Supportive Care in Cancer

, Volume 3, Issue 2, pp 93–105 | Cite as

Intensive care and oncology

  • Jean-Paul Sculier
Special Article

Abstract

Intensive care is increasingly used in the management of cancer patients. The main reasons for admitting a cancer patient to an intensive-care unit are postoperative recovery, critical complications of the cancer disease and its treatment, the administration and monitoring of intensive anticancer treatment, and acute disease unrelated to cancer or its treatement. The present review is focused on the prognosis of critically ill cancer patients, on the description of the types of complications requiring intensive care, on specific aspects of the application of critical-care techniques in cancer patients, on ethical considerations and on ICU organization in the context of oncology.

Key words

Cancer Oncology Intensive care Cardiac arrest Artificial ventilation 
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Abbott RR, Setter M, Chan S, Choi K (1991) APACHE II: prediction of outcome of 451 ICU oncology admissions in a community oospital. Ann Oncol 2:571–574Google Scholar
  2. 2.
    Allen A (1992) The cardiotoxicity of chemotherapeutic drugs. Semin Oncol 9:529–542Google Scholar
  3. 3.
    Arning M, Gehrt A, Aul C, Runde V, Hadding U, Schneider W (1990) Septicemia due to Streptococcus mitis in neutropenic patients with acute leukemia. Blut 61:364–368Google Scholar
  4. 4.
    Attal M, Huguet F, Rubie H, Huynh A, Laurent G (1992) Prevention of hepatic veno-occlusive disease after bone marrow transplantation by continuous infusion of low dose heparin: a prospective randomized trial. Blood 79:2834–2840Google Scholar
  5. 5.
    Ayash LJ, Wright JE, Tretyakou O, Gonin R, Elias AC, Wheeler C, Eder JP, Rosowsky A, Antman K, Frei E III (1992) Cyclophosphamide pharmacokinetics: correlation with eardiac toxicity and tumor response. J Clin Oncol 10:995–1000Google Scholar
  6. 6.
    Baglin TP (1994) Veno-occlusive disease of the liver complicating bone marrow transplantation. Bone Marrow Transplant 13:1–4Google Scholar
  7. 7.
    Bauduer F, Delmer A, Quieffin J, Delmas-Marsalet B, Rio B, Marie JP, Zittoun R (1992) Hemorragies intra-alvéolaires aucours des traitements des leucémies aiguës. Bull Cancer 79:1071–1075Google Scholar
  8. 8.
    Bertrand M, Presant CA, Klein L, Scott E (1984) Iatrogenic superior vena cava syndrome A new entity. Cancer 54:376–378Google Scholar
  9. 9.
    Bilezikian JP (1992) Management of acute hypercalcemia. N Engl J Med 326:1196–1203Google Scholar
  10. 10.
    Bock SN, Lee RE, Fisher B, Rubin JT, Schwartzentruber DJ, Wei JP, Callender DPE, Yang JC, Lotze MT, Pizzo PA, Rosenberg SA (1990) A prospective randomized trial evaluating prophylactic antbioties to prevent triple-lumen catheterrelated sepsis in patients treated with immunotherapy. J Clin Oncol 8:161–169Google Scholar
  11. 11.
    Brunet E, Lanore JJ, Dhainaut JF, Dreyfus F, Vaxelaire JF, Nouira S, Giraud T, Armaganidis A, Monsallier JF (1990) Is intensive care justified for patients with haematological malignancies? Intensive Care Med 16:291–297Google Scholar
  12. 12.
    Buckner CD, Rudolph RH, Fefer A, Clift RA, Epstein RB, Funk DD, Neiman PE, Slichter SJ, Storb R, Thomas ED (1972) High-dose cyclophosphamide therapy for malignant disease. Toxicity, tumor response, and the effects of stored autologous marrow. Cancer 29:357–365Google Scholar
  13. 13.
    Butt W, Barker G, Walker C, Gillis J, Kilham H, Stevens M (1988) Outcome of children with hematologic malignancy who are admitted to an intensive care unit. Crit Care Med 16:761–764Google Scholar
  14. 14.
