| Pacientes con diagnostico reciente de cáncer el pronostico lo determina la naturaleza y el numero de órganos afectados. Fallo hepático, necesidad de drogas vasoactivas y de ventilación mecánica (VM) son variables independientes que predicen incremento de mortalidad a los 30 y 180 días ( supervivencia 60 y 49 % respectivamente) | |
| La mortalidad del paciente sometido a quimioterapia y que precisan de UCI es del 50% | |
| El Fracaso respiratorio es la causa mas común de necesidad de UCI | |
| La VM es determinante en el pronostico: mortalidad 50 % y del 75% si se acompaña de severa injuria pulmonar. (Cálculos ALI y LIS) | |
| Hipoxemia < 55 mmHg AA y/o pO2/fiO2 < 150 previos a VM presagian una alta mortalidad (menor si se trata de neumonía o de sepsis) | |
| VMNI debe de intentarse como alterantiva a la VM ( además de tto paliativo para la disnea) | |
| En cancer de pulmón inoperable mortalidad del 91% en VM y 100% si la precisan mas de 6 días. | |
| VM > de 14 dias en oncológicos de cualquier etiología mortalidad 99.9 %. | |
| Fracaso Multiorgánico: | |
| Mas de 4 órganos mortalidad 100% | |
| Trasplante de medula ósea (TMO) | |
| Mortalidad 20% | |
| Si precisan VM más de 24 horas solo sobreviven el 6% a los 30 dias postextubación. | |
| Mortalidad 100% si VM fio2 ≥0'6 , PEEP≥5 y una de las siguientes: Br > 4 mg/dl + creatinina >2 mg/dl o necesidad de vasopresores mas de 4 horas. | |
| El Apache II no es un buen indicador pronostico para ptes oncológicos, si el APACHE III del primer dia . | |
| Recomendaciones: | |
| El ingreso en UCI pude estar indicado en pacientes oncológicos sometidos a quimioterapia o TMO. Sin embargo, si requieren VM > de 24 horas probablemente mueran en el hospital ( 94%). | |
| Reevaluar diariamente si se desarrolla DMO. | |
| Adoptar medidas paliativas si no se recuperan en los primeros días. | |
Darmon, M, Thiery, G, Ciroldi, M, et al. Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 2005; 33:2488.
Staudinger, T, Stoiser, B, Mullner, M, et al. Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 2000; 28:1322.Afessa, B, Tefferi, A, Hoagland, H, et al. Outcome of recipients of bone marrow transplants who require intensive care unit support. Mayo Clin Proc 1992; 67:117.
Faber-Langendoen, K, Caplan, A, McGlave, P. Survival of adult bone marrow transplant patients receiving mechanical ventilation: A case for restricted use. Bone Marrow Transplant 1993; 12:501.Paz, H, Crilley, P, Weinar, M, Brodsky, I. Outcome of patients requiring medical ICU admission following bone marrow transplantation. Chest 1993; 104:527.
Lloyd-Thomas, A, Wright, I, Lister, T, Hinds, C. Prognosis of patients receiving intensive care for life-threatening complications of hematologic malignancy. Br Med J 1988; 296:1025.Schuster, D, Marion, J. Precedents for meaningful recovery during treatment in a medical intensive care unit: Outcome of patients with hematologic malignancy. Am J Med 1983; 75:402.
Todd, K. Survival outcome among 54 intubated pediatric bone marrow transplant patients. Crit Care Med 1994; 22:171.Turnbull, A, Goldiner, P, Silverman, D, Howland, W. The role of an intensive care unit in a cancer center: An analysis of 1035 critically ill patients treated for life-threatening complications. Cancer 1976; 37:82.
Larche, J, Azoulay, E, Fieux, F, et al. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 2003; 29:1688.Bartlett, R, Morris, A, Fairley, B, et al. A prospective study of hypoxic respiratory failure. Chest 1986; 89:684
Soares, M, Salluh, JI, Spector, N, Rocco, JR. Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for 24 hrs. Crit Care Med 2005; 33:520.Davis, H, LeFrak, S, Miller, D, Malt, S. Prolonged assisted mechanical ventilation: an analysis of outcomes and charges. JAMA 1980; 243:43.
