Wohlfarth P, Schellongowski P
Intensivstation 13i2, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
Med Klin Intensivmed Notfmed. 2020 Nov;115(8):633-640. doi: 10.1007/s00063-020-00737-5. Epub 2020 Oct 12.
Intensivists are confronted with a broad spectrum of specific clinical problems while caring for critically ill cancer patients. These include defining proper goals of intensive care treatment, managing acute respiratory failure with diverse differential considerations, treating immunologic side-effects of ever new and innovative cancer therapies, as well as numerous clinical scenarios which may exclusively arise in cancer patients. To help clinicians handle such challenges, the initiative Intensive Care in Hematologic and Oncologic Patients (iCHOP) has been dealing with these topics for several years. Supported by several Austrian and German medical societies of intensive care medicine, hematology and oncology, the first "Consensus statement for cancer patients requiring intensive care support" has only recently been released. Acute respiratory failure and its management continues to be a major focus in critically ill cancer patients due to its frequency and its prognostic impact. While noninvasive oxygenation strategies were considered the gold standard of therapy, more recent high-quality data do not show clinical benefits of such techniques including high flow nasal oxygen. On the contrary, several studies revealed an unidentified etiology of an acute respiratory failure as the only potentially modifiable risk factor for adverse outcome. Consequently, evidence-based and rigorously applied diagnostic algorithms are of utmost importance in these patients. Furthermore, intensivists are increasingly confronted with the rising incidence of various and new immunotherapy-associated toxicities and their management.
在照料重症癌症患者时，重症医学专家面临着一系列广泛的特定临床问题。这些问题包括确定重症监护治疗的恰当目标、处理伴有多种鉴别考虑因素的急性呼吸衰竭、治疗不断涌现的新型癌症疗法的免疫副作用，以及众多可能仅在癌症患者中出现的临床情况。为帮助临床医生应对此类挑战，“血液学和肿瘤学患者的重症监护”（iCHOP）倡议已针对这些主题开展了数年的工作。在奥地利和德国的多个重症医学、血液学和肿瘤学医学协会的支持下，首个“需要重症监护支持的癌症患者共识声明”最近才发布。急性呼吸衰竭及其管理由于其发生频率和预后影响，仍然是重症癌症患者的主要关注点。虽然无创氧合策略曾被视为治疗的金标准，但最近的高质量数据并未显示包括高流量鼻导管给氧在内的此类技术具有临床益处。相反，多项研究表明，急性呼吸衰竭不明病因是唯一可能改善不良结局的潜在风险因素。因此，基于证据且严格应用的诊断算法对这些患者至关重要。此外，重症医学专家越来越多地面临各种新型免疫疗法相关毒性的发病率上升及其管理问题。
