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

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 acute respiratory failure (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 the rapid diagnosis in critically ill cancer patients suspected of pulmonary infections; ⑵ extracorporeal membrane oxygenation (ECMO) therapy should not be used as a routine rescue therapy for acute respiratory distress syndrome in critically ill cancer patients, and may benefit to highly selected patients after a multi-disciplinary consultation; ⑶ cancer patients who received immune checkpoint inhibitor therapy have an increased incidence of pneumonitis compared with standard chemotherapy;⑷ critically ill cancer patients who are on invasive mechanical ventilation and estimated to be extubated after 14 days may benefit from early tracheotomy; ⑸ high-flow nasal oxygen and noninvasive ventilation therapy can be used as a first-line oxygen strategy for critically ill cancer patients with ARF, and a weak recommendation: ⑹ for critically ill cancer patients with ARF caused by tumor compression, urgent chemotherapy as a rescue therapy is recommended only to patients determined being potentially sensitive to the anticancer therapy after a multidisciplinary consultation.Conclusions The recommendations based on the available evidences can guide diagnosis and treatment in critically ill cancer patients with acute respiratory failure and improve outcomes.