Adult Patients with Primary Malignant Brain Tumor and Admission to the Intensive Care Unit

Abstract

Recent therapeutic advances have allowed improving prognosis and quality of life of adult patients suffering from malignant primary brain tumors (MPBT), sometimes after a transient medical support in the intensive care unit (ICU). Indeed, patients with MPBT may have, during the course of their neuro-oncological disease, organ failure(s) due to: (i) a destabilization of pre-existing chronic conditions; (ii) an acute pathology unrelated to MPBT; (iii) a complication of MPBT; and/or (iv) complications induced by anti-tumor treatments. The short-term and the long-term benefits of an ICU stay for patients with MPBT are not clearly documented in the literature. A dedicated study, including recent advances in the field of MPBT, would participate to remove the historical brake associated with admission of MPBT patients in ICU. Due to the lack of medical and scientific evidences, admission of MPBT patients in ICU requires a multidisciplinary discussion between the neuro-oncologist, the intensivist, the relatives of the patient and the family of the patient. This discussion will also incorporate patient’s advanced directives registered during the first visit, the prognosis and the therapeutic perspectives of the MPBT and the acute affection. Further prospective clinical studies will modulate with higher level of evidence these recommendations.