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Evaluation of Patients with Hematological Malignancies Admitted to the General Intensive Care Unit - Should There be Dedicated Hematological ICUs?

TURKISH JOURNAL OF INTENSIVE CARE-TURK YOGUN BAKIM DERGISI(2023)

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Abstract
Objective: With new treatment modalities, the overall survival of patients with hematological malignancies (HM) has increased over the years. However, intensive care unit (ICU) mortality is still high. This study aimed to evaluate the clinical characteristics, treatment methods, and results of HM patients admitted to the ICU at a center in Turkey. Materials and Methods: Patients with HM admitted to the ICU between January 2013 and 2020 were retrospectively evaluated. A total of 172 adult patients with HM were included in the study. Results: The median (interquartile range) age of patients was 60 (47-67) years, admission Acute Physiology Assessment and Chronic Health Evaluation-II score was 30 (26-32), Sequential Organ Failure Assessment score was 10 (7-12). Results of the 172 patients, 60 (34.9%) had newly diagnosed malignancies, 16 (9.3%) were in remission, and 96 (55.8%) had relapsed/refractory disease. The ICU admission was mostly required for acute respiratory failure (62.5%) and/or shock (42.3%). Forty-seven (27.3%) patients had stem cell transplantation, and 59 (34.3%) were neutropenic. Of them, 143 (83.2%) patients were admitted to intensive care after intubation and 159 (92.4%) patients needed vasopressors during intensive care stay. Thirteen (7.5%) patients were diagnosed with fiberoptic bronchoscopy-bronchoalveolar lavage sampling only, and treatment was changed in 85% according to the results. We observed that the patients were admitted to the ICU at the 28th hour (11-55) after determining the need for ICU follow-up. Intensive care mortality was 94.3% (163). Conclusion: Early detection of critical illness and rapid admission to the ICU are important for the patients with HM. Collaborative studies determining early admission criteria to ICUs should be performed by the intensivists and hematologists to improve survival. This may be achieved by allocating special ICUs for these patients within the hematology clinics.
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Key words
Hematological malignancies,intensive care,mortality,admission time
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