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Der hämatologisch-onkologische Patient auf der Intensivstation

Therapieziele – Ethik – Palliation

Cancer patients in the intensive care unit

Goals of therapy, ethics, and palliation

Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Die intensivmedizinische Versorgung von Krebspatienten erfordert ein hohes Maß an gelebter Interdisziplinarität zwischen Intensivmedizinern und Onkologen. Intensivmediziner sollten ein solides Basiswissen über maligne Erkrankungen sowie die typischen Komplikationen von Grunderkrankung und Therapie haben. Hämatooonkologen sollten bei Auftreten von Organdysfunktionen möglichst frühzeitig eine Intensivstationsaufnahme evaluieren. Beide Seiten sollten eine realistische Einschätzung der kurzfristigen intensivmedizinischen sowie langfristigen onkologischen Optionen und Perspektiven des jeweiligen Patienten haben. Eine gute Zusammenarbeit ist die Basis für sinnhafte Aufnahmeentscheidungen, individuelle Therapiezielfestlegungen, gelungenes Patientenmanagement, sowie situationsadaptierte Begrenzungen des intensivtherapeutischen Spektrums mit fließenden Übergängen in ein palliativmedizinisches Setting.

Abstract

Providing critical care to cancer patients requires a high degree of practical multidisciplinary teamwork between intensivists and cancer specialists. Intensivists should have a solid basic knowledge of malignant diseases as well as of the typical complications of the underlying illness and its therapies. Hemato-oncologists should evaluate the transfer of these patients to the intensive care unit early in the course of emerging organ dysfunctions. Both parties should have a realistic impression of the short-term intensive care and long-term oncologic options and perspectives of the respective patient. Good cooperation between intensivists and cancer specialists is the basis for meaningful decisions on admission, planning of individual therapeutic aims, successful patient management, and tailored therapy, with a smooth transition into a palliative care setting whenever appropriate.

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Literatur

  1. Anderson WG, Arnold RM, Angus DC et al (2008) Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med 23:1871–1876

    Article  PubMed  Google Scholar 

  2. Azoulay E, Kouatchet A, Jaber S et al (2012) Noninvasive mechanical ventilation in patients having declined tracheal intubation.Intensive Care Med

  3. Azoulay E, Soares M, Darmon M et al (2011) Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care 1:5

    Article  PubMed  Google Scholar 

  4. Azoulay E, Recher C, Alberti C et al (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401

    Article  PubMed  CAS  Google Scholar 

  5. Darmon M, Azoulay E, Alberti C et al (2002) Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients. Intensive Care Med 28:1775–1780

    Article  PubMed  Google Scholar 

  6. Ferrer R, Artigas A, Levy MM et al (2008) Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 299:2294–2303

    Article  PubMed  CAS  Google Scholar 

  7. Gristina GR, Antonelli M, Conti G et al (2011) Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. Crit Care Med 39:2232–2239

    Article  PubMed  Google Scholar 

  8. Gruson D, Vargas F, Hilbert G et al (2004) Predictive factors of intensive care unit admission in patients with haematological malignancies and pneumonia. Intensive Care Med 30:965–971

    Article  PubMed  Google Scholar 

  9. Hanzelka KM, Yeung SC, Chisholm G et al (2012) Implementation of modified early goal directed therapy for sepsis in the emergency center of a comprehensive care center. Support Care Cancer 21:727−734

    Article  PubMed  Google Scholar 

  10. Kress JP, Christenson J, Pohlman AS et al (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 160:1957–1961

    Article  PubMed  CAS  Google Scholar 

  11. Lautrette A, Darmon M, Megarbane B et al (2007) A Communication Strategy and Brochure for Relatives of Patients Dying in the ICU. N Engl J Med 356:469–478

    Article  PubMed  CAS  Google Scholar 

  12. Lecuyer L, Chevret S, Thiery G et al (2007) The ICU Trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 35:808–814

    Article  PubMed  Google Scholar 

  13. Lengliné E, Raffoux E, Lemiale V et al (2012) Intensive care unit management of patients with newly diagnosed acute myeloid leukemia with no organ failure. Leuk Lymphoma 53:1352–1359

    Article  PubMed  Google Scholar 

  14. Nelson JE, Meier DE, Oei EJ et al (2001) Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med 29:277–282

    Article  PubMed  CAS  Google Scholar 

  15. Norton SA, Hogan LA, Holloway RG et al (2007) Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients. Crit Care Med 35:1530–1535

    Article  PubMed  Google Scholar 

  16. Oeyen SG, Benoit DD, Annemans L et al (2012) Long-term outcomes and quality of life in critically ill patients with hematological or solid malignancies: a single center study. Intensive Care Med

  17. Peigne V, Rusinová K, Karlin L et al (2009) Continued survival gains in recent years among critically ill myeloma patients. Intensive Care Med 35:512–518

    Article  PubMed  Google Scholar 

  18. Legrand M, Max A, Peigne V et al (2012) Survival in neutropenic patients with severe sepsis or septic shock. Crit Care Med 40:43–49

    Article  PubMed  Google Scholar 

  19. Puntillo KA, Arai S, Cohen NH et al (2010) Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med 38:2155–2160

    Article  PubMed  Google Scholar 

  20. Royal College of Physicians and Royal College of Radiologists (2012) Cancer patients in crisis: responding to urgent needs. Report of a working party. RCP, London

  21. Schellongowski P, Staudinger T, Kundi M et al (2011) Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience. Haematologica 96:231–237

    Article  PubMed  Google Scholar 

  22. Squadrone V, Massaia M, Bruno B et al (2010) Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy. Intensive Care Med 36:1666–1674

    Article  PubMed  Google Scholar 

  23. Siegel MD, Hayes E, Vanderwerker LC et al (2008) Psychiatric illness in the next of kin of patients who die in the intensive care unit. Crit Care Med 36:1722–1728

    Article  PubMed  Google Scholar 

  24. Smith TJ, Temin S, Alesi ER et al (2012) American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30:880–887

    Article  PubMed  Google Scholar 

  25. Staudinger T, Stoiser B, Müllner M et al (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328

    Article  PubMed  CAS  Google Scholar 

  26. Taccone FS, Artigas AA, Sprung CL et al (2009) Characteristics and outcomes of cancer patients in European ICUs. Crit Care 13(1):R15

    Article  PubMed  Google Scholar 

  27. Thiéry G, Azoulay E, Darmon M et al (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23:4406–4413

    Article  PubMed  Google Scholar 

  28. Wermke M, Schiemanck S, Höffken G et al (2012) Respiratory failure in patients undergoing allogeneic hematopoietic SCT: a randomized trial on early non-invasive ventilation based on standard care hematology wards. Bone Marrow Transplant 47:574–580

    Article  PubMed  CAS  Google Scholar 

  29. http://www.who.int/cancer/palliative/definition/en/. (Zugegriffen: 5. März 2013)

  30. http://www.capc.org/ipal-icu/. (Zugegriffen: 5. März 2013)

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Schellongowski, P. Der hämatologisch-onkologische Patient auf der Intensivstation. Med Klin Intensivmed Notfmed 108, 203–208 (2013). https://doi.org/10.1007/s00063-012-0177-z

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  • DOI: https://doi.org/10.1007/s00063-012-0177-z

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