AP-HP, Hôpital Saint-Louis, Medical ICU, Paris, France.
Ann Intensive Care. 2011 Mar 23;1(1):5. doi: 10.1186/2110-5820-1-5.
A few decades have passed since intensive care unit (ICU) beds have been available for critically ill patients with cancer. Although the initial reports showed dismal prognosis, recent data suggest that an increased number of patients with solid and hematological malignancies benefit from intensive care support, with dramatically decreased mortality rates. Advances in the management of the underlying malignancies and support of organ dysfunctions have led to survival gains in patients with life-threatening complications from the malignancy itself, as well as infectious and toxic adverse effects related to the oncological treatments. In this review, we will appraise the prognostic factors and discuss the overall perspective related to the management of critically ill patients with cancer. The prognostic significance of certain factors has changed over time. For example, neutropenia or autologous bone marrow transplantation (BMT) have less adverse prognostic implications than two decades ago. Similarly, because hematologists and oncologists select patients for ICU admission based on the characteristics of the malignancy, the underlying malignancy rarely influences short-term survival after ICU admission. Since the recent data do not clearly support the benefit of ICU support to unselected critically ill allogeneic BMT recipients, more outcome research is needed in this subgroup. Because of the overall increased survival that has been reported in critically ill patients with cancer, we outline an easy-to-use and evidence-based ICU admission triage criteria that may help avoid depriving life support to patients with cancer who can benefit. Lastly, we propose a research agenda to address unanswered questions.
几十年来，重症监护病房（ICU）一直为患有癌症的危重病患者提供服务。尽管最初的报告显示预后不佳，但最近的数据表明，越来越多的实体瘤和血液恶性肿瘤患者受益于重症监护支持，死亡率显著降低。基础恶性肿瘤治疗的进步和器官功能障碍的支持导致了因恶性肿瘤本身的致命并发症以及与肿瘤治疗相关的感染和毒性不良反应而危及生命的患者的生存获益。在这篇综述中，我们将评估预后因素，并讨论与癌症危重病患者管理相关的总体观点。某些因素的预后意义随时间而变化。例如，中性粒细胞减少症或自体骨髓移植（BMT）的不良预后意义比二十年前要小。同样，由于血液科医生和肿瘤学家根据恶性肿瘤的特征选择患者进入 ICU，基础恶性肿瘤很少影响 ICU 入院后的短期生存。由于最近的数据并未明确支持 ICU 支持对未选择的异基因 BMT 接受者有益，因此需要在这一亚组中进行更多的预后研究。由于报告的癌症危重病患者总体生存率提高，我们概述了一种易于使用且基于证据的 ICU 入院分诊标准，这可能有助于避免剥夺可以受益的癌症患者的生命支持。最后，我们提出了一个研究议程，以解决未解决的问题。
