Adv Hematol. 2014;2014:704318. doi: 10.1155/2014/704318. Epub 2014 Oct 1.

Ethical and clinical aspects of intensive care unit admission in patients with hematological malignancies: guidelines of the ethics commission of the French society of hematology.

Malak S1, Sotto JJ2, Ceccaldi J3, Colombat P4, Casassus P5, Jaulmes D6, Rochant H7, Cheminant M8, Beaussant Y9, Zittoun R10, Bordessoule D11.

Author information

• 1Hematology Department of the René Huguenin Hospital, Institut Curie, 35 rue Dailly, 92210 Saint-Cloud, France ; Ethics Commission of the French Society of Hematology, France.
• 2Ethics Commission of the French Society of Hematology, France ; Hematology Department of the University of Grenoble, 38043 Grenoble, France.
• 3Ethics Commission of the French Society of Hematology, France ; Hematology Department of the Robert Boulin Hospital, 33505 Libourne, France.
• 4Ethics Commission of the French Society of Hematology, France ; Hematology Department of the University of Tours, 37044 Tours, France.
• 5Ethics Commission of the French Society of Hematology, France ; Hematology Department of the University of Bobigny, 93000 Bobigny, France.
• 6Ethics Commission of the French Society of Hematology, France ; Hematology Department of the University of Saint-Antoine, 75012 Paris, France.
• 7Ethics Commission of the French Society of Hematology, France ; Hematology Department of the University of Créteil, 94010 Créteil, France.
• 8Ethics Commission of the French Society of Hematology, France ; Hematology Department of the University of Necker, 75015 Paris, France.
• 9Ethics Commission of the French Society of Hematology, France ; Hematology Department of the University of Besançon, 25030 Besançon, France.
• 10Ethics Commission of the French Society of Hematology, France ; Hematology Department of the Hôtel-Dieu Hospital, 75001 Paris, France.
• 11Ethics Commission of the French Society of Hematology, France ; Hematology Department of the University of Limoges, 87042 Limoges, France.

Abstract

Admission of patients with hematological malignancies to intensive care unit (ICU) raises recurrent ethical issues for both hematological and intensivist teams. The decision of transfer to ICU has major consequences for end of life care for patients and their relatives. It also impacts organizational human and economic aspects for the ICU and global health policy. In light of the recent advances in hematology and critical care medicine, a wide multidisciplinary debate has been conducted resulting in guidelines approved by consensus by both disciplines. The main aspects developed were (i) clarification of the clinical situations that could lead to a transfer to ICU taking into account the severity criteria of both hematological malignancy and clinical distress, (ii) understanding the process of decision-making in a context of regular interdisciplinary concertation involving the patient and his relatives, (iii) organization of a collegial concertation at the time of the initial decision of transfer to ICU and throughout and beyond the stay in ICU. The aim of this work is to propose suggestions to strengthen the collaboration between the different teams involved, to facilitate the daily decision-making process, and to allow improvement of clinical practice.