Intensivmedizin und Notfallmedizin

, Volume 42, Issue 5, pp 440–448 | Cite as

Intensivmedizinische Behandlung von Patienten mit einer malignen Tumorerkrankung: Analyse von prognostischen Faktoren

  • P. Schütt
  • T. Konorza
  • P. Ebeling
  • P. Lütkes
  • M. Flasshove
  • T. Moritz
  • M. R. Nowrousian
  • S. Seeber
  • M. Haude
  • R. Erbel
ORIGINALARBEIT

Zusammenfassung

Hintergrund

Eine Heilung von Tumorpatienten ist häufig nur mit risikoreichen Therapiestrategien möglich. Hierbei können lebensbedrohliche Nebenwirkungen auftreten, die eine intensivmedizinische Behandlung erforderlich machen. Das Ziel dieser Arbeit war es, die Prognose von Patienten mit einer malignen Tumorerkrankung, die intensivmedizinisch behandelt werden mussten, zu bestimmen und prognostische Faktoren zu ermitteln.

Methode

Retrospektiv wurden die Krankenakten von 94 Patienten mit einer malignen Tumorerkrankung ausgewertet, die in einem Zeitraum von 5 Jahren intensivmedizinisch behandelt werden mussten.

Ergebnisse

Von 94 Tumorpatienten hatten 64 eine hämatologische und 30 eine solide Tumorerkrankung. 92 Patien- ten (98%) waren chemotherapeutisch vorbehandelt. Die Gründe für die intensivmedizinische Behandlung waren respiratorische Insuffizienz (49%), Sepsis (21%), Blutungen (7.4%) und kardiale Dekompensation (6,4%). Eine Intubation mit maschineller Beatmung war bei 68% der Patienten erforderlich und 66% der Patienten benötigten kreislaufunterstützende Medikamente (Noradrenalin, Dopamin). Die Letalität während des intensivmedizinischen Aufenthaltes und während des gesamten Krankenhausaufenthaltes betrug 55 bzw. 67%. In der multivariaten Regressionsanalyse waren respiratorisches Versagen mit der Notwendigkeit der maschinellen Beatmung, eine erhöhte Konzentration der Laktatdehydrogenase im Serum und multiples Organversagen gemessen mit dem SOFA-Score unabhängige ungünstige prognostische Faktoren für die Letalität auf der Intensivstation. Respiratorisches Versagen mit der Notwendigkeit der maschinellen Beatmung, multiples Organversagen gemessen mit dem SOFA-Score und der Remissionsstatus der zugrunde liegenden Tumorerkrankung waren prognostisch signifikant für das Gesamtüberleben.

Schlussfolgerung

Respiratorisches Versagen und multiples Organversagen sind die bedeutsamsten unabhängigen prognostischen Faktoren für die Letalität während des Aufenthaltes auf der Intensivstation, während der Remissionsstatus der zugrunde liegenden Tumorerkrankung die Langzeitprognose beeinflusst.

Schlüsselwörter

Tumor Intensivmedizin maschinelle Beatmung SOFA LODS 

Intensive care medicine for cancer patients: analysis of prognostic factors

Summary

Dose escalation of chemotherapy has been shown to improve the prognosis of various malignancies; however, these therapies are associated with considerable morbidity requiring the use of intensive care medicine in some of these patients. The objective of this study was to assess the prognosis of cancer patients treated in an intensive care unit (ICU) and to identify clinical parameters which are predictive for their outcome. We performed a retrospective analysis of charts from 94 cancer patients admitted to an ICU over a five-year period. From these 94 cancer patients, 64 patients had a hematological malignancy, while 30 patients had a solid tumor. Ninety-two patients (98%) had already been treated with chemotherapy. The main reasons for ICU transferal were respiratory failure (49%), sepsis (21%), bleeding complications (7.4%), and cardiac decompensation (6.4). Mechanical ventilation and vasopressor therapy (noradrenaline, dopamine) were required in 68% and 66% of patients, respectively. The ICU and the in-hospital mortality rate was 55% and 67%, respectively. In multivariate regression analysis, respiratory failure requiring mechanical ventilation, serum level of lactate dehydrogenase, and multiple organ dysfunction assessed by the SOFA score were predictive for intensive care mortality, whereas respiratory failure requiring mechanical ventilation, multiple organ dysfunction assessed by the SOFA score, and the remission status of the underlying malignancy were predictive for overall survival. In conclusion, the main risk factors for death in an ICU are respiratory failure and multiple organ dysfunction, while the prognosis of the underlying malignancy becomes relevant for the long-term survival.

Key words

Cancer intensive care mechanical ventilation SOFA LODS 

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Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • P. Schütt
    • 1
  • T. Konorza
    • 2
  • P. Ebeling
    • 1
  • P. Lütkes
    • 3
  • M. Flasshove
    • 1
  • T. Moritz
    • 1
  • M. R. Nowrousian
    • 1
  • S. Seeber
    • 1
  • M. Haude
    • 2
  • R. Erbel
    • 2
  1. 1.Mohammad Resa Nowrousian, Siegfried Seeber, Innere Klinik und Poliklinik (Tumorforschung)Universitätsklinikum EssenEssen
  2. 2.Klinik für KardiologieUniversitätsklinikum EssenEssen
  3. 3.Stabsstelle für Medizinisches Controlling und QualitätsmanagementEssen

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