Critically ill patients with cancer: A clinical perspective

Abstract

Cancer patients account for 15% of all admissions to intensive care unit (ICU) and 5% will experience a critical illness resulting in ICU admission. Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods. Since early critical care and organ support is associated with improved survival, timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying. This article focused on relevant and current information on epidemiology, diagnosis, and treatment of the main clinical disorders experienced by critically ill cancer patients.

Keywords: Acute respiratory failure; Cancer; Cardiotoxicity; Chemotherapy; Critical care; Infection; Mechanical ventilation; Neutropenia; Postoperative; Sepsis.

Figure 1

Diagnostic approach for cancer patients with suspected pulmonary infection. ARF: Acute respiratory failure; BAL: Bronchoalveolar lavage; CT: Computed tomography; HSCT: Hematopoietic stem cell transplant; MRI: Magnetic resonance image; SIRS: Systemic inflammatory response syndrome.

Figure 2

Pulmonary complications in patients with hematopoietic stem cell transplant[41]. BOS: Bronchiolitis obliterans syndrome; COP: Cryptogenic organizing pneumonia; DPTS: Delayed pulmonary toxicity syndrome; HSV: Herpes simplex virus; PERDS: Peri-engraftment respiratory distress syndrome; PTLD: Post-transplant lymphoproliferative disorder.

Figure 3

Sepsis diagnosis and treatment in neutropenic patients. ANC: Absolute neutrophil count; CISNE: Clinical Index of Stable Febrile Neutropenia score; CGS: Coma Glasgow Scale; MAP: Mean arterial pressure; MASCC: Multinational association of supportive care of cancer risk-index; SBP: Systolic blood pressure; UO: Urine output.

Figure 4

Pathogenic, diagnostic and therapeutic approach of chemotherapy-associated cardiac dysfunction[92,102,103]. ACEI: Angiotensin-converting enzyme inhibitor; ECG: Electrocardiography; DM: Diabetes mellitus; hs-cT: High-sensitive cardiac troponins; HTN: Arterial hypertension; LVMS: Left ventricular mechanical support; MRI: Magnetic resonance image; NT-ProBNP: N-terminal pro-B-type natriuretic peptide; ROS: Reactive oxygen species.