• Hsiu-Nien Shen, Kuo-Chen Cheng, Ching-Cheng Hou, Che-Kim Tan, and Wen-Tsung Huang.
• Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
• Am. J. Clin. Oncol. 2009 Oct 1; 32 (5): 467-71.

ObjectivesTo 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.MethodsWe 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.ResultsThirty-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.ConclusionsAlthough 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.

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