Characteristics and outcomes of haematology patients admitted to the intensive care unit

Authors

  • Caroline McCaughey,

    Practice Educator, Corresponding author
    • C McCaughey, Practice Educator, Belfast Health and Social Care Trust and School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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  • Bronagh Blackwood,

    Lecturer
    1. B Blackwood, Lecturer, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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  • Marie Glackin,

    Nurse Lecturer
    1. M Glackin, Nurse Lecturer, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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  • Michele Brady,

    Anaesthetist
    1. MF McMullin, Professor of Haematology, Belfast Health and Social Care Trust, Belfast, UK, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
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  • Mary Frances McMullin

    Haematologist
    1. M Brady, Consultant Anaesthetist, Belfast Health and Social Care Trust, Belfast, UK
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Address for correspondence: C McCaughey, Practice Educator, Belfast Health and Social Care Trust and School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.

E-mail: caroline.mccaughey@qub.ac.uk

ABSTRACT

Aim

To profile the characteristics and outcomes of adult haematology patients admitted to the intensive care unit (ICU).

Background

The role of intensive care support for haematology patients is contentious due to high mortality rates thus generating debate regarding the inappropriate use of limited resources versus denial of effective care.

Methods

Medical notes, laboratory records and Intensive Care National Audit and Research Centre (ICNARC) data for all adult haematology patients admitted to Belfast City Hospital ICU in 2009 were analysed.

Results

Twenty one patients were admitted to the ICU; mean age was 56 years (SD 12·5), 52% were male and 82% (n = 19) had a malignant diagnosis. The main indication for admission was neutropenic sepsis with associated organ impairment (n = 18, 85%). ICU mortality was 43%. Three-month and six-month mortality rates were 62% and 67%, respectively. ICU survivors had lower acute physiology and chronic health evaluation (APACHE II) scores, and decreased requirements for invasive ventilation and inotropic support. Of the post-six-month survivors, one had a relapse, one had responding disease and five remained in remission. Two patients have subsequently undergone a reduced intensity conditioning transplant.

Conclusion

One third of patients survived for >6 months indicating that critically ill haematology patients can benefit from ICU admission, allowing progression to potentially curative therapies.

Relevance to clinical practice

This study highlights the necessity of individualized assessment regarding patient suitability for admission to a critical care facility, incorporating the perspective of both the haematologist and the intensivist.

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