緩和ケアと医学

抽象的な

Causes of Death and Incidence of Life-support Techniques Limitations in Oncological Patients Dying in the ICU: A Retrospective Study

Anne-Pascale Meert, Séverine Dept, Thierry Berghmans and Jean-Paul Sculier

Background: Our objectives were to determine, for cancer patients dying in the ICU, the reasons for admission, the causes of death and the impact of life-support techniques limitations (LSTL).

Methods: This is a retrospective study including only cancer patients dying in the ICU .

Results: From 1 st January 2008 to 31 st December 2009, 658 patients were admitted in the ICU, 71 of whom had neoplastic disease and ultimately died after admission for a medical/surgical complications. Their principal characteristics were: men/women 38/33, median age 57 years, solid/haematological tumours 46/25. Solid tumours were mainly presenting at a metastatic stage (93.5%). Out of the 25 haematological patients, 6 were allograft recipients. The most frequent causes of admission were respiratory failure (36.6%) and infection (47.9%). Infection was the cause of death in 53.5%. Twenty-one patients had LSTL at or during the first 24 hours of ICU admission, especially because of cancer progression. Another 33 had LSTL later due to clinical deterioration. Seventeen patients did not receive any LSTL; all died with mechanical invasive ventilatory support. Early LSTL is mainly related to cancer progression while late LSTL are often decided in front of unfavourable evolution of the acute complications in patients with better cancer prognosis.

Conclusions: This study, restricted to cancer patients dying in the ICU, showed that respiratory failure and infec - tion were the leading cause of ICU admission. Infection was the first cause of death. The majority of the cancer patients dying in the ICU had LSTL. All patients with no LSTL died with mechanical invasive ventilatory support. Functional stages, the existence of an oncological treatment project and the evolution of complication leading to ICU admission have a major impact in the decision of LSTL.