• Enikö Egyed, Markus M Heiss, Frank Wappler, and Samir G Sakka.
• Department of Anesthesiology and Operative Intensive Care Medicine, Medical Center Cologne Merheim, University of Witten/Herdecke, Germany; Department of Anaesthesia, Southland Hospital, Kew Road, Invercargill, New Zealand.. Electronic address: Egyed@southerndhb.govt.nz.
• J Crit Care. 2019 Jun 1; 51: 26-28.

AbstractMortality of patients treated on the intensive care unit suffering from cancer is high, especially when admitted with an unknown malignancy. Still, anti-tumor therapy in critically ill patients requiring mechanical ventilation is a clinical challenge. Over the last years, successful chemotherapy has been reported, even in critically ill patients with infections and organ failure. In this report, we present a 42-year old male patient who later was been diagnosed for a highly-malignant lymphoma (Burkitt) developed an abdominal compartment syndrome due to ileus, ascites and progressive intestinal tumor manifestation. During the course, he required mechanical ventilation and developed several organ failures including need for renal replacement therapy. After laparotomy the abdomen was left open and managed by a vacuum dressing. The patient received systemic chemotherapy and broad anti-infective treatment in presence of markedly elevated markers of inflammation. Fortunately, he was successfully weaned from vasopressor and respiratory support. By obtaining negative fluid balances closure of the abdomen succeeded 18 days after laparotomy. The patient was transferred to the normal ward without organ dysfunction on day 27 and discharged home after a second cycle of chemotherapy. In conclusion, aggressive treatment using chemotherapy in critically ill patients with initially unkown malignancy may be successful.Copyright © 2019 Elsevier Inc. All rights reserved.

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