title: Clinical features and short-term outcome of critically ill patients with head and neck cancer in the medical intensive care unit.
abstract: OBJECTIVE
  To investigate the clinical features, especially cancer-related complications, and short-term outcome of critically ill patients with head and neck cancer (HNC) in the medical intensive care unit.
  
  
  METHODS
  We reviewed 57 patients with a diagnosis of HNC in the medical intensive care unit (≥ 24 hours) of a tertiary-care medical center between January 1999 and December 2005.
  
  
  RESULTS
  Thirty-two (56.1%) patients had advanced cancers (stage III/IV), and 21 (36.8%) remained uncontrolled (ie, relapsed or progressive). Twenty-five (43.9%) patients had cancer-related complications, including airway obstruction, tumor bleeding, or wound infection. Among 47 (82.4%) patients with acute respiratory failure, 25.5% of them were caused by cancer-related life-threatening airway complications. After excluding 5 already tracheostomized acute respiratory failure patients, difficult intubation was encountered in 26.2% (11/42); and 72.7% (8/11) of them required emergency tracheostomy. The 30-day mortality was 38.6%. Uncontrolled HNC (adjusted odds ratio [OR], 4.13; 95% confidence interval, 1.14-14.92) and Acute Physiology and Chronic Health Evaluation II score (adjusted OR 1.13; 95% confidence interval, 1.04-1.22) were found as the risk factors for 30-day mortality in multivariate analysis.
  
  
  CONCLUSIONS
  Although critically ill patients with HNC usually had advanced cancers and carried a high rate of cancer-related life-threatening airway complications, their 30-day mortality was favorable and only independently associated with cancer status and Acute Physiology and Chronic Health Evaluation II score.
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Hsiu-Nien
authors.initials: HN
authors.lastname: Shen
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Cheng
authors.forename: Ching-Cheng
authors.initials: CC
authors.lastname: Hou
authors.forename: Che-Kim
authors.initials: CK
authors.lastname: Tan
authors.forename: Wen-Tsung
authors.initials: WT
authors.lastname: Huang
mesh_terms: D018806:APACHE; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan