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VOLUME 11 , ISSUE 1 ( January, 2007 ) > List of Articles

REVIEW ARTICLE

Deciding intensive care unit-admission for critically ill cancer patients

Guillaume Thiery, Michael Darmon, Elie Azoulay

Keywords : Critically ill patients, oncology, intensive care, admission refusal, prognosis

Citation Information : Thiery G, Darmon M, Azoulay E. Deciding intensive care unit-admission for critically ill cancer patients. Indian J Crit Care Med 2007; 11 (1):12-18.

DOI: 10.4103/0972-5229.32431

License: CC BY-ND 3.0

Published Online: 00-01-2007

Copyright Statement:  Copyright © 2007; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Over the last 15 years, the management of critically ill cancer patients requiring intensive care unit admission has substantially changed. High mortality rates (75-85%) were reported 10-20 years ago in cancer patients requiring life sustaining treatments. Because of these high mortality rates, the high costs, and the moral burden for patients and their families, ICU admission of cancer patients became controversial, or even clearly discouraged by some. As a result, the reluctance of intensivists regarding cancer patients has led to frequent refusal admission in the ICU. However, prognosis of critically ill cancer patients has been improved over the past 10 years leading to an urgent need to reappraise this reluctance. In this review, the authors sought to highlight that critical care management, including mechanical ventilation and other life sustaining therapies, may benefit to cancer patients. In addition, criteria for ICU admission are discussed, with a particular emphasis to potential benefits of early ICU-admission.


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  1. Improved survival in cancer patients requiring mechanical ventilatory support: Impact of noninvasive mechanical ventilatory support. Crit Care Med 2001;29:519-25.
  2. Changing use of intensive care for hematological patients: The example of multiple myeloma. Intensive Care Med 1999;25:1395-401.
  3. Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation. Chest 2002;121:185-8.
  4. Survival of acute myelogenous leukemia patients requiring intubation/ventilatory support. Clin Invest Med 1995;18:19-24.
  5. Acute respiratory failure in severe hematologic disorders. Crit Care Med 1984;12:26-8.
  6. Mechanical ventilation in cancer patients. Analysis of clinical data and outcome. Neth J Med 1990;37:183-8.
  7. Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: A case for evidence-based guidelines. Ann Intern Med 1996;125:625-33.
  8. Is intensive care justified for patients with haematological malignancies? Intensive Care Med 1990;16:291-7.
  9. Multicenter outcome study of cancer patients admitted to the intensive care unit: A probability of mortality model. J Clin Oncol 1998;16:761-70.
  10. Admitting cancer patients to the intensive care unit. Crit Care Clin 1988;4:183-91.
  11. Outcome of cancer patients considered for intensive care unit admission: A hospital-wide prospective study. J Clin Oncol 2005;23:4406-13.
  12. Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 2003;31:104-12.
  13. Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med 2002;30:2260-70.
  14. Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 2000;28:1322-8.
  15. Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 2005;33:2488-93.
  16. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 2002;346:235-42.
  17. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med 2003;348:994-1004.
  18. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med 2005;352:2487-98.
  19. Long-term survival rates of cancer patients achieved by the end of the 20 th century: A period analysis. Lancet 2002;360:1131-5.
  20. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 2003;29:1688-95 Epub 2003 Sep 1612.
  21. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
  22. Diagnostic strategy in cancer patients with acute respiratory failure. Intensive Care Med 2006;32:808-22 Epub 2006 Apr 2029.
  23. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever and acute respiratory failure. N Engl J Med 2001;344:481-7.
  24. Preventing acute renal failure is crucial during acute tumor lysis syndrome. Indian J Crit Care 2007;11:(in this issue).
  25. Compliance with triage to intensive care recommendations. Crit Care Med 2001;29:2132-6.
  26. National questionnaire survey on what influences doctors′ decisions about admission to intensive care. BMJ 2004;329:425.
  27. APACHE-acute physiology and chronic health evaluation: A physiologically based classification system. Crit Care Med 1981;9:591-7.
  28. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957-63.
  29. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 1993;270:2478-86.
  30. Prognostic factors for neutropenic patients in an intensive care unit: Respective roles of underlying malignancies and acute organ failures. Eur J Cancer 1997;33:1031-7.
  31. Severity-of-illness scores for neutropenic cancer patients in an intensive care unit: Which is the best predictor? Do multiple assessment times improve the predictive value? Crit Care Med 1998;26:488-93.
  32. Scoring systems in cancer patients admitted for an acute complication in a medical intensive care unit. Crit Care Med 2000;28:2786-92.
  33. Is a specific oncological scoring system better at predicting the prognosis of cancer patients admitted for an acute medical complication in an intensive care unit than general gravity scores? Support Care Cancer 2004;12:234-9 Epub 2004 Jan 2023.
  34. Is there any usefulness for a specific scoring system in assessing the prognosis of cancer patients admitted to the intensive care unit? Intensive Care Med 2004;30:1849. Epub 2004 Jun 1822.
  35. Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 1999;17:991-7.
  36. Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients. Intensive Care Med 2002;28:1775-80.
  37. Cancer patients with septic shock: Mortality predictors and neutropenia. Support Care Cancer 2004;12:833-9 Epub 2004 Aug 2012.
  38. Using outcomes research to improve the management of blood and marrow transplant recipients in the intensive care unit. New Horiz 1998;6:69-74.
  39. Long-term survival from respiratory failure after marrow transplantation for malignancy. Am Rev Respir Dis 1992;145:510-4.
  40. Mechanical ventilation after marrow transplantation. Risk factors and clinical outcome. Am Rev Respir Dis 1988;137:682-7.
  41. Prognostic assessment of the acute complications of bone marrow transplantation requiring intensive therapy. Intensive Care Med 1988;14:393-8.
  42. Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: A reappraisal of indications for organ failure supports. J Clin Oncol 2006;24:643-9 Epub 2005 Dec 2027.
  43. The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 2004;83:360-70.
  44. The ICU Trial: A new admission policy for cancer patients requiring mechanical ventilationFNx01. Crit Care Med 2007; [Epub ahead of print].
  45. Evaluation of triage decisions for intensive care admission. Crit Care Med 1999;27:1073-9.
  46. Predictive factors of intensive care unit admission in patients with haematological malignancies and pneumonia. Intensive Care Med 2004;30:965-71 Epub 2004 Mar 2030.
  47. Discrepancies in criteria for ICU proposal by hematologists and criteria for ICU admission by intensivists: A national survey. Submitted 2006.
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