Staudinger T
Universitätsklinik für Innere Medizin I, Intensivstation 13.i2, Medizinische Universität Wien, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
Med Klin Intensivmed Notfmed. 2013 Apr;108(3):191-6. doi: 10.1007/s00063-012-0178-y.
Critically ill cancer patients on intensive units with hematological or oncological underlying diseases are a special situation: the underlying disease may be incurable, acute problems are often therapy associated and immunosuppression is regularly present. Due to evolving knowledge about special aspects of these patients and optimized supportive therapy, the prognosis has substantially improved during the last decades. General reluctance to admit cancer patients to an intensive care unit is therefore no longer justified. Reasons for admission are often infections and/or respiratory failure. Extensive diagnostic measures, causal and supportive therapy of sepsis according to current guidelines has led to improved outcome even in cancer patients. In respiratory failure, non-invasive ventilation is the key to improved prognosis if used early enough and indications, contraindications and break-off criteria are strictly followed. The prognosis of critically ill cancer patients is determined by the severity of the acute problem and not by the underlying disease.
基础疾病可能无法治愈，急性问题通常与治疗相关，且经常存在免疫抑制。由于对这些患者特殊情况的认识不断发展以及支持治疗的优化，在过去几十年中预后有了显著改善。因此，普遍不愿收治癌症患者进入重症监护病房已不再合理。收治的原因通常是感染和/或呼吸衰竭。根据当前指南进行广泛的诊断措施、脓毒症的病因治疗和支持治疗，即使在癌症患者中也能改善预后。在呼吸衰竭中，如果足够早地使用无创通气并严格遵循适应证、禁忌证和中断标准，这是改善预后的关键。重症癌症患者的预后取决于急性问题的严重程度，而非基础疾病。
