title: Managing critically Ill hematology patients: Time to think differently.
abstract: The number of patients living with hematological malignancies (HMs) has increased steadily over time. This is the result of intensive and effective treatments that also increase the probability of infiltrative, infectious or toxic life threatening event. Over the last two decades, the number of patients with HMs admitted to the ICU increased and their mortality has dropped sharply. ICU patients with HMs require an extensive diagnostic workup and the optimal use of ICU treatments to identify the reason for ICU admission and the nature of the complication that explains organ dysfunctions. Mortality of ARDS or septic shock is up to 50%, respectively. In this review, the authors share their experience with managing critically ill patients with HMs. They discuss the main aspects of the diagnostic and therapeutic management of critically ill patients with HMs and argue that outcomes have improved over time and that many classic determinants of mortality have become irrelevant.
authors.affiliation: AP-HP Saint Louis, Paris, France. Electronic address: elie.azoulay@sls.aphp.fr.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: AP-HP Cochin, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
authors.affiliation: CHU Saint Etienne, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: AP-HP Saint Louis, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Lengliné
authors.affiliation: Universitair ziekenhuis Gent, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Benoit
authors.affiliation: Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Marcio
authors.initials: M
authors.lastname: Soares
authors.affiliation: Monfermeil Hospital, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Vincent
authors.affiliation: Andre Mignot Hospital, Versailles, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.affiliation: CHU Nancy, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Perez
authors.affiliation: AP-HP Saint Louis, Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.affiliation: Paoli Calmette Institute, Marseilles, France.
authors.forename: Djamel
authors.initials: D
authors.lastname: Mokart
mesh_terms: D000465:Algorithms; D016026:Bone Marrow Transplantation; D016638:Critical Illness; D019468:Disease Management; D019337:Hematologic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D011379:Prognosis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Acute respiratory failure; Bone marrow transplantation; Leukemia; Mechanical ventilation; Outcomes