Intensive care management of patients with haematological malignancy

Abstract

Serious complications are common among patients admitted to hospital with a diagnosis of haematological malignancy, with one British study of 1437 admissions identifying 7% as being complicated by an episode of critical illness. Although most of these episodes did not result in admission to intensive care unit (ICU), an increasing number of patients with a diagnosis of haematological malignancy are being managed within ICU or are receiving critical care input. Complication rates are higher for posthaematopoietic stem cell transplant (HSCT) patients with a recent abstract revealing an overall ICU admission rate for transplant patients of 13.6% among 1671 British patients over a 10 yr period. ICU admission for patients with haematological malignancies, and particularly after bone marrow transplantation, has been associated with very poor outcomes, and in some cases, critical care has been withheld because it was perceived to be futile. Newer studies suggest that ICU outcomes have improved, probably as a result of changes in both haematological treatments and ICU care. Patients with haematological malignancy may develop critical illness either as part of their first presentation with the malignancy or more commonly after chemotherapy or HSCT. Some presentations are specific to each scenario, whereas others may occur in all groups of patients. Respiratory failure is present in approximately half of all referrals to ICU. Between 10% and 50% of the patients have signs of shock, and there is evidence of multiple organ failure in about onefifth. Other causes for admission include neurological failure, gastrointestinal (GI) bleeding, renal failure, and metabolic derangement.