Indications de réanimation en oncologie thoracique

Lung cancer is the first cause of cancer related death. When a patient with lung cancer presents an organ failure, the question about the intensity of care to provide comes up. It is important to identify patients who may benefit from an intensive care unit (ICU) admission. Prognostic factors are related to cancer and acute disease. Patient's general condition and cancer's characteristics (TNM stage, driver mutation, tumor progression) should be taken into account. An admission for respiratory failure requiring mechanical ventilation and a high number of organ failures are associated with a poor prognosis. However, these criteria are not sufficient to take the appropriate decision. The discussion of ICU admission and management of organ failure must be multidisciplinary, combining the oncologists, the intensivists, the patient and his family. Advanced reflection facilitates decision making in emergency situations. When prognosis is uncertain, “ICU trial” may be explained and offered, and the treatment strategy should be reviewed after 3 to 5 days. The lack of improvement of organ failure after the fifth day is a major prognostic factor. © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.