Advertisement

Wiener klinisches Magazin

, Volume 21, Issue 2, pp 68–77 | Cite as

Krebspatienten in der operativen Intensivmedizin

  • Thorsten Annecke
  • Andreas Hohn
  • Boris Böll
  • Matthias Kochanek
Intensivmedizin

Zusammenfassung

Die Prävalenz onkologischer Erkrankungen ist in den vergangenen Jahrzehnten stetig angestiegen. Durch neue Therapieoptionen können immer mehr Patienten mit einem kurativen Therapieansatz behandelt werden. Diese individualisierten und teilweise sehr aggressiven Therapien können jedoch auch zu schweren Nebenwirkungen führen. Diese sollten als wichtige Differenzialdiagnosen zu anderen vitalbedrohlichen Krankheitsbildern auch dem im OP und als Intensivmediziner tätigen Anästhesisten bekannt sein. Krebspatienten werden häufig auf operativen Intensivstationen aufgenommen, um Komplikationen der malignen Grunderkrankung oder auch Nebenwirkungen einer operativen oder konservativen Therapie zu behandeln. Aktuelle Untersuchungen zeigen, dass die maligne Grunderkrankung entgegen bisheriger Annahme keinen wesentlichen Einfluss auf das Intensivüberleben hat. Bei der Aufnahme eines onkologischen Patienten sollte daher die akut vorliegende Organdysfunktion zunächst im Vordergrund stehen. Bei der Therapiezielplanung gilt es, nicht zu übersehen, wann ein kuratives in ein palliatives Konzept übergehen muss. Hierfür müssen neue Aufnahmestrategien und -kriterien entwickelt und evaluiert werden. In diesem Übersichtsartikel werden Diagnosen und Therapien häufiger intensivmedizinischer Krankheitsbilder von onkologischen Patienten sowie Nebenwirkungen moderner onkologischer Therapien dargelegt und Aufnahmestrategien für Patienten mit malignen Erkrankungen vorgestellt.

Schlüsselwörter

Intensivmedizin Onkologie Notfallmedizin Hämatologie Neutropenie Anästhesie 

Cancer patients in operative intensive care medicine

Abstract

Cancer is one of the leading causes of death worldwide. New targeted and individualized therapies and drugs provide a survival benefit for an increasing number of patients, but can also cause severe side effects. An increasing number of oncology patients are admitted to intensive care units (ICU) because of cancer-related complications or treatment-associated side effects. Postoperative care, respiratory distress and sepsis are the leading causes for admission. Tumor mass syndromes and tumor lysis may require urgent treatment. Traditional anticancer chemotherapy is associated with infections and immunosuppression. Newer agents are generally well-tolerated and side effects are mild or moderate, but overwhelming inflammation and autoimmunity can also occur. Cellular treatment, such as with chimeric antigen receptor modified T‑cells, monoclonal and bispecific antibodies targeting immune effectors and tumor cells are associated with cytokine release syndrome (CRS) with hypotension, skin reactions and fever. It is related to excessively high levels of inflammatory cytokines. Immune checkpoint inhibitors can lead to immune-related adverse events (IRAEs), such as colitis and endocrine disorders. Noninfectious respiratory complications, such as pneumonitis can also occur. Recent studies revealed that short-term and medium-term survival of cancer patients is better than previously expected. In this review article we summarize diagnostic and treatment strategies for common life-threatening complications and emergencies requiring ICU admission. Furthermore, strategies for rational admission policies are presented.

