Intensive care unit management of patients with newly diagnosed acute myeloid leukemia with no organ failure.
Patients with acute myeloid leukemia (AML) may present with early complications from sepsis or leukemic infiltration. Benefits from early in-intensive care unit (ICU) hematological management was evaluated in 42 adults with newly diagnosed AML with hematological risk of early death (age 46 years, French-American-British [FAB] M4/5 58%, leukocytes 103 × 10(9)/L) first admitted to the ICU without immediate life support (early-ICU). Controls were 42 patients primarily admitted to hematology wards, matched for age, leukocytes and FAB subtype. Twenty (47.6%) control patients were subsequently admitted to the ICU (late-ICU). Late-ICU patients presented with increased respiratory and cardiac rates, decreased oxygen saturation (SpO(2)) and blood pressure, at hospital admission. Late-ICU admission resulted in increased use of mechanical ventilation (60% vs. 33%) and vasopressors (60% vs. 16%), longer ICU stay (9 [6-25] vs. 5 [2-9] days) and decreased ICU survival (65% vs. 79%). Direct admission to the ICU of patients with high-risk AML with physiological disturbances but no organ dysfunction is associated with improved outcomes.
Medical ICU, Hôpital Saint-Louis, AP-HP and UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France.
Etienne
E
Lengliné
Emmanuel
E
Raffoux
Virginie
V
Lemiale
Michael
M
Darmon
Emmanuel
E
Canet
Nicolas
N
Boissel
Benoît
B
Schlemmer
Hervé
H
Dombret
Elie
E
Azoulay
D000328:Adult; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D007948:Leukemia, Monocytic, Acute / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015479:Leukemia, Myelomonocytic, Acute / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D016896:Treatment Outcome