Patients with hematological malignancies admitted to intensive care units: new challenges for the intensivist

Analysis of 206 oncohematological patients admitted to the intensive care unit

“…However, delaying admission to the ICU or rejecting patients based on the type and stage of the OH pathology does not seem to be justified. [1][2][3] In recent years, many of these diseases have achieved better survival rates due to advances in treatment and prophylaxis strategies along with the development of support therapies. 3 In addition, currently, advances in the diagnosis and treatment of OH diseases have produced a radical change in the prognosis of patients; advances in the molecular biology of specific mutations manage to achieve particular and selective therapeutic options.…”

“…6 As described in the study published by Cornish in 2016, ICU survival approaches 40%, 5 in part due to advances in the management of underlying hematologic disorders as well as supportive therapies for organ dysfunction and management of life-threatening complications that this population develops, related or not to the cancer treatment itself. 7,8 Historically, OH patients have a poor prognosis when admitted to the ICU. 3 Advances in critical care through different pharmacological therapies, together with improvements in equipment, have increased the survival of these patients and the criteria for admitting them to the ICU are currently under review since the literature shows that there are patients who benefit from cancer interventions.…”

“…3 Advances in critical care through different pharmacological therapies, together with improvements in equipment, have increased the survival of these patients and the criteria for admitting them to the ICU are currently under review since the literature shows that there are patients who benefit from cancer interventions. 1,9,10 We have carried out a study that describes the current situation of adult patients with OH diseases in the ICU, to identify those variables that may have prognostic utility with respect to mortality.…”

Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes

“…Patients with hematological neoplasms hospitalized in intensive care units (ICU) present high mortality rates—50 to 70%—making the need of invasive mechanical ventilation (IMV) one of the main determining factors of this outcome. Acute respiratory failure (ARF) in these patients is multifactorial, and it is generally associated with disease progression, opportunistic infections, and treatment-associated toxicity [ 1 – 5 ]. Early use of non-invasive mechanical ventilation (NIMV) in patients with hematological neoplasms has been associated in some studies with a reduction in mortality and IMV requirement [ 1 , 6 – 8 ].…”

Planejamento da assistência ao paciente em cuidados paliativos na terapia intensiva oncológica

“…(10) Ethical dilemmas and conflicts mainly stem from lack of alignment with palliative care principles, as per the recommendations of the World Health Organization, when dealing with life-threatening chronic diseases and the need to implement palliative measures from the time of diagnosis, although the usefulness of these is much clearer and more evident as the disease progresses and reaches high levels of suffering, where medicine can no longer work against the disease, but in favor of the person. (11)(12)(13)(14) The need for early integration of curative and palliative care in ICUs has been addressed in the literature. Among the various strategies to promote this practice, there is unanimous agreement about ongoing investment in health professionals, since, regardless of the model to be followed, they will have the means to recognize patients in need of palliative care, make a better diagnosis and even screen those eligible or not for intensive care.…”