Keywords

Intensive care Oncology Emergency medicine Hematology Neutropenia Anesthesiology 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Annecke, A. Hohn, B. Böll und M. Kochanek geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30CrossRefPubMedGoogle Scholar
  2. 2.
    Fouad YA, Aanei C (2017) Revisiting the hallmarks of cancer. Am J Cancer Res 7(5):1016–1036PubMedPubMedCentralGoogle Scholar
  3. 3.
    Demaria S, Pikarsky E, Karin M, Coussens LM, Chen YC, El-Omar EM, Trinchieri G, Dubinett SM, Mao JT, Szabo E et al (2010) Cancer and inflammation: promise for biologic therapy. J Immunother 33(4):335–351CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Huitink JM, Teoh WH (2013) Current cancer therapies – a guide for perioperative physicians. Best Pract Res Clin Anaesthesiol 27(4):481–492CrossRefPubMedGoogle Scholar
  5. 5.
    Carmeliet P, Jain RK (2011) Principles and mechanisms of vessel normalization for cancer and other angiogenic diseases. Nat Rev Drug Discov 10(6):417–427CrossRefPubMedGoogle Scholar
  6. 6.
    Mahoney KM, Rennert PD, Freeman GJ (2015) Combination cancer immunotherapy and new immunomodulatory targets. Nat Rev Drug Discov 14(8):561–584CrossRefPubMedGoogle Scholar
  7. 7.
    Lohmueller J, Finn OJ (2017) Current modalities in cancer immunotherapy: immunomodulatory antibodies, CARs and vaccines. Pharmacol Ther 178:31–47.  https://doi.org/10.1016/j.pharmthera.2017.03.008 CrossRefPubMedGoogle Scholar
  8. 8.
    Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL (2009) Characteristics and outcomes of cancer patients in European ICUs. Crit Care 13(1):R15CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lambertz R, Drinhaus H, Schedler D, Bludau M, Schroder W, Annecke T (2016) Perioperative management of transthoracic oesophagectomies: fundamentals of interdisciplinary care and new approaches to accelerated recovery after surgery. Anaesthesist 65(6):458–466CrossRefPubMedGoogle Scholar
  10. 10.
    Beutel G, Schellongowski P, Kiehl M, Kochanek M (2017) Intensive care of hematological and oncological patients: recent challenges. Dtsch Med Wochenschr 142(7):500–505CrossRefPubMedGoogle Scholar
  11. 11.
    von Bergwelt-Baildon M, Boll B, Shimabukuro-Vornhagen A, Kochanek M (2013) Hematologic and oncologic emergencies. Med Klin Intensivmed Notfmed 108(3):184–190CrossRefGoogle Scholar
  12. 12.
    Shimabukuro-Vornhagen A, Boll B, Kochanek M, Azoulay E, von Bergwelt-Baildon MS (2016) Critical care of patients with cancer. Ca Cancer J Clin.  https://doi.org/10.3322/caac.21351 PubMedGoogle Scholar
  13. 13.
    Azoulay E, Lemiale V, Mokart D, Pene F, Kouatchet A, Perez P, Vincent F, Mayaux J, Benoit D, Bruneel F et al (2014) Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 40(8):1106–1114CrossRefPubMedGoogle Scholar
  14. 14.
    Maschmeyer G, Carratala J, Buchheidt D, Hamprecht A, Heussel CP, Kahl C, Lorenz J, Neumann S, Rieger C, Ruhnke M et al (2015) Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 26(1):21–33CrossRefPubMedGoogle Scholar
  15. 15.
    Rieger C, Barlow S, Maschmeyer G (2014) What’s new in diagnosis and antimicrobial therapy of febrile neutropenic patients with lung infiltrates? Intensive Care Med 40(10):1549–1552CrossRefPubMedGoogle Scholar
  16. 16.
    Soares M, Salluh JI, Azoulay E (2010) Noninvasive ventilation in patients with malignancies and hypoxemic acute respiratory failure: a still pending question. J Crit Care 25(1):37–38CrossRefPubMedGoogle Scholar
  17. 17.
    Knight T, Ahn S, Rice TW, Cooksley T (2017) Acute oncology care: a narrative review of the acute management of neutropenic sepsis and immune-related toxicities of checkpoint inhibitors. Eur J Intern Med 45:59–65CrossRefPubMedGoogle Scholar
