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SHORT AND LONG-TERM OUTCOMES OF CRITICALLY ILL PATIENTS WITH CANCER AND PROLONGED ICU LENGTH OF STAY

Márcio Soares, MD, PhD, Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Jorge I. F. Salluh, MD, MSc, Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Viviane B. L. Torres, MD, Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Juliana V. R. Leal, Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Nelson Spector, MD, PhD, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

marciosoaresms{at}yahoo.com.br

Abstract

BackgroundData on patients with cancer who experience a prolonged length of stay (LOS) at the intensive care unit (ICU) are scarce. The aim of the present study was to evaluate the characteristics and the outcomes of cancer patients with life-threatening complications with an ICU stay 21 days.

MethodsCohort study performed at a ten-bed oncologic medical-surgical ICU from May 2000 to December 2005. Prolonged ICU LOS was defined as an ICU stay of 21 days.

ResultsDuring the period, 1090 patients were admitted to the ICU and 163 (15%) had a prolonged ICU LOS. These patients, however, accounted for 48% (5828/12224) of the total ICU bed-days. The hospital and six-month mortality rates were 50% and 60%, respectively, and similar to patients with ICU LOS < 21 days (51% and 61%, respectively). ICU-acquired events and complications were common and the most frequent were infections (90%), mechanical ventilation (99%) and need for vasopressors (88%). The number of organ failures, older age and poor performance status were the main outcome predictors. The median long-term follow-up after hospital discharge was 537 (193-1119) days and 29 (18%) patients were alive at last medical record.

Conclusions15% of critically ill patients with cancer experienced a prolonged ICU LOS. Their short- and long-term survival rates were reasonable and their prognosis was better than expected a priori. In our opinion, the length of ICU admission per se should not be used in the clinical decisions regarding the continuation of treatment in these patients.

Key Words: Cancer • prolonged admission • intensive care unit • outcome