[Critical care management as part of oncological therapy]

With the global rise in cancer incidence, the number of critically ill oncology patients with potential need for intensive care unit (ICU) admission is also increasing. This trend is not solely attributable to disease progression, but also to the aging of the cancer population, often accompanied by significant comorbidities, and to complications arising from modern oncologic therapies. In particular, adverse effects related to chemotherapy, hematopoietic stem cell transplantation, and immunotherapies increasingly require intensive medical intervention. Although the marked heterogeneity of this patient population makes generalizations difficult, studies have shown that critically ill patients with hematologic malignancies can demonstrate favorable survival and recovery rates despite the severity of their illness. Acute respiratory failure (ARF) is among the most frequent indications for ICU admission in cancer patients. Therapeutic management is often complex and not standardized, especially in the context of treatment limitations. Non-invasive respiratory support strategies, such as high-flow oxygen therapy or non-invasive ventilation (NIV), may offer clinical benefit in carefully selected patients, provided that close monitoring and readiness to escalate therapy are ensured. Innovative immuno-oncologic treatment strategies have substantially broadened the therapeutic spectrum in oncology and often provide severely ill patients with curative options. However, these therapies are associated with specific and sometimes life-threatening adverse effects. Among the most significant are the cytokine release syndrome (CRS), triggered for example by CAR-T cells or T-cell engagers, and the immune effector cell-associated neurotoxicity syndrome (ICANS). In addition, other immune-related adverse events (irAEs) may occur in association with checkpoint inhibitor (ICI) therapies. These potentially life-threatening complications require structured diagnostic approaches, close interdisciplinary management, and early initiation of immunomodulatory therapy.