The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation.
OBJECTIVE
Cancer patients requiring mechanical ventilation are widely viewed as poor candidates for intensive care unit (ICU) admission. We designed a prospective study evaluating a new admission policy titled The ICU Trial.


METHODS
Prospective study.


METHODS
Intensive care unit.


METHODS
One hundred eighty-eight patients requiring mechanical ventilation and having at least one other organ failure.


METHODS
Over a 3-yr period, all patients with hematologic malignancies or solid tumors proposed for ICU admission underwent a triage procedure. Bedridden patients and patients in whom palliative care was the only cancer treatment option were not admitted to the ICU. Patients at earliest phase of the malignancy (diagnosis < 30 days) were admitted without any restriction. All other patients were prospectively included in The ICU Trial, consisting of a full-code ICU admission followed by reappraisal of the level of care on day 5.


RESULTS
Among the 188 patients, 103 survived the first 4 ICU days and 85 died from the acute illness. Hospital survival was 21.8% overall. Among the 103 survivors on day 5, none of the characteristics of the malignancy were significantly different between the 62 patients who died and the 41 who survived. Time course of organ dysfunction over the first 6 ICU days differed significantly between survivors and nonsurvivors. Organ failure scores were more accurate on day 6 than at admission or on day 3 for predicting survival. All patients who required initiation of mechanical ventilation, vasopressors, or dialysis after 3 days in the ICU died.


CONCLUSIONS
Survival was 40% in mechanically ventilated cancer patients who survived to day 5 and 21.8% overall. If these results are confirmed in future interventional studies, we recommend ICU admission with full-code management followed by reappraisal on day 6 in all nonbedridden cancer patients for whom lifespan-extending cancer treatment is available.
Lecuyer
Lucien
L
AP-HP, Saint Louis Hospital, Medical ICU, Paris 7 University, Paris, France.
Chevret
Sylvie
S
Thiery
Guillaume
G
Darmon
Michael
M
Schlemmer
Benoît
B
Azoulay
Elie
E
D000328:Adult; D000368:Aged; D005260:Female; D005602:France; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D016134:Organizational Policy; D010166:Palliative Care; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D016019:Survival Analysis; D014218:Triage; D028761:Withholding Treatment