Admission en unité de soins critiques et niveau de réanimation : application au cancer du poumon ?

Abstract

Patients with lung cancer are at high risk of developing organ failures, either directly related to the disease itself or as a consequence of its treatment, which may require admission to the intensive care unit (ICU). Such an event represents a major turning point in the patient's care pathway and remains associated with high morbidity and mortality. Recently, advances in targeted therapies and immunotherapy have significantly altered the clinical trajectory of patients with non-small cell lung cancer, prompting a reevaluation of ICU admission strategies, particularly in the context of acute respiratory failure. ICU admission decisions—as well as the intensity of organ support—must always be individualized and based on a tripartite discussion between the patient, the intensivist, and the oncologist. The aim is to establish a realistic and personalized care plan. Key elements in this decision-making process include the assessment of patient frailty, the tumor history, the number and expected reversibility of organ failures (and their underlying causes), as well as the patient's goals and family expectations.

In this review, we summarize the factors associated with ICU survival in patients with bronchial cancer—whether patient-related, tumor-related, or linked to the acute event. We then focus on the specific case of acute respiratory failure, examining its reversibility, prognosis, and the etiologic and supportive therapies that should be considered. 1877-1203/© 2025 SPLF. Published by Elsevier Masson SAS. All rights reserved.