Critical Care Medicine

Oncology Medical Intensive Care Unit

Approximately 20% of critically ill patients carry a diagnosis of cancer and up to 5% of all cancer patients will require ICU care for the management of acute life-threatening emergencies. The complexity of their underlying illness, rapidly evolving oncologic therapies, and distinct treatment-related toxicities make the ICU care needs of critically ill patients with cancer uniquely challenging. Studies show better outcomes when patients receive their care in centers that are experienced with chemotherapy as well as standardized processes for the oncological population.

In January of 2023, the Cleveland Clinic Main Campus Medical Intensive Care Unit launched a dedicated Oncology Medical Intensive Care Unit (ICU), one of a few dedicated Oncology ICUs across the US, to better meet the complex care needs of this vulnerable patient population. This dedicated ICU team aims to address exactly these items by facilitating effective collaboration and communication between ICU and oncology teams, standardizing inter-disciplinary ICU workflows, and establishing and implementing oncology-specific protocols and best practices. In addition, the Oncology Medical ICU team conducts a daily, virtual, morning ICU-oncology huddle, which allows the coordination of care and identifies at-risk patients for early ICU evaluation and interventions if indicated.

The Oncology Medical ICU team is an interdisciplinary team led by core ICU faculty with expertise in the care of oncologic and hematologic disorders, dedicated oncology-ICU pharmacists, experienced advanced-practice providers (nurse practitioners and physician assistants), and, importantly, a nursing team cross-trained in oncology care. The Oncology Medical ICU team works in close collaboration with the lymphoma, myeloma, leukemia, bone marrow transplant, and solid tumor oncology faculty, as well as dedicated infectious disease, nephrology, and palliative care faculty.

In 2023, the Oncology Medical ICU team collaborated in the care of 307 patients. (456 ICU admissions). In addition, the Oncology Medical ICU nursing team independently administered 182 doses of IV chemotherapy in the ICU. Average ICU and hospital length of stay in 2023 was 5.9 days and 20.2 days, respectively.

Podcasts

Cleveland Clinic Respiratory Medicine hosts podcasts series available on all major platforms including Apple, Google, Soundcloud and Spotify. Click on a link below to find and listen to the following podcasts:

‘Critical Care for Patients With Cancer’ hosted by Hassan Khouli, MD, Director, Critical Care Center and Chair, Critical Care Medicine with guests Simon Mucha, MD, Director, Oncology Medical Intensive Care Unit, Main Campus, and Humberto Choi, MD, Medical Director, Critical Care Advanced Practice Providers, Associate Medical Director, Oncology Medical Intensive Care Unit. Find it at both Respiratory Inspirations and Respiratory Exchange.

'Immunotherapy Pulmonary Toxicity' hosted by Daniel Culver, DO, Chair, Pulmonary Medicine with guests Simon Mucha, MD, Director, Oncology Medical Intensive Care Unit, Main Campus, and Mamoun Abdoh, MD, Director of Operations, Thoracic Oncology Section, East Region. Find it at Respiratory Inspirations.

‘Immunotherapy-Caused Pneumonitis: Identification and Treatment’ hosted by Daniel Culver, DO, Chair, Pulmonary Medicine with guests Simon Mucha, MD, Director, Oncology Medical Intensive Care Unit, Main Campus, and Mamoun Abdoh, MD, Director of Operations, Thoracic Oncology Section, East Region. Find it at Respiratory Exchange.

Oncology Medical ICU APACHE® III Score

2023

APACHE = The Acute Physiology and Chronic Health Evaluation, a severity-of-disease classification system, ICU = Intensive Care Unit

ᵃ Benchmark is for national average for all critical care patients. The national average of 54.5 reflects the current practice of critical care in the US for a large adult population.

This patient population had a high severity of illness with an APACHE III Score of 78.08.

Reference

  1. Lilly CM, Zuckerman IH, Badawi O, Riker RR. Benchmark data from more than 240,000 adults that reflect the current practice of critical care in the United States. Chest. 2011 Nov;140(5):1232-1242.
Oncology Medical ICU and Hospital Mortality O:E

2023

ICU = intensive care unit, O:E = observed to expected

The ICU and hospital mortality rates for these patients were 16% and 23% percent respectively, both with an expected to observed (O:E) mortality rate of 1.02.

Oncology Medical ICU Hospital Discharge Alive Disposition

2023

ICU = intensive care unit

Despite a high level of critical illness, 55% of patients who were in the Oncology Medical ICU were transferred to the regular nursing floor and discharged to home or to a rehab facility.