Lecuyer Lucien, Chevret Sylvie, Thiery Guillaume, Darmon Michael, Schlemmer Benoît, Azoulay Elie
AP-HP, Saint Louis Hospital, Medical ICU, Paris 7 University, Paris, France.
Crit Care Med. 2007 Mar;35(3):808-14. doi: 10.1097/01.CCM.0000256846.27192.7A.
Cancer patients requiring mechanical ventilation are widely viewed as poor candidates for intensive care unit (ICU) admission. We designed a prospective study evaluating a new admission policy titled The ICU Trial.
Prospective study.
Intensive care unit.
One hundred eighty-eight patients requiring mechanical ventilation and having at least one other organ failure.
Over a 3-yr period, all patients with hematologic malignancies or solid tumors proposed for ICU admission underwent a triage procedure. Bedridden patients and patients in whom palliative care was the only cancer treatment option were not admitted to the ICU. Patients at earliest phase of the malignancy (diagnosis < 30 days) were admitted without any restriction. All other patients were prospectively included in The ICU Trial, consisting of a full-code ICU admission followed by reappraisal of the level of care on day 5.
Among the 188 patients, 103 survived the first 4 ICU days and 85 died from the acute illness. Hospital survival was 21.8% overall. Among the 103 survivors on day 5, none of the characteristics of the malignancy were significantly different between the 62 patients who died and the 41 who survived. Time course of organ dysfunction over the first 6 ICU days differed significantly between survivors and nonsurvivors. Organ failure scores were more accurate on day 6 than at admission or on day 3 for predicting survival. All patients who required initiation of mechanical ventilation, vasopressors, or dialysis after 3 days in the ICU died.
Survival was 40% in mechanically ventilated cancer patients who survived to day 5 and 21.8% overall. If these results are confirmed in future interventional studies, we recommend ICU admission with full-code management followed by reappraisal on day 6 in all nonbedridden cancer patients for whom lifespan-extending cancer treatment is available.
需要机械通气的癌症患者被广泛认为是重症监护病房（ICU）收治的不佳人选。我们设计了一项前瞻性研究，评估一项名为“ICU试验”的新收治政策。
前瞻性研究。
重症监护病房。
188例需要机械通气且至少有一个其他器官功能衰竭的患者。
在3年期间，所有拟收入ICU的血液系统恶性肿瘤或实体瘤患者均接受了分诊程序。卧床患者以及姑息治疗是唯一癌症治疗选择的患者未收入ICU。处于恶性肿瘤最早期（诊断<30天）的患者无限制入院。所有其他患者前瞻性纳入“ICU试验”，包括全代码ICU收治，然后在第5天重新评估护理级别。
188例患者中，103例在ICU的前4天存活，85例死于急性疾病。总体医院生存率为21.8%。在第5天的103例幸存者中，死亡的62例患者和存活的41例患者之间，恶性肿瘤的特征均无显著差异。幸存者和非幸存者在ICU的前6天器官功能障碍的时间进程有显著差异。器官衰竭评分在第6天比入院时或第3天更能准确预测生存。在ICU住院3天后需要开始机械通气、使用血管升压药或进行透析的所有患者均死亡。
存活至第5天的机械通气癌症患者生存率为40%，总体生存率为21.8%。如果这些结果能在未来的干预性研究中得到证实，我们建议对所有可获得延长寿命癌症治疗的非卧床癌症患者进行全代码管理的ICU收治，然后在第6天重新评估。
