人在住院期間因為腫瘤進展、新發生的敗血症或反覆的呼吸衰竭而死亡。而五個即使已經接受支架置放仍未能脫離機械式呼吸器患者，則死於肺炎。這十六位患者平均住院天數和平均生存天數分別為36.1天(range, 5-113)和56.1天(range, 5-183)。能夠成功脫離機械式呼吸器者較不能脫離者，其加護病房生存率為佳，分別為91%,10/11 vs. 0%,0/5 (p ＜0.01)，整體平均生存天數也是比較好，分別為75.3 vs. 13.8天(p ＜0.01)。結論：在食道癌併呼吸衰竭的重症患者，接受氣道極彎支架置放後是有機會脫離機械式呼吸器的，並且可以延長其存活時間。