Serrano OA, Gerson R, Álvarez M, Murillo A, Guzmán C

Language: Spanish
References: 13
Page: 245-250
PDF size: 59.03 Kb.

ABSTRACT

Background: Therapeutic advances have improved life expectancy of cancer patients. In order to obtain it situations that require high technology support therapy emerge. Ethical and philosophical dilemmas develop when a cancer patient needs to be admitted to ICU. Mortality is high. Objective: To determine the reasons for admission and to establish prognostic expectations for oncology patients that require medical attention in ICU. Patients and methods: From January 1993 to September 1994. Females and males with diagnosis of malignancy with similar clinical stage that were admitted to ICU were included. Only the first admission was considered. Pts with incomplete medical records or inadequate follow-up were excluded. Age, tumor type, clinical stage, metastatic sites and number, Karnofsky scale, admission diagnosis and staying time in ICU, APACHE II score and cause of dead were evaluated. Results: 150 patients, mean age 48.9 ± 17.1 years (range 14 to 92 years); Karnofsky scale: 62 ± 12; 99 (66%) patients were women and 51 (44%) men. We observed 131 (87.3%) surgical cases and 19 (31.5%) no surgical cases. Forty-nine (32.6%) patients with diagnosis of uterine cervix cancer; thyroid 10 (6.6%); larynx 8 (5.3%); ovary 7 (4.6%); squamous cell carcinoma of different sites 7 (4.6%). 47.8% of tumors were clinical stage III-IV. Seventy-four (49.3%) patients were admitted for post surgical observation; 18 (12%) for acute respiratory insufficiency; 14 (9.3%) for bleeding; 14 (9.3%) for mechanic ventilatory assistance after tracheostomy; 8 (5.3%) for dysrhythmia and 8 (5.3%) for hypovolemic shock. Staying time in ICU was 4 (range 1 to 44). Mean APACHE II score was 17.9 ± 4.4 points (range 12 to 32). Eighteen (12%) patients died in ICU, 48 (32%) several months after their discharge. Mortality causes were: hypovolemic shock, 44.4%; dysrhythmia , 16.6%; pulmonary embolism, 16.6%, acid-base disturbances, 11.1%; pneumonia, 5.5% and sepsis, 5.5%. We detected significant prognostic survival value for no surgical reason for admission, APACHE II above 20 points and hypovolemic shock. Conclusions: The majority of patients with cancer that were admitted to ICU were under 50 years. The most frequent cause of admission was respiratory failure. Life expectancy for the first four days is poor, more than 20% died in the first day. No surgical reason for admission, high APACHE II score and hypovolemic shock are significant prognostic factors. Consensus guidelines for admission to ICU should be dictated.

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