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The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation.
Crit Care Med. 2007 Mar; 35(3):808-14.CC

Abstract

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.

DESIGN

Prospective study.

SETTING

Intensive care unit.

PATIENTS

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

INTERVENTIONS

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.

MEASUREMENTS AND MAIN 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.

Authors+Show Affiliations

AP-HP, Saint Louis Hospital, Medical ICU, Paris 7 University, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17235261

Citation

Lecuyer, Lucien, et al. "The ICU Trial: a New Admission Policy for Cancer Patients Requiring Mechanical Ventilation." Critical Care Medicine, vol. 35, no. 3, 2007, pp. 808-14.
Lecuyer L, Chevret S, Thiery G, et al. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med. 2007;35(3):808-14.
Lecuyer, L., Chevret, S., Thiery, G., Darmon, M., Schlemmer, B., & Azoulay, E. (2007). The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Critical Care Medicine, 35(3), 808-14.
Lecuyer L, et al. The ICU Trial: a New Admission Policy for Cancer Patients Requiring Mechanical Ventilation. Crit Care Med. 2007;35(3):808-14. PubMed PMID: 17235261.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. AU - Lecuyer,Lucien, AU - Chevret,Sylvie, AU - Thiery,Guillaume, AU - Darmon,Michael, AU - Schlemmer,Benoît, AU - Azoulay,Elie, PY - 2007/1/20/pubmed PY - 2007/5/3/medline PY - 2007/1/20/entrez SP - 808 EP - 14 JF - Critical care medicine JO - Crit Care Med VL - 35 IS - 3 N2 - 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. DESIGN: Prospective study. SETTING: Intensive care unit. PATIENTS: One hundred eighty-eight patients requiring mechanical ventilation and having at least one other organ failure. INTERVENTIONS: 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. MEASUREMENTS AND MAIN 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. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17235261/The_ICU_trial:_a_new_admission_policy_for_cancer_patients_requiring_mechanical_ventilation_ L2 - https://dx.doi.org/10.1097/01.CCM.0000256846.27192.7A DB - PRIME DP - Unbound Medicine ER -