Management of the end stage Management of the end stage lung cancer patients: lung cancer patients: What would the politics be on What would the politics be on the intensive care support? the intensive care support? Dr Zuhal Karakurt Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Respiratory Intensive Care Unit
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Dr Zuhal Karakurt Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital,
Management of the end stage lung cancer patients: What would the politics be on the intensive care support?. Dr Zuhal Karakurt Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Respiratory Intensive Care Unit. Priority 1 Priority 2 Priority 3 Priority 4 - PowerPoint PPT Presentation
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Management of the end stage Management of the end stage lung cancer patients:lung cancer patients:What would the politics be on What would the politics be on the intensive care support?the intensive care support?
Dr Zuhal KarakurtSüreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital,
Respiratory Intensive Care Unit
Admission for ICU: ATS 1999 GuidelinesAdmission for ICU: ATS 1999 Guidelines
Priority 1Priority 1 Priority 2Priority 2 Priority 3Priority 3 Priority 4Priority 4 Category ACategory A Category BCategory B
3. Patients with ARF but have a reduced likelihood of recovery due to underlying diseases.
metastatic malignancy complicated by infection, crdiac tamponade,or airwayobstruction
4. Generally not appropriate for ICU admission
Category A:Too well to benefit from ICU care
Category B: Too sick to benefit from ICU care (severe irreversible: brain damage,organ failure, metastatic cancer unresponsive to CTx& RTx, persistant vegetative state
Patients with Cancer:Common reasons of Patients with Cancer:Common reasons of ICU admissionICU admission
Respiratory failure due to CancerRespiratory failure due to Cancer After CTx & bone marrow transplantAfter CTx & bone marrow transplant SepsisSepsis Electrolite disorders (hyponatremia)Electrolite disorders (hyponatremia) Pulmonary edemaPulmonary edema Changes mental statatusChanges mental statatus Acute airway obstructionsAcute airway obstructions Side effects of medical treatmentSide effects of medical treatment Postoperative observationPostoperative observation
Paz H, Chest, 1993
Thomas A Br Med J 1988
Soares, M Chest 2007
Adam AK. ERJ, 2008
Cancer patients with high mortality Cancer patients with high mortality raterate
Bed restricted patientsBed restricted patients Patients with paliative cancer Patients with paliative cancer
teraphyteraphy Mechanical ventilation requirment Mechanical ventilation requirment High SOFA scoresHigh SOFA scores Late stage lung cancerLate stage lung cancer
Lung Cancer: Admission of ICU
ICU admission of patients with ICU admission of patients with newly diagnosed cancernewly diagnosed cancer
Specific organ failure & need Specific organ failure & need for administration of CT.for administration of CT.
Mortality:Mortality:
* need for vasopressor * need for vasopressor
* need for mechanical * need for mechanical
ventilationventilation
* hepatic failure* hepatic failure
Darmon M. Crit Care Med. 2005; 33:2488
Terminal Cancer & COPD Terminal Cancer & COPD patientspatients
NSCLC (939 pts)NSCLC (939 pts)
Severe dispnea %32Severe dispnea %32
Severe pain %28Severe pain %28
Short term effectiveness MVShort term effectiveness MV %19%19
Tube feeding %18Tube feeding %18
CPR %7.5CPR %7.5
COPD (1008 pts)COPD (1008 pts)
% 56% 56
%21%21
%70%70
%38%38
%25%25
Claessens MT .Dying with lung cancer or chronic obstructive pulmonary diseases: insights from SUPPORT.. J Am Geriatr Soc. 2000.:48 (5 Supp) 146
Metastatic colon cancer: 316 stage III-IV lung cancer: 7471. Severity of dieases (APACHE) 2. Activities of daily life (ADLs)
score,3. Physical and emotinal
symptoms (pain, depretion, anxiety)
4. Patients preference for care5. Financial impact on patient’s
families
3 days before death 4 or more impairments. More pain (%40) confusion, decrease
mood,anxiety. 2/3 patients forego
resuscitation.
3-6 month before death: 25% suffer pain, Families incurred significant
financial burdens
McCarthy EP. Dying with cancer:patient’s function, symptoms, and care preferences as
death approaches. JAm Geriatry Soc. 2000; 48 (5 Suppl): 110
Terminal colon & lung (NSCLC)cancer:three days before death