Intensive therapy for life-threatening medical complications of haematological malignancy

The medical records of 22 consecutive adult admissions to an intensive care unit (ICU) with life-threatening complications of haematological malignancy, or its treatment, are reviewed. Twenty patients (91%) were in acute respiratory failure, and 17 of the 22 patients required intermittent positive pressure ventilation (IPPV). The in-unit mortality was 55%, but only 4 patients (18%) survived to leave the hospital. Although the unit mortality appeared to be related to the acute physiology score (APS), this small series did not demonstrate a clear relationship between the APS and long-term survival (discharge from hospital). There were, however, significant differences in the number of organ systems involved between those who died on the ICU and those who returned to the ward, as well as between those who survived to leave hospital and those who died. No patient with more than three systems involved became a long-term survivor. All long-term survivors had either reasonable peripheral white cell counts throughout or their bone marrow showed significant recovery prior to discharge from the ICU. Unresponsive malignant disease and a failure to recover bone marrow function were major factors in those patients who died shortly after discharge from the ICU. Although long-term survival rates are low and are probably largely determined by the progress of the underlying malignancy, intensive care was life-saving in four patients, three of whom are alive several years after discharge.