Indications for intensive care in the management of infections in cancer patients

  • Jean-Paul Sculier
Part of the Cancer Treatment and Research book series (CTAR, volume 79)


Intensive care physicians manage cancer patients with infections principally under two different conditions. In the first, patients are admitted for severe infectious complications due to the neoplastic disease and/or its treatment. Management has to include specific treatment of the complication, as well as critical care to support associated organ failure(s). In the second, patients are admitted for reasons not related to infection, but the patient develops infectious complications during the intensive care unit (ICU) stay, eventually requiring critical care support. It is important to be aware that cancer patients can be admitted to the ICU for many reasons [1]: (1) postoperative recovery, with advantages that are the same as those for any high-risk postoperative patient; (2) critical complications of the underlying disease and its treatment; (3) administration or monitoring of intensive, new, or risky anticancer treatment; and (4) acute disease unrelated to the underlying disease and its treatment.


Continuous Positive Airway Pressure Neutropenic Patient Multiple Organ Dysfunction Syndrome Liposomal Amphotericin Adult Respiratory Distress Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Soulier JP. 1991. Intensive care in the treatment of cancer patients. Curr Opin Oncol 3:656–662.Google Scholar
  2. 2.
    Masur H. 1987. Infections in critically ill immunosuppressed patients. In: Parillo JE, Masur H, eds The Critically Ill Immunosuppressed Patient. Rockville, MD: Aspen, pp 215–242.Google Scholar
  3. 3.
    Regnier B, Brun-Buisson CH. 1989. L’infection en Réanimation. Collection d’Anesthesiologie et de Réanimation. Paris: Masson.Google Scholar
  4. 4.
    Sculier JP, Weerts D, Klastersky J. 1984. Causes of death in febrile granulocytopenic cancer patients receiving empiric antibiotic therapy. Eur J Cancer Clin Oncol 20:55–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Gerain J, Sculier JP, Malengreaux A, Rykaert C, Thémelin L. 1990. Causes of deaths in an oncologic intensive care unit: A clinical and pathological study of 34 autopsies. Eur J Cancer 26:377–371.PubMedCrossRefGoogle Scholar
  6. 6.
    Pitter D, Thiévent B, Wenzel RP, Li N, Gurman G, Suter PM. 1933. Importance of pre-existing comorbidities for prognosis of septicemia in critically ill patients. Intensive Care Med 19:265–272.Google Scholar
  7. 7.
    Schuster DP, Marion JA. 1983. Precedents for meaningful recovery during treatment in a medical intensive care unit. Am J Med 75:402–408.PubMedCrossRefGoogle Scholar
  8. 8.
    Brunet F, Lanore JJ, Dhainaut JF, Dreyfus F, Vaxelaire JF, Nouira S, Giraud T, Armaganidis A, Monsallier JF. 1990. Is intensive care justified for patients with haematological malignancies? Intensive Care Med 16:291–297.PubMedCrossRefGoogle Scholar
  9. 9.
    Torrecilla C, Cortés JL, Chamorro C, Rubio JJ, Galdos P, Dominguez de Villota E. 1988. Prognostic assessment of the acute complications of bone marrow transplantation requiring intensive therapy. Intensive Care Med 14:393–398.PubMedCrossRefGoogle Scholar
  10. 10.
    Butt W, Barker G, Walker C, Gillis J, Kilham H, Stevens M. 1988. Outcome of children with hematologic malignancy who are admitted to an intensive care unit. Crit Care Med 16:761–764.PubMedCrossRefGoogle Scholar
  11. 11.
    Schlag G, Redl H. 1987. Mediator of sepsis. In: Vincent JL, Thys, eds. Update in Intensive Care and Emergency Medicine. 4. Septic Shock. Berlin: Springer-Verlag, pp 51–73.Google Scholar
  12. 12.
    Ognibene FP, Martin SE, Parker MM, Schlesinger T, Roach P, Burch C, Shelhamer JH, Parrillo JE. 1986. Adult respiratory distress syndrome in patients with severe neutropenia. N Engl J Med 315:547–551.PubMedCrossRefGoogle Scholar
  13. 13.
    Maunder RJ, Hackman RC, Riff E, Albert RK, Springmeyer SC. 1986. Occurrence of the adult respiratory distress syndrome in neutropenic patients. Am Rev Respir Dis 133:313–316.PubMedGoogle Scholar
  14. 14.