  18. 18.
    Schuttrumpf S, Binder L, Hagemann T, Berkovic D, Trumper L, Binder C (2003) Procalcitonin: a useful discriminator between febrile conditions of different origin in hemato-oncological patients? Ann Hematol 82(2):98–103CrossRefPubMedGoogle Scholar
  19. 19.
    Sakr Y, Sponholz C, Tuche F, Brunkhorst F, Reinhart K (2008) The role of procalcitonin in febrile neutropenic patients: review of the literature. Infection 36(5):396–407CrossRefPubMedGoogle Scholar
  20. 20.
    Christofilopoulou S, Charvalos E, Petrikkos G (2002) Could procalcitonin be a predictive biological marker in systemic fungal infections?. Study of 14 cases. Eur J Intern Med 13(8):493–495CrossRefPubMedGoogle Scholar
  21. 21.
    Buhaescu I, Yood RA, Izzedine H (2010) Serum procalcitonin in systemic autoimmune diseases – where are we now? Semin Arthritis Rheum 40(2):176–183CrossRefPubMedGoogle Scholar
  22. 22.
    Bihan H, Becker KL, Snider RH, Nylen E, Vittaz L, Lauret C, Modigliani E, Moretti JL, Cohen R (2003) Calcitonin precursor levels in human medullary thyroid carcinoma. Thyroid 13(8):819–822CrossRefPubMedGoogle Scholar
  23. 23.
    Briegel J, Mohnle P (2017) International guidelines from the surviving sepsis campaign: 2016 update. Anaesthesist 66(7):530–538.  https://doi.org/10.1007/s00101-017-0299-z CrossRefPubMedGoogle Scholar
  24. 24.
    Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 45(3):486–552CrossRefPubMedGoogle Scholar
  25. 25.
    Howard SC, Jones DP, Pui CH (2011) The tumor lysis syndrome. N Engl J Med 364(19):1844–1854CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Inauen R, Cathomas R, Boehm T, Koeberle D, Pestalozzi BC, Gillessen S, von Moos R (2007) Feasibility of using cetuximab and bevacizumab in a patient with colorectal cancer and terminal renal failure. Oncology 72(3):209–210CrossRefPubMedGoogle Scholar
  27. 27.
    Kroschinsky F, Stolzel F, von Bonin S, Beutel G, Kochanek M, Kiehl M, Schellongowski P, Intensive Care H, Oncological Patients Collaborative G (2017) New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management. Crit Care 21(1):89CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    National Cancer Institute (2017) Common Terminology Criteria for Adverse Events (CTCAE). https://www.cancer.gov/about-cancer/treatment/side-effects. Zugegriffen: 16.01.2017
  29. 29.
    Spain L, Diem S, Larkin J (2016) Management of toxicities of immune checkpoint inhibitors. Cancer Treat Rev 44:51–60CrossRefPubMedGoogle Scholar
  30. 30.
    Ranpura V, Hapani S, Chuang J, Wu S (2010) Risk of cardiac ischemia and arterial thromboembolic events with the angiogenesis inhibitor bevacizumab in cancer patients: a meta-analysis of randomized controlled trials. Acta Oncol 49(3):287–297CrossRefPubMedGoogle Scholar
  31. 31.
    Ranpura V, Hapani S, Wu S (2011) Treatment-related mortality with bevacizumab in cancer patients: a meta-analysis. JAMA 305(5):487–494CrossRefPubMedGoogle Scholar
  32. 32.
    Azoulay E, Pene F, Darmon M, Lengline E, Benoit D, Soares M, Vincent F, Bruneel F, Perez P, Lemiale V et al (2015) Managing critically ill hematology patients: time to think differently. Blood Rev 29(6):359–367CrossRefPubMedGoogle Scholar
  33. 33.
    Azoulay E, Mokart D, Pene F, Lambert J, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne LM et al (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium – a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol 31(22):2810–2818CrossRefPubMedGoogle Scholar
  34. 34.