    Carde P, Cosset-Delaigne MF, Laplanche A, Chareau I (1989) Classical external indwelling central venous catheter versus totally implanted venous access systems for chemotherapy administration: a randomized trial in 100 patients with solid tumors. Eur J Cancer Clin Oncol 25:939–944Google Scholar
  15. 15.
    Carreras E, granena A, Rozman C (1993) Hepatic veno-occlusive disease after bone marrow transplant. Blood Rev 7:43–51Google Scholar
  16. 16.
    Chalfin DB, Carlon GC (1990) Age and utilization of intensive care unit resources of critically ill, cancer patients. Crit Care Mec 18:694–698Google Scholar
  17. 17.
    Chao NJ, Duncan SR, Long GD, Horning SJ, Blume KG (1991) Corticosteroid therapy for diffuse alveolar hemorrhage in autologous bone marrow transplant recipients. Ann Intern Med 114:145–146Google Scholar
  18. 18.
    Charasse C, Camus C, Darnault P, Guillé F, Tulzo Y le, Zimbacca F Thomas R (1991) Acute nondilated anuric obstructive nephropathy on echography: difficult diagnosis in the intensive care unit. Intensive Care Med 17:387–391Google Scholar
  19. 19.
    Chevrolet JC, Jolliet P (1991) An ethical look at intensive care for patients with malignancies. Eur J Cancer 27:210–212Google Scholar
  20. 20.
    Cox SC, Norwood SH, Duncan CA (1985) Acute respiratory failure: mortality associated with underlying disease. Crit Care Med 13:1005–1008Google Scholar
  21. 21.
    Crawford SW, Hickman RO, Ulz L, O'Quin T, Wong R, McDonald GB (1994) Use of the Hickman-Crawford critical care catheter in marrow transplant recipients: a pulmonary artery catheter-adaptable central venous access. Crit Care Med 22:347–352Google Scholar
  22. 22.
    Crawford SW, Petersen FB (1992) Long-term survival from respiratory failure after marrow transplantation for malignancy. Am Rev Respir Dis 145:510–514Google Scholar
  23. 23.
    Davis S, Rambotti P, Grignani F (1984) Intrapericardial tetracycline sclerosis in the treatment of malignant pericardial effusion: an analysis of thirty-three cases. J Clin Oncol 2:631–636Google Scholar
  24. 24.
    De Forni M, Malet-Martino MC, Jaillais P, Shubinski RE, Bachaud JM, Lemaire L, Canal P, Chevreau C, Carrié D, Soulié P, Roché H, Boudjema B, Mihura J, Martino R, Bernadet P, Bugat R (1992) Cardiotoxicity of high-dose continuous fluorouracil: a prospective clinical study. J Clin Oncol 10:1795–1801Google Scholar
  25. 25.
    Dedhia HV, Le Roy N, Jain PR, thompson AB, Withers A (1985) Endoscopic laser therapy for respiratory distress due to obstructive airway tumors. Crit Care Med 13:464–467Google Scholar
  26. 26.
    Denardo SJ, Oye RK, Bellamy PE (1989) Efficacy of intensive care for bone marrow transplant patients with respiratory failure. Crit Care Med 17:4–6Google Scholar
  27. 27.
    Dickinson MC (1990) Education for staff who care for cancer patients in the critical care unit. J Nurs Staff Dev 6:202–203Google Scholar
  28. 28.
    Dombret H, Hunault M, Faucher C, Dombret MC, Degos L (1992) Acute lysis pneumopathy after chemotherapy for acute myelomonocytic leukemia with abnormal marrow eosinophils. Cancer 69:1356–1361Google Scholar
  29. 29.
    Dutcher JP, Wiernik PH (1987) Handbook of hematologic and oncologic emergencies. Plenum Press, New YorkGoogle Scholar
  30. 30.
    Ebie N, Ryan W, Harris J (1986) Metabolic emergencies in cancer medicine.Med Clin North Am 70:1151–1166Google Scholar
  31. 31.
