Lecture Summary

The survival of patients with cancer is improving. Reasons include better screening and early detection, more specific and effective treatments, as well as improvements in the management of side effects in and out of critical care. Approximately 5% to 10% of patients with cancer will develop a life-threatening condition that necessitates ICU admission, and the survival of these patients has improved over recent decades. Acute respiratory failure (ARF) is the most common reason for ICU admission and its management still remains controversial. The use of non-invasive ventilation (NIV) and high-flow nasal cannula oxygen appears to prevent intubation but has no impact on mortality. In this instance, careful selection of patients and identification of the underlying aetiology of the acute respiratory failure, as well as early assessment of NIV efficacy is of great importance. The mortality in patients with ARF mortality appears to be determined by the cause of ARF, rather than the modality and technique of ventilation. Short-term survival after ICU admission short-term outcome is predicted by the severity of the acute illness, whereas long-term outcome is determined by comorbidity, performance status before ICU admission and the underlying malignancy. Appropriate diagnosis of respiratory infections is crucial to improve survival of critically ill immunocompromised with acute hypoxemic respiratory failure. The diagnostic strategy relies on a series of clinical and radiographic elements available at the bedside on the use of non-invasive sampling, thanks to innovative tests, and sometimes on bronchoscopy and bronchoalveolar lavage. Optimal care for critically ill patients with cancer requires specialised knowledge and multidisciplinary communication and management.

Target Audience

Critical Care Doctors
Experienced or advanced Critical Care Nurses

Learning Objectives:

Upon completion of this activity, you should be able to:

• Appreciate changing ICU and hospital mortality for immunocompromised patients
• Describe an appropriate balance between non-invasive treatments and avoiding delays in optimal therapies (ventilation, chemotherapy)
• Understand the need for collaboration between critical care and haematology teams

None.