Short- and long-term outcomes of critically ill patients with cancer and prolonged ICU length of stay.
BACKGROUND
Data on patients with cancer who have a prolonged length of stay (LOS) in the ICU are scarce. The aim of the present study was to evaluate the characteristics and the outcomes of cancer patients with life-threatening complications with an ICU stay > or = 21 days.


METHODS
A cohort study performed at a 10-bed oncology medical-surgical ICU from May 2000 to December 2005. Prolonged ICU LOS was defined as an ICU stay > or = 21 days.


RESULTS
During the period, 1,090 patients were admitted to the ICU and 163 patients (15%) had a prolonged ICU LOS. These patients, however, accounted for 48% (5,828/12,224) of the total ICU bed-days. The hospital and 6-month mortality rates were 50% and 60%, respectively, and similar to patients with ICU LOS < 21 days (51% and 61%, respectively). ICU-acquired events and complications were common, and the most frequent were infections (90%), mechanical ventilation (99%), and need for vasopressors (88%). The number of organ failures, older age, and poor performance status were the main outcome predictors. The median long-term follow-up after hospital discharge was 537 days (range, 193 to 1,119 days), and 29 patients (18%) were alive.


CONCLUSIONS
Fifteen percent of critically ill patients with cancer had a prolonged ICU LOS. Short- and long-term survival rates were reasonable, and the prognosis was better than expected a priori. In our opinion, the length of ICU admission per se should not be used in the clinical decisions regarding the continuation of treatment in these patients.
Soares
Márcio
M
Intensive Care Unit, Instituto Nacional de Câncer, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: marciosoaresms@yahoo.com.br.
Salluh
Jorge I F
JIF
Intensive Care Unit, Instituto Nacional de Câncer, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Torres
Viviane B L
VBL
Intensive Care Unit, Instituto Nacional de Câncer, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Leal
Juliana V R
JVR
Intensive Care Unit, Instituto Nacional de Câncer, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Spector
Nelson
N
Intensive Care Unit, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
D000328:Adult; D000368:Aged; D001938:Brazil; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors