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Table 3 Different ICU admission policies

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

 

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