    Estopa R, Marti AT, Kastanos N, Rives A, Agusti- Vidal A, Rozman C (1984) Acute respiratory failure in severe hematologic disorders. Crit Care Med 12:26–28Google Scholar
  32. 32.
    Ewer MS, Ali MK, Atta MS, Morice RC, Balakrishnan PV (1986) Outcome of lung cancer patients requiring mechanical ventilation for pulmonary failure. JAMAGoogle Scholar
  33. 33.
    Faber-Langendoen K (1991) Resuscitation of patients with metastatic cancer. Is trnsient benefit still futile? Arch Intern Med 151:235–239Google Scholar
  34. 34.
    Filshie J, Robbie DS (1989) Anaesthesia and malignant disease. Arnold. LondonGoogle Scholar
  35. 35.
    Frankel SR, Eardley A, Lauwers G, Weiss M, Warrell RP Jr (1992) The “retinoic acid syndrome” in acute promyelocytic leukemia. Ann Intern Med 117:292–296Google Scholar
  36. 36.
    Fulkerson WJ, McLendon RE, Prosnitz LR (1986) Adult respiratory distress syndrome after limited thoracic radiotherapy, Cancer 57:1941–1946Google Scholar
  37. 37.
    Gerain J, Sculier JP, Malengreaux A, Rykaert C, Thémelin L (1990) Causes of deaths in an oncologic intensive care unit: a clinical and pathological study of 34 patients. Eur J Cancer 26:377–381Google Scholar
  38. 38.
    Goldberg MA, Antin JH, Guinan EC, Rappeport JM (1986) Cyclophosphamide cardiotoxicity: an analysis of dosing as a risk factor Blood 68:1114–1118Google Scholar
  39. 39.
    Gradishar WJ, Vokes EE (1990) 5-Fluorouracil cardiotoxicity: a critical review. Ann Oncol 1:409–414Google Scholar
  40. 40.
    Gregg RW, Friedman BC, Williams JF, Mc Grath BJ, Zimmerman JE (1990) Continuous positive airway pressure by face mask in Pneumocysus carihil Pneuumonia. Crit Care Med 18:21–24Google Scholar
  41. 41.
    Groeger JS (1991) Critical care of the cancer patient, 2nd edn. Mosby Year Book, St Louis, MoGoogle Scholar
  42. 42.
    Gucalp R, Ritch P, Wiernik PH, Sarma PR, Keller A, Richman SP, Tauer K, Neidhart J, Mallette LE, Siegel R, Vandepol CJ (1992) Comparative study of pamidronate disodium and etidronate disodium in the treatment of cancer-related hypercalcemia. J Clin Oncol 10:134–142Google Scholar
  43. 43.
    Gyves JW, Ensminger WD, Niederhuber JE Dent T, Walker S, Gilbertson S, Cozzi F, Saran P (1989) A totally implanted injection port system for blood sampling and chemotherapy administration. JAMA 251:2538–2541Google Scholar
  44. 44.
    Haines IE, Zalcberg J, Buchanan JD (1990) Not for resuscitation orders in cancer patients—principles of decision-making. Med J Aust 153:225–229Google Scholar
  45. 45.
    Haire WD, Liebermans RP, Lund GB, Edney J, Wieczorek BM (1990) Obstracuted central venous catheters. Restoring function with a 12-hour infusion of low-dose urokinase. Cancer 66:2279–2285Google Scholar
  46. 46.
    Harris KPG, Hattersley JM, Feehally F, Walls J (1991) Acute renal failure associated with haematological ure associated with haematological malignancies: a review of 10 years experience. Eur J Haematol 47:119–122Google Scholar
  47. 47.
    Haupt HM, Hutchins GM, Moore GW (1981) Ara-C lung: noncardiogenic pulmonary edema complicating cytosine arabinoside therapy of leukemia. Am J Med 70256–261Google Scholar
  48. 48.
    Hauser M, Tabak J, Baier H (1982) Survival of patients with cancer in a medical critical care unit. Arch Intern Med 142:527–529Google Scholar
  49. 49.
    Headley J, Theriault R, Smith TL (1992) Independent validation of APACHE II severity of illness score for predicting mortality in patients with breast cancer admitted to the intensive care unit. Cancer 70:497–503Google Scholar
  50. 50.
