From: Intensive care of the cancer patient: recent achievements and remaining challenges
Type of ICU admission | Code status | Clinical situation |
---|---|---|
1. Full code ICU management | Full code | Newly diagnosed malignancies Malignancies in complete remission |
2. ICU trial | Unlimited for a limited time period—at least 3 to 5 days | Clinical response to therapy not available or undetermined |
3. Exceptional ICU admission | Same as ICU trial | Newly available effective therapy that should be tested in a patient who becomes critically ill |
4. Heroic ICU admission | ICU management until conflict resolution | Both hematologists/oncologists and intensivists agree that ICU admission is not appropriate, but patients or relatives disagree with the appropriate level of care |
5. Other admission modalities that are performed but not yet formally evaluated | Â | |
a) Prophylactic ICU admission | Full code; intensive clinical and biological monitoring; invasive procedures under safer conditions | Earliest phase of high-risk malignancies. Admission to the ICU is warranted to avoid development of organ dysfunction (acute respiratory failure, tumor lysis syndrome, etc.) |
b) Early ICU admission | Full code; intensive clinical and biological monitoring; invasive procedures under safe conditions; no life-sustaining therapies | Admission to the ICU in patients with no organ dysfunction but physiological disturbances. ICU is warranted to avoid late ICU admission (condition associated with higher mortality) |
c) Palliative ICU admission | Noninvasive strategies only | Admission to the ICU for the purpose of undergoing noninvasive mechanical ventilation as the ceiling of therapy |
d) In-ICU non-ICU care | No life-sustaining therapies | Short ICU admission to help for optimal and prompt management (catheter withdrawal, early antibiotics etc.) |
e) Terminal ICU admission | No life-sustaining therapies | ICU admission is required to best provide palliative care and symptom control. Controversial issue |