++
Respiratory, neurologic, metabolic, thoracic, and cardiac emergencies constitute life-threatening complications in patients with malignancies. These oncologic emergencies often result from the cancer itself and/or from treatment of the cancer.
Increased activation of the coagulation system, administration of thrombogenic chemotherapy regimens, and placement of intravascular venous catheters place cancer patients at higher risk for pulmonary embolism and hemodynamic instability.
Neurologic emergencies in cancer patients include status epilepticus, malignant spinal cord compression, and intracranial hemorrhage.
Radiation therapy and corticosteroids are the mainstays of treatment of malignant spinal cord compression.
Malignancy-associated hypercalcemia (MAH) can be divided into humoral, osteolytic, and calcitriol-associated hypercalcemia. Bisphosphonates are the most efficient and recommended treatment for MAH.
Tumor lysis syndrome is associated with hyperuricemia, hyperphosphatemia, hypocalcemia, and hyperkalemia, which if left untreated can lead to arrhythmias and death. Treatment includes aggressive hydration, specific treatment of individual metabolic derangements, allopurinol or rasburicase, and hemodialysis for severe hyperphosphatemia and symptomatic hypocalcemia.
Leukapheresis is usually initiated for the treatment of leukostasis associated with acute myelogenous leukemia if the WBC count >50,000/mm3 and in acute lymphoblastic leukemia if the WBC count is >250,000/mm3.
Ninety percent of malignant causes of superior vena cava syndrome (SCVS) are due to lung cancer and lymphoma. Patients presenting with cerebral edema and airway compromise due to SVCS should be treated urgently and considered for SVC stenting.
Treatment for cardiac tamponade requires emergent drainage by either pericardiocentesis or pericardial window.
++
Significant advances in cancer care and preventive strategies have decreased the incidence of the classic oncologic emergencies (eg, superior vena cava syndrome, tumor lysis syndrome, and malignant spinal cord compression) that previously necessitated admission to the intensive care unit (ICU). Currently, cancer patients in the ICU are more frequently admitted for respiratory and cardiac failure, life-threatening sepsis, metabolic complications, and hemorrhagic and thrombotic disorders. Similar to the classic oncologic emergencies, these syndromes often result from the cancer itself and/or from treatment of the cancer. This chapter will discuss the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of the common and classic oncologic emergencies that ICU clinicians will encounter in their practice. These include respiratory, neurologic, metabolic, thoracic, and cardiac emergencies.
+++
RESPIRATORY EMERGENCIES
++
Pulmonary embolism (PE) leads to 300,000 deaths a year and is the second most common cause of death in cancer patients.1-3 Increased activation of the coagulation system, administration of thrombogenic chemotherapy regimens, and placement of intravascular venous catheters place oncological patients at higher risk for thromboembolic disease.3 Early recognition and treatment of PE is essential due to its high mortality when left untreated.
++
Patients with PE should be admitted to the ICU when there is significant respiratory compromise, presence of hemodynamic instability, right-sided heart failure, or high risk of cardiovascular collapse. Right-sided heart failure in the setting of massive PE is associated with a ...