Recent Intensive Care Unit Advances in the Management of Critically Ill Cancer Patients

Abstract

Only a few years ago, intensive care unit (ICU) mortality of critically ill cancer patients was unacceptably high, especially in those requiring invasive mechanical ventilation. Meanwhile, evidence-based intensive care unit admission criteria, general improvements in the management of organ dysfunctions, advances in the diagnosis and treatment of specific complications, as well as new therapeutic options for cancer and infections have led to a marked improvement of outcomes. The available data suggest that ICU survivors regain favorable quality-of-life, return to a state in which the continuation of anticancer therapy is feasible, and that their long-term survival as well as their hematologic and oncologic outcome may not be different from cancer patients who were never admitted to the ICU. Thus, a general reluctance to admit critically ill cancer patients to the ICU cannot be justified anymore. Oncologic emergencies (as hypercalcemia, hyponatremia, hypoglycemia, tumor lysis syndrome, cardiac tamponade, superior vena cava syndrome, neutropenic fever, spinal cord compression, increased intracranial pressure, seizures, hyperviscosity syndrome,, and airway obstruction in patients with malignancies) can occur at any time during the course of a malignancy, from the presenting symptom to end-stage disease. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of