Critically ill cancer patient’s resuscitation: a Belgian/French societies’ consensus conference

Abstract

To respond to the legitimate questions raised by the application of invasive methods of monitoring and life-support techniques in cancer patients admitted in the ICU, the European Lung Cancer Working Party and the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique, set up a consensus conference. The methodology involved a systematic literature review, experts’ opinion and a final consensus conference about nine predefined questions 1. Which triage criteria, in terms of complications and considering the underlying neoplastic disease and possible therapeutic limitations, should be used to guide admission of cancer patient to intensive care units? 2. Which ventilatory support [High Flow Oxygenation, Non-invasive Ventilation (NIV), Invasive Mechanical Ventilation (IMV), Extra-Corporeal Membrane Oxygenation (ECMO)] should be used, for which complications and in which environment? 3. Which support should be used for extra-renal purification, in which conditions and environment? 4. Which haemodynamic support should be used, for which complications, and in which environment? 5. Which benefit of cardiopulmonary resuscitation in cancer patients and for which complications? 6. Which intensive monitoring in the context of oncologic treatment (surgery, anti-cancer treatment …)? 7. What specific considerations should be taken into account in the intensive care unit? 8. Based on which criteria, in terms of benefit and complications and taking into account the neoplastic disease, patients hospitalized in an intensive care unit (or equivalent) should receive cellular elements derived from the blood (red blood cells, white blood cells and platelets)? 9. Which training is required for critical care doctors in charge of cancer patients? Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06508-w.

Outcome of Patients with Solid Malignancies Considered for Intensive Care Unit Admission: A Single-Center Prospective Cohort Study

“…Short-term mortality rates were high in patients considered too well to bene t from critical care and in those who were admitted to the ICU after refusal of the rst request [15,16]. Our study extends these ndings speci cally to patients with SM, highlighting the limitations of recommendations [33]. A third of our patients admitted after denial of the rst request died before hospital discharge.…”

The Impact of Do-Not-Resuscitate Order in the Emergency Department on Respiratory Failure after ICU Admission

“…To avoid the adverse effect of DNR in ED is important. Recently, a Belgian/French societies’ consensus conference has some suggestion on management of cancer patients in the ICU [ 20 ]. According to these guidelines, we believed that the discrepancy between physicians’ treatment on terminal patients could be diminished.…”

Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?

“…After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.08-1.81] [52]. These results inform ongoing conversations regarding the value and optimal timing of bronchoscopy-based diagnostics in patients with cancer experiencing acute respiratory failure [53][54][55][56][57]. We concur with Bauer et al that bronchoscopy should occur as early as possible if clinically indicated and that decisions should be based on the likelihood of postbronchoscopy management change (i.e., the pretest probability of relevant clinical entities), which is likely to evolve over time based on emerging cancer therapies and less-invasive diagnostics [48, [58][59][60].…”