Critical care of intrathoracic complications of lung cancer

Lung cancer is the most common underlying malignancy in cancer patients admitted to intensive care units. Because of the proximity to vital organs in the mediastinum, lung cancer frequently causes complications requiring critical care, including cardiac tamponade, central airway obstruction, massive hemopytsis, and superior vena cava syndrome. In addition, radiation and chemotherapeutic agents used to treat lung cancer may cause life- threatening pneumonitis in a minority of patients. There are several management options available for each complication. Educated decisions must be made based on individual patient circumstances. Technological advances have allowed for successful treatment of the majority of patients with such complications. For example, photoresection with the NdYAG laser can relieve dyspnea in 87% of patients with airway obstruction; hemorrhage can be controlled 80% of the time with bronchial artery embolization; and symptoms of superior vena cava syndrome may be relieved in more than 90% of patients. Although the median survival of cancer patients admitted to the intensive care unit is relatively short, such intervention can effectively palliate symptoms and may prolong survival.