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


METHODS
Retrospective observational study of prospectively collected data.


METHODS
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).


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.
Benoit
Dominique D
DD
Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. dominique.benoit@Ugent.be
Depuydt
Pieter O
PO
Vandewoude
Koenraad H
KH
Offner
Fritz C
FC
Boterberg
Tom
T
De Cock
Carole A
CA
Noens
Lucien A
LA
Janssens
Ann M
AM
Decruyenaere
Johan M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy*; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents