Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit.

Abstract

OBJECTIVE:

To assess the outcome in severely ill patients with hematological malignancies who receive intravenous chemotherapy in an intensive care unit (ICU) for a life-threatening malignancy-related complication.

DESIGN:

Retrospective observational study of prospectively collected data.

PATIENTS:

All 37 critically ill patients with hematological malignancies who received intravenous chemotherapy in the ICU between January 1997 and March 2005 (mean age 46+/-19 years; mean APACHE II 23+/-7).

MEASUREMENTS AND RESULTS:

Thirty-seven (69%) patients received chemotherapy because of extensive disease with organ involvement (54%), extensive disease without organ involvement (19%), severe disseminated intravascular coagulation (11%), and other reasons (16%). In 41% there was concomitant infection when chemotherapy was initiated, in 86% a high-grade malignancy, and 30% relapsing disease. Twenty-three (62%) patients received mechanical ventilation at the moment of or soon after initiation of chemotherapy for a median duration of 5 days (1-67), and 24% underwent renal replacement therapy during ICU stay. Only ventilation was associated with in-hospital mortality (odds ratio 9.3). ICU, in-hospital, and 6-month mortality rates in nonventilated vs. ventilated patients were 7% and 48%, 14% and 61%, and 54% and 74%, respectively.

CONCLUSIONS:

Starting chemotherapy in the ICU for a life-threatening malignancy related complication can be lifesaving even when infection or organ failure is present.

• Authors: Dominique D Benoit, Pieter O Depuydt, Koenraad H Vandewoude, Fritz C Offner, Tom Boterberg, Carole A De Cock, Lucien A Noens, Ann M Janssens, Johan M Decruyenaere
• Journal: Intensive care medicine (Intensive Care Med) Vol. 32 Issue 1 Pg. 93-9 (Jan 2006) ISSN: 0342-4642 [Print] United States
• PMID: 16308681 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents

Topics

• Adolescent
• Adult
• Aged
• Algorithms
• Antineoplastic Agents (administration & dosage)
• Critical Care
• Critical Illness
• Female
• Hematologic Neoplasms (complications, drug therapy)
• Hospital Mortality
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Patient Selection
• Retrospective Studies
• Survival Analysis
• Treatment Outcome