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Published in: Intensive Care Medicine 5/2008

01-05-2008 | Editorial

Can we still refuse ICU admissionof patients with hematological malignancies?

Authors: Frédéric Pène, Márcio Soares

Published in: Intensive Care Medicine | Issue 5/2008

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Excerpt

For many years, it was assumed that patients with hematological malignancies developing acute severe complications had a very grim prognosis, particularly in the presence of prolonged neutropenia and when mechanical ventilation or renal replacement therapy was needed [12]. Consequently, many intensivists were reluctant to admit these patients to the intensive care unit (ICU), and disagreements with hemato-oncologists were frequent. However, this scenario has fortunately been changing. Over recent years, the medical literature has seen numerous studies reporting improved survival rates for cancer patients, with either hematological malignancies or solid tumors, requiring intensive care [38]. Advances in anticancer treatments and improvements in intensive care, coupled with the attempt at more judicious patient triage with earlier ICU admission, have been translated into this outcome improvement. …
Literature
1.
go back to reference Lloyd-Thomas AR, Wright I, Lister TA, Hinds CJ (1988) Prognosis of patients receiving intensive care for life-threatening medical complications of haematological malignancy. Br Med J 296:1025–1029CrossRef Lloyd-Thomas AR, Wright I, Lister TA, Hinds CJ (1988) Prognosis of patients receiving intensive care for life-threatening medical complications of haematological malignancy. Br Med J 296:1025–1029CrossRef
2.
go back to reference Brunet F, Lanore JJ, Dhainaut JF, Dreyfus F, Vaxelaire JF, Nouira S, Giraud T, Armaganidis A, Monsallier JF (1990) Is intensive care justified for patients with haematological malignancies? Intensive Care Med 16:291–297PubMedCrossRef Brunet F, Lanore JJ, Dhainaut JF, Dreyfus F, Vaxelaire JF, Nouira S, Giraud T, Armaganidis A, Monsallier JF (1990) Is intensive care justified for patients with haematological malignancies? Intensive Care Med 16:291–297PubMedCrossRef
3.
go back to reference Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, Fermand JP, Schlemmer B (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401PubMedCrossRef Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, Fermand JP, Schlemmer B (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401PubMedCrossRef
4.
go back to reference Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 160:1957–1961PubMed Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 160:1957–1961PubMed
5.
go back to reference Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328PubMedCrossRef Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328PubMedCrossRef
6.
go back to reference Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525PubMedCrossRef Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525PubMedCrossRef
7.
go back to reference Larche J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G, Darmon M, Le Gall JR, Schlemmer B (2003) Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29:1688–1695PubMedCrossRef Larche J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G, Darmon M, Le Gall JR, Schlemmer B (2003) Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29:1688–1695PubMedCrossRef
8.
go back to reference Soares M, Salluh JI, Ferreira CG, Luiz RR, Spector N, Rocco JR (2005) Impact of two different comorbidity measures on the 6-month mortality of critically ill cancer patients. Intensive Care Med 31:408–415PubMedCrossRef Soares M, Salluh JI, Ferreira CG, Luiz RR, Spector N, Rocco JR (2005) Impact of two different comorbidity measures on the 6-month mortality of critically ill cancer patients. Intensive Care Med 31:408–415PubMedCrossRef
9.
go back to reference Vandijck DM, Benoit DD, Depuydt PO, Offner FC, Blot SI, Van Tilborgh AK, Nollet J, Steel E, Noens LA, Decruyenaere JM (2008) Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med DOI 10.1007/s00134-008-1002-2 Vandijck DM, Benoit DD, Depuydt PO, Offner FC, Blot SI, Van Tilborgh AK, Nollet J, Steel E, Noens LA, Decruyenaere JM (2008) Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med DOI 10.​1007/​s00134-008-1002-2
10.
go back to reference Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34:344–353PubMedCrossRef Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34:344–353PubMedCrossRef
11.
go back to reference Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) 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 31:104–112PubMedCrossRef Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) 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 31:104–112PubMedCrossRef
12.
go back to reference Pène F, Aubron C, Azoulay E, Blot F, Thiery G, Raynard B, Schlemmer B, Nitenberg G, Buzyn A, Arnaud P, Socie G, Mira JP (2006) Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol 24:643–649PubMedCrossRef Pène F, Aubron C, Azoulay E, Blot F, Thiery G, Raynard B, Schlemmer B, Nitenberg G, Buzyn A, Arnaud P, Socie G, Mira JP (2006) Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol 24:643–649PubMedCrossRef
13.
go back to reference Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Intensive Care Med 36(1):296–327 Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Intensive Care Med 36(1):296–327
14.
go back to reference Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310PubMedCrossRef Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310PubMedCrossRef
15.
go back to reference Annane D, Aegerter P, Jars-Guincestre MC, Guidet B (2003) Current epidemiology of septic shock: the CUB-Rea Network. Am J Respir Crit Care Med 168:165–172PubMedCrossRef Annane D, Aegerter P, Jars-Guincestre MC, Guidet B (2003) Current epidemiology of septic shock: the CUB-Rea Network. Am J Respir Crit Care Med 168:165–172PubMedCrossRef
16.
go back to reference Pène F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marqué S, Charpentier J, Angus DC, Cariou A, Chiche JD, Mira JP (2008) Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med (in press) Pène F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marqué S, Charpentier J, Angus DC, Cariou A, Chiche JD, Mira JP (2008) Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med (in press)
17.
go back to reference Soares M, Fontes F, Dantas J, Gadelha D, Cariello P, Nardes F, Amorim C, Toscano L, Rocco JR (2004) Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Crit Care 8:R194–203PubMedCrossRef Soares M, Fontes F, Dantas J, Gadelha D, Cariello P, Nardes F, Amorim C, Toscano L, Rocco JR (2004) Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Crit Care 8:R194–203PubMedCrossRef
18.
go back to reference Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23:4406–4413PubMedCrossRef Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23:4406–4413PubMedCrossRef
19.
go back to reference Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E (2007) The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 35:808–814PubMedCrossRef Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E (2007) The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 35:808–814PubMedCrossRef
Metadata
Title
Can we still refuse ICU admissionof patients with hematological malignancies?
Authors
Frédéric Pène
Márcio Soares
Publication date
01-05-2008
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 5/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1003-1

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