    Laufe MD, Simon RH, Flint A, Keller JB. 1986. Adult respiratory distress syndrome in neutropenic patients. Am J Med 80:1022–1026.PubMedCrossRefGoogle Scholar
  15. 15.
    Vansteenkiste JF, Boogaerts MA. 1989. Adult respiratory distress syndrome in neutropenic leukemia patients. Blut 58:287–290.PubMedCrossRefGoogle Scholar
  16. 16.
    Sivan Y, Mor C, Al-Jundi S, Newth CJL. 1990. Adult respiratory distress syndrome in severely neutropenic children. Pediatr Pulmonol 8:104–108.PubMedCrossRefGoogle Scholar
  17. 17.
    Yurt RW, Lowry SF. 1990. Role of the macrophage and endogeneous mediators in multiple organ failure. In: Deitch EA, ed Multiple Organ Failure. Pathophysiology and Basic Concepts of Therapy. New York: Thieme Medical, pp 60–71.Google Scholar
  18. 18.
    Tobias JD, Bozeman PM, Stokes DC. 1991. Postsepsis bradycardia in children with leukemia. Crit Care Med 19:1172–1176.PubMedCrossRefGoogle Scholar
  19. 19.
    Sculier JP, Markiewicz E. 1993. Cardiopulmonary resuscitation in medical cancer patients: The experience of a medical intensive-care unit of a cancer center. Support Care Cancer 1:135–138.PubMedCrossRefGoogle Scholar
  20. 20.
    Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. 1992. American College of Chest Physicians Society of Critical Care Medicine Consensus Conference: Definitions of sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874.CrossRefGoogle Scholar
  21. 21.
    Tobias JD. 1991. Tumour lysis pneumopathy. Clin Intensive Care 2:305–308.Google Scholar
  22. 22.
    Emminger W, Emminger-Schmidmeier W, Peters C, Susani M, Hawliczek R, Höcker P, Gadner H. 1990. Capillary leak syndrome during low dose granulocyte-macrophage colony-stimulating factor (rh GM-CSF) treatment of a patient in a continuous febrile state. Blut 61:219–221.PubMedCrossRefGoogle Scholar
  23. 23.
    Cohen J, Worsley AM, Goldman JM, Donnelly JP, Catovsky D, Galton DAG. 1983. Septicaemia caused by viridans streptococci in neutropenic patients with leukaemia. Lancet 24/31:1452–1454.CrossRefGoogle Scholar
  24. 24.
    Coullioud D, Van der Auwera P, Viot M, Lasset C, CEMIC (French-Belgian Study Club of Infectious Diseases in Cancer). 1993. Prospective multicentric study of the etiology of 1051 bacteremic episodes in 782 cancer patients. Support Care Cancer 1:34–36.PubMedCrossRefGoogle Scholar
  25. 25.
    Awada A, Van der Auwera P, Meunier F, Daneau D, Klastersky J. 1992. Streptococcal and enterococcal bacteremia in patients with cancer. Clin Infect Dis 15:33–48.PubMedCrossRefGoogle Scholar
  26. 26.
    Elting LS, Bodey GP, Keefe BH. 1992. Septicemia and shock syndrome due to viridans streptococci: A case-control study of predisposing factors. Clin Infect Dis 14:1201–1207.PubMedCrossRefGoogle Scholar
  27. 27.
    Burden AD, Oppenheim BA, Crowther D, Howell A, Morgenstern GR, Scarffe JH, Thatcher N. 1991. Viridans streptococcal bacteraemia in patients with haematological and solid malignancies. Eur J Cancer 27:409–411.PubMedCrossRefGoogle Scholar
  28. 28.
    Valteau D, Hartmann O, Brugieres L, Vassal G, Benhamou E, Andremont A, Kalifa C, Lemerle J. 1991. Streptococcal septicaemia following autologous bone marrow transplantation in children treated with high-dose chemotherapy. Bone Marrow Transplant 7:415–419.PubMedGoogle Scholar
  29. 29.
    Arning M, Gehrt A, Aul C, Runde V, Hadding U, Schneider W. 1990. Septicemia due to Streptococcus mitis in neutropenic patients with acute leukemia. Blut 61:364–368.PubMedCrossRefGoogle Scholar
  30. 30.
    Ries F, Sculier JP, Klastersky J. 1987. Diffuse bilateral pneumopathies in patients with cancer. Cancer Treat Rev 14:119–130.PubMedCrossRefGoogle Scholar
  31. 31.
