Clinical Scorecard: Clinical Outcomes for Glioblastoma Patients Requiring Invasive Mechanical Ventilation in the Intensive Care Unit: A Multicenter Study

At a Glance

Key Highlights

• Glioblastoma patients admitted to ICU with invasive mechanical ventilation have diverse reasons for admission including infections (34.3%), status epilepticus (31.4%), and elevated intracranial pressure (22.9%).
• Median overall survival for glioblastoma remains poor (12–18 months) despite multimodal therapy.
• ICU mortality rates for cancer patients, including glioblastoma, are comparable to non-oncological patients and should not be a reason for ICU refusal.

Guideline-Based Recommendations

Diagnosis

• Histological confirmation of glioblastoma according to WHO classification.
• Diagnosis of elevated intracranial pressure based on clinical, imaging, and intracranial pressure measurements where available.
• Status epilepticus diagnosis based on clinical parameters and EEG according to national guidelines.

Management

• Admission to ICU with invasive mechanical ventilation for acute medical conditions such as coma, elevated intracranial pressure, sepsis with respiratory failure, airway protection, or refractory status epilepticus.
• Treatment according to national and international guidelines in interdisciplinary teams including neuro-intensive care physicians and neuro-oncologists.
• Prophylactic antibiotic therapy (e.g., cotrimoxazole) during radio-chemotherapy to prevent opportunistic infections.

Monitoring & Follow-up

• Regular reassessment of treatment goals due to poor prognosis.
• Monitoring of functional status using Karnofsky Performance Status Scale (KPS).
• Close surveillance for complications such as infections, seizures, and intracranial pressure changes.

Risks

• High risk of mortality associated with glioblastoma despite ICU care.
• Potential for opportunistic infections including Pneumocystis jirovecii pneumonia despite prophylaxis.
• Complications from tumor therapy and disease progression leading to ICU admission.

Patient & Prescribing Data

33 adult glioblastoma patients requiring invasive mechanical ventilation in ICU across four German brain tumor centers (2015–2019).

Multimodal tumor therapy including surgery, radiotherapy, temozolomide or temozolomide/lomustine, and tumor treating fields; prophylactic antibiotics during radio-chemotherapy; ICU treatment tailored to acute complications.

Clinical Best Practices

• Use interdisciplinary teams including neuro-intensive care and neuro-oncology specialists for management.
• Apply structured data collection and regular reassessment of treatment goals in ICU patients with glioblastoma.
• Do not deny ICU admission solely based on cancer diagnosis given comparable ICU mortality to non-oncological patients.
• Implement prophylactic antibiotic strategies during immunosuppressive therapies to reduce opportunistic infections.
• Assess functional status at ICU discharge to guide post-ICU care and rehabilitation.

References

• Primary malignant brain tumor statistics
• Median overall survival in glioblastoma
• Multimodal therapy including temozolomide
• Temozolomide and lomustine combination therapy
• Tumor treating fields therapy
• Brain edema and intracranial pressure complications
• Structural epilepsy in glioblastoma
• ICU admission due to tumor therapy complications
• Retrospective studies on brain tumor patients in ICU
• Heterogeneous prognosis in primary malignant brain tumors
• Functional status at ICU discharge
• ICU admission policies for metastatic brain tumors
• ICU mortality rates in cancer vs non-cancer patients
• National guidelines for status epilepticus diagnosis