Outcome of chemotherapy among intubated patients with small cell lung cancer: A systematic review.

Abstract

e20163 Background: Small cell lung cancer (SCLC) is characterized by rapid doubling time and early metastasis, often leading to acute physiological decompensation. The association of paraneoplastic syndrome with SCLC may necessitate airway management. This study aims to characterize the indications for intubation and the subsequent clinical outcomes in this high-risk population. Methods: A thorough systematic search was conducted to identify studies done on intubation in small cell lung cancer patients using Covidence. After appropriate exclusion of studies, data analysis was done using MS-Excel. Results: We identified a total of 1483 studies after thorough database searching. After excluding the studies, a total of 29 patients (M/F = 17/12) from 24 case reports and one case series were included in the qualitative analysis . Only 7 patients had been diagnosed with small cell lung cancer prior to the hospital presentation. For the remaining 22 patients, the median age at diagnosis was 57 years. 16 patients (55.17%) had a diagnosed paraneoplastic syndrome of which 15 patients were intubated for respiratory failure or airway protection and one was intubated for cardiac arrest. Other common indications were structural obstructions and procedural requirement. Liver metastases were reported in 3 patients and brain metastasis was reported in one patient. Patients were intubated for a mean duration of 7.16 days. 2 patients required tracheostomy following prolonged intubation. 8 patients (27.5%) succumbed to death while 21 patients (72.41%) were alive after receiving intubation and chemotherapy; of which 11 patients (37.93%) were either discharged home or to nursing home. Conclusions: Intubation in SCLC is not universally futile. Indications extend beyond simple respiratory failure to include reversible oncological emergencies and paraneoplastic neurological decline. Survival is possible, particularly when mechanical ventilation serves as a bridge to allow for the rapid initiation of systemic chemotherapy.