    Donowitz GR, Harman C, Pope T, Stewart M. 1991. The role of chest roentgenogram in febrile neutropenic patients. Arch Intern Med 151:701–704.PubMedCrossRefGoogle Scholar
  32. 32.
    Barloon TJ, Galvin JR, Mori M, Stanford W, Gingrich RD. 1991. High-resolution ultrafast chest CT in the clinical management of febrile bone marrow transplant patients with normal or nonspecific chest roentgenograms. Chest 99:928–933.PubMedCrossRefGoogle Scholar
  33. 33.
    Browne MJ, Potter D, Gress J, Cotton D, Hiemenz J, Thaler M, Hathorn J, Brower S, Gill V, Glatstein E, Pass H, Roth J, Wesley R, Shelhamer J, Pizzo P. 1990. A randomized trial of open lung biopsy versus empiric antimicrobial therapy in cancer patients with diffuse pulmonary infiltrates. J Clin Oncol 8:222–229.PubMedGoogle Scholar
  34. 34.
    Stover DE, Zaman MB, Hajda SL, Lange M, Gold J, Armstrong D. 1984. Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med 101:1–7.PubMedGoogle Scholar
  35. 35.
    Masur H. 1992. Prevention and treatment of Pneumocystis pneumonia. N Engl J Med 327:1853–1860.PubMedCrossRefGoogle Scholar
  36. 36.
    Varthalitis I, Meunier F. 1993. Pneumocystis carinii pneumonia in cancer patients. Cancer Treat Rev 19:387–413.PubMedCrossRefGoogle Scholar
  37. 37.
    National Institute of Health—University of California Expert Panel for Corticosteroids as Adjunctive Therapy for Pneumocystis pneumonia. 1990. Consensus statement on the use of corticosteroids as adjunctive therapy for Pneumocystis pneumonia in the acquired immunodeficiency syndrome. N Engl J Med 323:1500–1504.CrossRefGoogle Scholar
  38. 38.
    Parker MM, Ognibene FP, Rogers P, Shelhamer JH, Masur H, Parrillo JE. 1994. Severe Pneumocystis carinii pneumonia produces a hyperdynamic profile similar to bacterial pneumonia with sepsis. Crit Care Med 22:50–54.PubMedGoogle Scholar
  39. 39.
    Schlemmer B, Dhainaut JE, Bons J, Mathiot C, Varet B, Sylvestre R, Monsallier JE. 1982. Pneumopathies aiguës au cours des hémopathies malignes en aplasie: Nouvelle approche nosologique et thérapeutique. Ann Méd Interne 133:174–177.Google Scholar
  40. 40.
    Gregg RW, Friedman BC, Williams JF, McGrath BJ, Zimmerman JE. 1990. Continuous positive airway pressure by face mask in Pneumocystis carinii pneumonia. Crit Care Med 18:21–24.PubMedCrossRefGoogle Scholar
  41. 41.
    Hughes WT, Kuhn S, Chandhary S, Verzosa M, Aur RJA, Pratt C, George SL. 1977. Successful chemoprophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med 297:1419–1426.PubMedCrossRefGoogle Scholar
  42. 42.
    Mustafa MM, Pappo A, Cash J, Winick NJ, Buchanan GR. 1994. Aerosolized pentamidine for the prevention of Pneumocystis carinii pneumonia in children with cancer intolerant or allergic to trimethoprim/sulfamethoxazole. J Clin Oncol 12:258–261.PubMedGoogle Scholar
  43. 43.
    Sommer SE, Emanuel D, Groeger JS, Carlon GC. 1991. Successful management of CMV pneumonia in a mechanically ventilated patient. Chest 100:856–858.PubMedCrossRefGoogle Scholar
  44. 44.
    Goodrich JM, Mori M, Gleaves CA, Dumond C, Cays M, Ebeling DF, Buhles WC, Dearmond B, Meyers JD. 1991. Early treatment with ganciclovir to prevent cytomegalovirus disease after allogenic bone marrow transplantation. N Engl J Med 325:1601–1607.PubMedCrossRefGoogle Scholar
  45. 45.
    Schmidt GM, Horak DA, Niland JC, Duncan SR, Forman SJ, Zaia JA, the City of Hope-Stanford-Syntex CMV Study Group. 1991. A randomized, controlled trial of prophylactic ganciclovir for cytomegalovirus pulmonary infection in recipients of allogeneic bone marrow transplants. N Engl J Med 324:1005–1011.CrossRefGoogle Scholar
  46. 46.
