Lung Cancer in the ICU

Abstract

Objective: To establish current trends regarding the utilization, prognostic factors, and outcomes of patients with advanced lung cancer requiring admission to the intensive care unit (ICU). Data Sources and Study Selection: MEDLINE/PubMed search from January 1980 to January 2009, was conducted using the search terms “lung cancer,” “critical care,” “intensive care,” “prognosis,” “outcomes,” and “mechanical ventilation (MV),” alone and in combination. One additional non-Medline study was selected based on 1 author’s personal knowledge of the literature. Three authors collaboratively selected 11 original studies and/or retrospective reviews. Data Extraction and Synthesis: ICU utilization in patients with advanced lung cancer is increasing. Assessing the appropriateness of admitting these patients to the ICU is a rather complex issue, which is also difficult to evaluate. Prognostic factors have been examined in several heterogeneous small studies and suggest that performance status and the ability to control tumor growth are important considerations. Other prognostic factors such as the need for MV are less clear. The overall ICU mortality in advanced lung cancer patients is 40% to 50%. Improvements in mortality are attributed to advances in ICU care. Conclusions: ICU utilization in patients with advanced lung cancer is increasing. Although ICU mortality has decreased, the overall survival remains poor, though not much lower than in other ICU patients, such as in sepsis. Patients with poor baseline performance, multiple organ failure, and evidence of disease progression while receiving treatment seem less likely to benefit from admission to the ICU. Additional studies are needed to decide how to best allocate advanced technological resources in this patient population.