Knaus, W. Prognosis with mechanical ventilation: The influence of disease, severity of disease, and chronic health status on survival from acute illness. Am Rev Respir Dis 1989; 140:S6.Gillespie, D, Marsh, H, Divertie, M, Meadows, J. Clinical outcome of respiratory failure in patients requiring prolonged (>24 hours) mechanical ventilation. Chest 1986; 90:364.
Peters, S, Meadows, A, Gracey, D. Outcome of respiratory failure in hematologic malignancy. Chest 1988; 94:99..Estopa, R, Marti, A, Kastanos, N, et al. Acute respiratory failure in severe hematologic disorders. Crit Care Med 1984; 12:26.
Snow, R. Respiratory failure in cancer patients. JAMA 1979; 241:203.Reichner, CA, Thompson, JA, O'Brien, S, et al. Outcome and code status of lung cancer patients admitted to the medical ICU. Chest 2006; 130:719.
Ewer, M, Ali, M, Atta, M, et al. Outcome of lung cancer patients requiring mechanical ventilation for pulmonary failure. JAMA 1986; 256:3364.Keenan, HT, Bratton, SL, Martin, LD, et al. Outcome of children who require mechanical ventilatory support after bone marrow transplantation. Crit Care Med 2000; 28:830.
Poe, R, Wahl, G, Qazi, R, et al. Predictors of mortality in the immunocompromised patient with pulmonary infiltrates. Arch Intern Med 1986; 146:1304.Greenman, R. Lung biopsy in immunocompromised hosts. Am J Med 1975; 59:488.
Benoit, DD, Vandewoude, KH, Decruyenaere, JM, et al. Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 2003; 31:104.Pearl, R, Rosenthal, M. ICU Survival in adult patients with acute leukemia. Anaesthesiology 1983; 59:A141.
Pennington, J, Feldman, N. Pulmonary infiltrates and fever in patients with hematologic malignancy. Am J Med 1977; 62:581.Massion, PB, Dive, AM, Doyen, C, et al. Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med 2002; 30:2260.
Cuomo, A, Delmastro, M, Ceriana, P, et al. Noninvasive mechanical ventilation as a palliative treatment of acute respiratory failure in patients with end-stage solid cancer. Palliat Med 2004; 18:602.Knaus, W, Draper, E, Wagner, D, Zimmerman, J. Prognosis from acute organ-system failure. Ann Surg 1985; 202:685.
Rubenfeld, GD, Crawford, SW. Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: A case for evidence-based guidelines. Ann Intern Med 1996; 125:625.Crawford, SW, Peterson, FB. Long term survival from respiratory failure after marrow transplantation for malignancy. Am Rev Respir Dis 1992; 145:510.
Jackson, SR, Tweeddale, MG, Barnett, MJ, et al. Admission of bone marrow transplant recipients to the intensive care unit: Outcome, survival and prognostic factors. Bone Marrow Transplant 1998; 21:697.Price, KJ, Thall, PF, Kish, SK, et al. Prognostic indicators for blood and marrow transplant patients admitted to an intensive care unit. Am J Respir Crit Care Med 1998; 158:876.
Huaringa, AJ, Leyva, FJ, Giralt, SA, et al. Outcome of bone marrow transplantation patients requiring mechanical ventilation. Crit Care Med 2000; 28:1014.Hallahan, AR, Shaw, PJ, Rowell, G, et al. Improved outcomes of children with malignancy admitted to a pediatric intensive care unit. Crit Care Med 2000; 28:3718.
Rosenow E, 3rd. Respiratory failure in bone marrow transplant patients. Crit Care Med 2000; 28:1232.Scott, PH, Morgan, TJ, Durrant, S, Boots, RJ. Survival following mechanical ventilation of recipients of bone marrow transplants and peripheral blood stem cell transplants. Anaesth Intensive Care 2002; 30:289.
Crawford, SW, Pepe, M, Lin, D, Benedetti, F. Abnormalities of pulmonary function tests after marrow transplantation predict nonrelapse mortality. Am J Respir Crit Care Med 1995; 152:690.Khassawneh, BY, White, P Jr, Anaissie, EJ, et al. Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation. Chest 2002; 121:185.
Afessa, B, Tefferi, A, Dunn, WF, et al. Intensive care unit support and Acute Physiology and Chronic Health Evaluation III performance in hematopoietic stem cell transplant recipients. Crit Care Med 2003; 31:1715.