    Hewlett RI, Wilson AF (1977) Adult respiratory distress syndrome (ARDS) following aggressive management of extensive acute lymphoblastic leukemia. Cancer 39:2422–2425Google Scholar
  51. 51.
    Howland WS, Rooney SM, Goldiner PL (1986) Manual of anesthesia in cancer patients. Churchill Livingstone, New YorkGoogle Scholar
  52. 52.
    Johnson MH, Gordon PW, Fitzgerald FT (1986) Stratification of prognosis in granulocytopenic patients with hematologic malignancies using the APACHE-II severity of illness score. Crit Care Med 4:693–697Google Scholar
  53. 53.
    Kragel AH, Travis WD, Steis RG, Rosenberg SA, Roberts WC (1990) Myocarditis or acute myocardial infarction associated with interleukin-2 therapy for cancer. Cancer 66:1513–1516Google Scholar
  54. 54.
    Laufe MD, Simon RH, Flint A, Keller JB (1986) Adult respiratory distress syndrome in neutropenic patients. Am J Med 80:1022–1026Google Scholar
  55. 55.
    Lawrence VA, Clark GM (1987) Cancer and resuscitation. Does the diagnosis affect the decision? Arch Intern Med 147:1637–1640Google Scholar
  56. 56.
    Leclercq B, Sculier JP (1993) Réanimation en cancérologie. Masson, ParisGoogle Scholar
  57. 57.
    Lesesne JB, Rothschild N, Erickson B, Korec S, Sisk R, Keller J, Arbus M, Wooley PV, Chiazze L, schein PS, Neefe JR (1989) Cancer-associated hemolytic-uremic syndrome: analysis of 85 cases from a national registry. J Clin Oncol 7:781–789Google Scholar
  58. 58.
    Lloyd-Thomas AR, Dhaliwal HS, Lister TA, Hinds CJ (1986) Intensive therapy for life-threatening medical complications of haematological malignancy. Intensive Care Med 12:317–324Google Scholar
  59. 59.
    Markiewicz E (1994) Organisation d'une unité de soins intensifs et proble; mes de nursing dans un centre anticancéreux. In. Formation Supérieure en Soins Infirmiers. Arnette, Paris, pp 129–132Google Scholar
  60. 60.
    Marsa-Vila L, Gorin NC, Laporte JP, Labopin M, Dupuy-Montbrun MC, Fouillard L, Isnard F, Najman A (1991) Prophylactic heparin does not prevent liver veno-occlusive disease foloowing autologous bone marrow transplantation. Eur J Haematol 47:346–354Google Scholar
  61. 61.
    Masson BG, Krikorian J, Luki P, Evans GL, McGrath J (1989) Pulmonary microvascular cytology in the diagnosis of lymphangitic carcinomatosis. N Engl J Med 321:71–76Google Scholar
  62. 62.
    McDonald GB, Hinds MS, Fisher LD, Schoch HG, Wolford JL, Banaji M, Hardin BJ, Shulman HM, Clift RA (1993) Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients. Ann Intern Med 118:255–267Google Scholar
  63. 63.
    McGowan MP, Pratter MR, Nash G (1990) Primary testicular choriocarcinoma with pulmonary metastases presenting as ARDS. Chest 97:1258–1259Google Scholar
  64. 64.
    Miranda DR, Williams A, Loirat P (1990) Management of intensive care. Guidelines for better use of resources. Kluwer, DordrechtGoogle Scholar
  65. 65.
    O'Brien MER, Souberbielle BE (1992) Allergic reactions to cytotoxic drugs— an update. Ann Oncol 3:605–610Google Scholar
  66. 66.
    Ognibene FP, Martin, SE, Parker MM, Schlesinger T, Roach P, Burch C, Shelhamer JH, Parrillo JE (1986) Adult respiratory distress syndrome in patients with severe neutropenia. N Engl J Med 315:547–551Google Scholar
  67. 67.
    Peters SG, Meadows JA III, Graley DR (1988) Outcome of respiratory failure in hematologic malignancy. Chest 94:99–102Google Scholar
  68. 68.
