Published in:
01-10-2014 | Con Editorial
Has survival increased in cancer patients admitted to the ICU? No
Published in: Intensive Care Medicine | Issue 10/2014
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As stated by Mokart, Pastores and Darmon in this issue [1], a number of studies have convincingly argued that the overall outcome of cancer patients in the intensive care unit (ICU) has improved over the last two decades [2]. Although we believe this is true for a significant number of critically ill cancer patients, this finding relies on cohorts of heterogeneous populations, and unrestricted application to all cancer patients would certainly be inaccurate. Table 1 illustrates this heterogeneity focusing on underlying diagnoses, severity of illness and especially the proportion of patients under mechanical ventilation which-is closely related to outcome. Although non-invasive ventilation (NIV) is assumed to have a beneficial effect on outcome if employed in cancer patients with acute respiratory failure, the failure rate is high yielding a grim prognosis, even worse than that of patients who undergo immediate invasive mechanical ventilation [3]. So only a small proportion of 10–20 % of patients are likely to be successfully managed by NIV [4, 5]. As the outcome of invasively mechanically ventilated patients is improving [3, 6], new trials are needed to address the current benefits of NIV in this population.
Table 1
Study populations in critically ill cancer patients during recent years
|
Study
|
PY
|
n
|
Population (%): hematol./solid/HSCT
|
MV (%)
|
Severity of illness scores
|
Survival: ICU/hospital/1-year
|
|---|---|---|---|---|---|---|
|
Staudinger et al. [12]
|
2000
|
414
|
58/42/9
|
62
|
APACHE III: 33
|
53/NR/23
|
|
Azoulay et al. [13]
|
2001
|
237
|
71/29/18
|
80
|
SAPS II: 58
|
30/27 (day 30)/NR
|
|
Kroschinsky et al. [14]
|
2002
|
104
|
100/0/NR
|
52
|
SAPS II: 46
|
56/NR/29
|
|
Maschmeyer et al. [11]
|
2003
|
189
|
46/54/14
|
50
|
NR
|
69/46/NR
|
|
Soares et al. [6]
|
2010
|
717
|
7/93/2
|
27
|
SAPS II: 32
|
79/70/NR
|
|
Azoulay et al. [15]
|
2010
|
220
|
84/16/25
|
37
|
LOD: 5
|
NR/69 (day 28)/NR
|
|
Bird et al. [16]
|
2012
|
199
|
100/0/42
|
52
|
APACHE II: 21
|
66/54/41 (6-month)
|
|
Legrand et al. [17]
|
2012
|
428
|
84/16/20
|
54
|
SAPS II: 56
|
60/50/37
|
|
Mokart et al. [18]
|
2012
|
70
|
94/6/20
|
94
|
SAPS II: 52
|
27/NR/13
|
|
Azoulay et al. [2]
|
2013
|
1,011
|
100/0/25
|
48
|
NR
|
72/61/43
|
|
Azevedo et al. [3]
|
2014
|
263
|
14/87/3
|
85
|
SAPS III: 54
|
46/33/NR
|