Clinical Features and Short-Term Outcome of Critically Ill Patients With Head and Neck Cancer in the Medical Intensive Care Unit

Am J Clin Oncol. 2009 Oct;32(5):467-71. doi: 10.1097/COC.0b013e3181931236.

Abstract

Objectives: To investigate the clinical features, especially cancer-related complications, and short-term outcome of critically ill patients with head and neck cancer (HNC) in the medical intensive care unit.

Methods: We reviewed 57 patients with a diagnosis of HNC in the medical intensive care unit (≥ 24 hours) of a tertiary-care medical center between January 1999 and December 2005.

Results: Thirty-two (56.1%) patients had advanced cancers (stage III/IV), and 21 (36.8%) remained uncontrolled (ie, relapsed or progressive). Twenty-five (43.9%) patients had cancer-related complications, including airway obstruction, tumor bleeding, or wound infection. Among 47 (82.4%) patients with acute respiratory failure, 25.5% of them were caused by cancer-related life-threatening airway complications. After excluding 5 already tracheostomized acute respiratory failure patients, difficult intubation was encountered in 26.2% (11/42); and 72.7% (8/11) of them required emergency tracheostomy. The 30-day mortality was 38.6%. Uncontrolled HNC (adjusted odds ratio [OR], 4.13; 95% confidence interval, 1.14-14.92) and Acute Physiology and Chronic Health Evaluation II score (adjusted OR 1.13; 95% confidence interval, 1.04-1.22) were found as the risk factors for 30-day mortality in multivariate analysis.

Conclusions: Although critically ill patients with HNC usually had advanced cancers and carried a high rate of cancer-related life-threatening airway complications, their 30-day mortality was favorable and only independently associated with cancer status and Acute Physiology and Chronic Health Evaluation II score.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • APACHE
  • Aged
  • Airway Obstruction / etiology
  • Critical Illness / mortality*
  • Female
  • Head and Neck Neoplasms / complications*
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / therapy
  • Hospital Mortality
  • Humans
  • Intensive Care Units*
  • Length of Stay
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Prognosis
  • Respiration, Artificial / methods*
  • Retrospective Studies
  • Risk Factors
  • Taiwan