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Wednesday, July 20, 2016

Critical care of patients with cancer - open access



open access

 Approximately 5% to 10% of patients with cancer will develop a life-threatening condition that necessitates ICU admission.[9-12]
 However, caution is needed when interpreting the results in the literature on ICU treatment for patients with cancer and when deriving conclusions for clinical practice. The vast majority of studies is retrospective and demonstrates considerable heterogeneity. It remains controversial whether the observed improvements in survival of critically ill patients with cancer are solely the result of advances in treatment of the underlying malignancy and progress in critical care.[38-40] Part of the improvements that were seen could be because of selection bias or earlier ICU admission of critically ill patients with cancer. Furthermore, there are substantial practice variations at the physician, hospital, country, and temporal levels. Thus, published data concerning cancer critical care, such as changes in ICU survival of patients with cancer, may be confounded by differences in clinical practice, case mix, and admission policies.[41]

Table 1. Causes for Intensive Care Unit Admission of Patients With Cancera
  1. ARF indicates acute respiratory failure; ATRA, all-trans retinoic acid; ICU, intensive care unit; PRES, posterior reversible encephalopathy syndrome; TRALI, transfusion-associated lung injury; TACO, transfusion-associated circulatory overload. aThe list summarizes some of the most frequent causes for ICU admission of patients with cancer.
Infections
• Pneumonia
• Sepsis
Oncologic emergencies
• Superior vena cava syndrome
• Tumor lysis syndrome
• Hypercalcemia
Noninfectious ARF
• TRALI
• TACO
• Pneumonitis
• Alveolar hemorrhage
• Engraftment syndrome
Surgery
• Regular postsurgical care
• Postsurgical complications, eg, bleeding
Adverse drug reactions
• Anaphylaxis
• Cytokine release syndrome
• ATRA syndrome
• Thrombotic microangiopathy
Neurologic complications
• Seizures
• PRES
Cardiovascular disease
• Myocardial infarction
• Congestive heart failure
• Arrhythmias
• Pulmonary thromboembolism

Conclusion

Comprehensive care for critically ill patients with cancer is a collaborative effort, and close cooperation between oncology as well as palliative and critical care is essential. Collaborative decision making is a cornerstone of high-quality critical care for patients with cancer. Like palliative medicine, critical care should be integrated early and seamlessly into the management of these patients. This will facilitate the early identification of patients who will most likely profit from aggressive management and the provision of optimal palliative care to those who are unlikely to benefit from intensive care. The ultimate goal should be to provide every critically ill patient who has cancer with high-quality critical care that is as tailored to his or her needs and personal preferences as the drugs that are used to treat their tumor.

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