    Pizzo PA (1993) Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 328:1323–1332Google Scholar
  69. 69.
    Quezado ZMN, Wilson WH, Cunnion RE, Parker MM, Reda D, Bryant G, Ognibene FP (1993) High-dose ifosfamide is associated with severe, reversible cardiac dysfunction. Ann Intern Med 118:31–36Google Scholar
  70. 70.
    Ralston SH, Gallacher SJ, Patel V, Campbell J, Boyle IT (1990) Cancer-asociated hypercalcemia: morbidity and mortality. Ann Intrn Med 112:499–504Google Scholar
  71. 71.
    Ravid M, Shapira J, Lang R, David R (1979) Acute respiratory distress syndrome: a presenting syndrome of malignant lymphoma. JAMA 241:2191–2192Google Scholar
  72. 72.
    Robbins RA, Linder J, Stahl MG, Thompson AB III, Haire W, Kessinger A, Armitage JO, Arneson M, Woods G, Vaughan WP, Rennard SI (1989) Diffuse alveolar hemorrhage in autologous bone marrow transplantation recipients. Am J Med 87:511–518Google Scholar
  73. 73.
    Schlemmer B (1990) Aplasie médullaire et ventilation artificielle. Rev Praticien 23:2152–2153Google Scholar
  74. 74.
    Schlemmer R, Dhainaut JF, Bons J, Mathiot C, Varet B, Sylvestre R, Monsallier JF (1982) Pneumopathies aiguës au cours des hémopathies malignes en aplasie: nouvelle approche nosologique et thérapeutique. Ann Méd Interne 133:174–177Google Scholar
  75. 75.
    Schuster DP, Marion JM (1983) Precedents formeaningful recovery during treatment in a medical intensive care unit. Outcome in patients with hematologic malignancy. Am J Med 75:402–408Google Scholar
  76. 76.
    Sculier JP, Bron D, Verboven N, Klastersky J (1988) Multiple organ failure during interleukin-2 administration and LAK cells infusion. Intensive Care Med 14:666–667Google Scholar
  77. 77.
    Sculier JP, Feld R (1985) Superior vena cava obstruction syndrome: recommendations for management. Cancer Treat Rev 12:209–218Google Scholar
  78. 78.
    Sculier JP, Markiewicz E (1993) Cardiopulmonary resuscitation in medical cancer patients: the experience of a medical intensive care unit of a cancer centre. Support Care Cancer 1:135–138Google Scholar
  79. 79.
    Sculier JP, Markiewicz E (1991) Medical cancer patients and intensive care. Anticancer Res 11:2171–2174Google Scholar
  80. 80.
    Sculier JP, Nicaise C, Klastersky J (1983) Lactic acidosis: a metabolic complication of extensive metstatic cancer. Eur J Cancer Clin Oncol 19:597–601Google Scholar
  81. 81.
    Sculier JP, Ries F, Verboven N, Coune A, Klastersky J (1988) Role of intensive care unit in a medical oncology department. Eur J Cancer Clin Oncol 24:513–517Google Scholar
  82. 82.
    Sculier JP, Trillet V, Paesmans M, Markiewicz E, Lebeau B, Dabouis G, Kleisbauer JP (1992) Table ronde sur la méthodologie des essais cliniques. Rev Mal Respir 9:223–226Google Scholar
  83. 83.
    Sculier JP, Weerts D, Klastersky J (1984) Cause of death in febrile granulocytopenic cancer patients receiving empiric antibiotic therapy. Eur J Cancer Clin Oncol 20:55–60Google Scholar
  84. 84.
    Shulman HM, Hinterberger W (1992) Hepatic veno-occlusive disease-liver toxicity syndrome after bone marrow transplantation. Bone Marrow Transplant 10:197–214Google Scholar
  85. 85.
    Sivan Y, Schwartz PH, Schonfeld T, Cohen IJ, Newth CJL (1991) Outcome of oncology patients in the pediatric intensive care unit. Intensive Care Med 17:11–15Google Scholar
  86. 86.