    Puxty K, McLoone P, Quasim T, Kinsella J, Morrison D (2014) Survival in solid cancer patients following intensive care unit admission. Intensive Care Med 40(10):1409–1428CrossRefPubMedGoogle Scholar
  35. 35.
    Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B (2011) Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care 1(1):5CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ney L, Annecke T (2014) Intercultural differences in the treatment of severely injured patients with poor prognosis. Unfallchirurg 117(2):167–168CrossRefPubMedGoogle Scholar
  37. 37.
    Dohner H, Estey EH, Amadori S, Appelbaum FR, Buchner T, Burnett AK, Dombret H, Fenaux P, Grimwade D, Larson RA et al (2010) Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood 115(3):453–474CrossRefPubMedGoogle Scholar
  38. 38.
    Schellongowski P (2013) Der hämatologisch-onkologische Patienet auf der Intensivstation. Med Klin Intensivmed Notfmed 108:203–208CrossRefPubMedGoogle Scholar
  39. 39.
    Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E (2007) The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 35(3):808–814CrossRefPubMedGoogle Scholar
  40. 40.
    Schuster DP, Marion JM (1983) Precedents for meaningfulrecovery during treatment in a medical intensive care unit. Outcome in patients with hematologic malignancy. Am J Med 75(3):402–408CrossRefPubMedGoogle Scholar
  41. 41.
    Estopa R, Torres Marti A, Kastanos N, Rives A, Agusti-Vidal A, Rozman C (1984) Acute respiratory failure in severe hematologic disorders. Crit Care Med 12(1):26–28CrossRefPubMedGoogle Scholar
  42. 42.
    Peters SG, Meadows JA 3rd, Gracey DR (1988) Outcome of respiratory failure in hematologic malignancy. Chest (94)(1):99-102CrossRefPubMedGoogle Scholar
  43. 43.
    Groeger JS, White P Jr, Nierman DM, Glassman J, Shi W, Horak D, Proce K (1999) Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 17(3):991–997CrossRefPubMedGoogle Scholar
  44. 44.
    Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complikation. Crit Care Med 31(1):104–112CrossRefPubMedGoogle Scholar
  45. 45.
    Depuydt PO, Benoit DD, Vandewounde KH, Decruyenaere JM, Colardyn FA (2004) Outcome in noninvasively and invasely ventilated hematologic patients with acute respiratory failure. Chest 126(4):1299–1306CrossRefPubMedGoogle Scholar
  46. 46.
    Soares M, Salluh JIF, Torres VBL, Leal JVR, Spector N (2008) Short- and long -term outcomes of critically ill paients with cancer and prolonged ICU lengh of stay. Chest 134(3):520–526CrossRefPubMedGoogle Scholar
  47. 47.
    Lecuyer L, Chevret S, Guidet B, Aegerter P, Martel P, Schlemmer B, Azoulay E (2008) Case volume and mortality in haematological patients with acute respiratory failure. Eur Respir J 32(3):748–754.CrossRefPubMedGoogle Scholar
  48. 48.
    Gristina GR, Antonelli M, Conti G, Ciarlone A, Rogante S, Rossi C, Bertolini G, GiViTi (Italian Group for the Evaluation of Interventions in Intensive Care Medicine) (2011) Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observation survey. Crit Care Med 39(10):2232–2239CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Thorsten Annecke
    • 1
    • 3
  • Andreas Hohn
    • 1
    • 3
  • Boris Böll
    • 2
    • 3
    • 4
  • Matthias Kochanek
    • 2
    • 3
    • 4
  1. 1.Klinik für Anästhesiologie und Operative IntensivmedizinUniklinik KölnKölnDeutschland
  2. 2.Medizinische Klinik IUniklinik KölnKölnDeutschland
  3. 3.Centrum für Integrierte Onkologie (CIO) Köln BonnUniversitätsklinikum KölnKölnDeutschland
  4. 4.Arbeitsgruppe Intensive Care in Hematologic and Oncologic Patients (iCHOP)DGHO/DGIINBerlinDeutschland

Personalised recommendations