    Reed EC, Bowden RA, Daudliker PS, Lilleby KE, Meyers JD. 1988. Treatment of cytomegalovirus pneumonia with ganciclovir and intravenous cytomegalovirus immunoglobulin in patients with bone marrow transplants. Ann Intern Med 109:783–788.PubMedGoogle Scholar
  47. 47.
    Ljungman P, Engelhard D, Link H, Biron P, Brandt L, Brunet S, Cordonnier C, Debusscher L, de Laurenzi A, Kolb HJ, Messina C, Newland AC, Prentice HG, Richard C, Ruutu T, Tilg H, Verdonck L. 1992. Treatment of interstitial pneumonitis due to cytomegalovirus with ganciclovir and intravenous immune globulin: Experience of the European Bone Marrow Transplant Group. Clin Infect Dis 14:831–835.PubMedCrossRefGoogle Scholar
  48. 48.
    Gerson SL, Talbot GH, Lust L, Hurwitz S, Strom BL, Cassileth PA. 1985 Invasive pulmonary aspergillosis in adult acute leukemia: Clinical clues to its diagnosis. J Clin Oncol 3:1109–1116.PubMedGoogle Scholar
  49. 49.
    Riichel R. 1993. Diagnosis of invasive mycoses in severely immunosuppressed patients. Ann Hematol 67:1–11.CrossRefGoogle Scholar
  50. 50.
    Sculier JP, Coune A, Meunier F, Brassinne C, Laduron C, Hollaert C, Colette N, Heymans C, Klastersky J. 1988. Pilot study of amphotericin B entrapped in sonicated liposomes in cancer patients with fungal infections. Eur J Cancer Clin Oncol 3:527–538.CrossRefGoogle Scholar
  51. 51.
    Sculier JP, Bron D, Coune A, Meunier F. 1989. Successful treatment with liposomal amphotericin B in two patients with persisting fungemia. Eur J Clin Microbiol Infect Dis 8:903–907.PubMedCrossRefGoogle Scholar
  52. 52.
    Björkholm M, Kallberg N, Grimfors G, Eklund LH, Eksborg S, Juneskaus OT, Uden AM. 1991. Successful treatment of hepatosplenic candidiasis with a liposomal amphotericin B preparation. J Intern Med 230:173–177.PubMedCrossRefGoogle Scholar
  53. 53.
    Gokhale PC, Barapatre RJ, Advani SH, Kshirsagar NA, Pandya SK. 1993. Successful treatment of disseminated candidiasis resistant to amphotericin B by liposomal amphotericin B: A case report. J Cancer Res Clin Oncol 119:569–571.PubMedCrossRefGoogle Scholar
  54. 54.
    Starnes HF, Moore FD, Mentzer S. Osteen RT, Steele GD, Wilson RE. 1986. Abdominal pain in neutropenic cancer patients. Cancer 57:616–621.PubMedCrossRefGoogle Scholar
  55. 55.
    Wade DS, Douglass H, Nava HR, Piedmonte M. 1990. Abdominal pain in neutropenic patients. Arch Surg 125:1119–1127.PubMedGoogle Scholar
  56. 56.
    Moir CR, Scudamore CH, Benny WB. 1986. Typhlitis: Selective surgical management. Am J Surg 151:563–566.PubMedCrossRefGoogle Scholar
  57. 57.
    Mower WJ, Hawkins JA, Nelson EW. 1986. Neutropenic enterocolitis in adults with acute leukemia. Arch Surg 121:571–574.PubMedGoogle Scholar
  58. 58.
    Glenn J, Funkhouser WK, Schneider PS. 1989. Acute illnesses necessitating urgent abdominal surgery in neutropenic cancer patients: Description of 14 cases and review of the literature. Surgery 105:778–789.PubMedGoogle Scholar
  59. 59.
    Wade DS, Nava HR, Douglass HO. 1992. Neutropenic enterocolitis. Clinical diagnosis and treatment. Cancer 69:17–23.PubMedCrossRefGoogle Scholar
  60. 60.
    Sloas MM, Flynn PM, Kaste SC, Patrick CC. 1993. Typhlitis in children with cancer: A 30-year experience. Clin Infect Dis 17:484–490.PubMedCrossRefGoogle Scholar

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© Kluwer Academic Publishers 1995

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  • Jean-Paul Sculier

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