    Snow RM, Miller WC, Rice DL, Ali MK (1979) Respiratory failure in cancer patients. JAMA 241:2039–2042Google Scholar
  87. 87.
    Soares FA, Landell GAM, Miranda Cardoso MA de (1992) Pulmonary leukostatis without hyperleukocytosis: a clinicopathologic study of 16 cases. Am J Hematol 40:28–32Google Scholar
  88. 88.
    Spain RC, Whittlesey D (1989) Respiratory emergencies in patients with cancer. Semin Oncol 16:471–489Google Scholar
  89. 89.
    The American Society of Clinical Oncology and American Society of Hematology (1990) Recommended criteria for the performance of bone marrow transplantation. J Clin Oncol 8:563–564Google Scholar
  90. 90.
    Tobias JD (1991) Tumour lysis pneumopathy. Clin Intensive Care 2:305–308Google Scholar
  91. 91.
    Todd K, Wiley F, Landaw E, Gajewski J, Bellamy PE, Harrison RE, Brill JE, Feig SA (1994) survival outcome among 54 intubated pediatric bone marrow transplant patients. Crit Care Med 22:171–176Google Scholar
  92. 92.
    Torrecilla C, Cortès JL, Chamorro C, Rubio JJ, Galdos P, Dominguez De Villota E (1988) Prognostic assessment of the acute complications of bone marrow transplantation requiring intensive therapy. Intensive Care Med 14:393–398Google Scholar
  93. 93.
    Turnbell A, Goldiner P, Silverman D, Howland W (1976) The role of an intensive care unit in a cancer canter. Cancer 37:82–84Google Scholar
  94. 94.
    Turnbull AD, Carlon G (1979) Airway management in the thrombocytopenic cancer patient with acute respiratory failure. Crit Care Med 7:76–77Google Scholar
  95. 95.
    Vernant JP, Brun B, Mannoni P, Dreyfus B (1979) Respiratory distress of hyperleukocytic granulocytic leukemias. Cancer 44:264–268Google Scholar
  96. 96.
    Vitelli CE, Cooper K, Rogatko A, Brennan MF (1991) Cardiopulmonary resuscitation and the patient with cancer. J Clin Oncol 9:111–115Google Scholar
  97. 97.
    Wachter RM, Luce JM, Hearst N, Lo B (1989) Decisions about resuscitation: inequities among patients with different diseases but similar prognoses. Ann Intern Med 111:525–532Google Scholar
  98. 98.
    Wade DS, Douglass H Jr, Nava HR, Piedmonte M (1990) Abdominal pain in neutropenic patients. Arch Surg 125:1119–1127Google Scholar
  99. 99.
    Wade DS, Nava HR, Douglass HO Jr (1992) Neutropenic enterocolitis. Clinical diagnosis and management. Cancer 69:17–23Google Scholar
  100. 100.
    Walsh TJ (1988) The febrile neutropenic patient in the intensive care unit. Crit Care Clin 4:259–280Google Scholar
  101. 101.
    Weiss RB (1992) Hypersensitivity reactions. Semin Oncol 19:458–477Google Scholar
  102. 102.
    Wojno KJ, Vogelsang GB, Beschorner WE, Santos GW (1994) Pulmonary hemorrhage as a cause of death in allogeneic bone marrow recipients with severe acute graft-versus-host disease. Transplantation 57:88–92Google Scholar
  103. 103.
    Yamauchi K, Omata T (1992) Leukemic pneumonitis as a poor prognostic factor in chronic myelomonocytic leukemia. Respiration 59:119–121Google Scholar
  104. 104.
    Yau E, Rohatiner AZS, Lister TA, Hinds CJ (1991) Long term prognosis and quality of life following intensive care for life-threatening complications of haematological malignancy. Br J Cancer 64:938–942Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • Jean-Paul Sculier
    • 1
  1. 1.Unité d'Administration et de Surveillance de Traitements Intensifs (ASTI), Service de Médecine et Laboratoire d'Investigation Clinique H.J. Tagnon, Institut Jules BordetCentre des Tumeurs de l'Université Libre de BruxellesBrusselsBelgium

Personalised recommendations