Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital was established in 1973. With the philosophy that critical care is an integral component of oncologic care, patients receiving treatment for cancer who become critically ill are cared for in the Cancer Center, rather than transferring to the Medical Intensive Care Unit. Critical care was historically provided in a dispersed open model. In 2014, with recognition of the increasing specialization and intensity of critical care, a dedicated Oncology and Bone Marrow Transplant Critical Care Unit was established on pod 5C of the Weinberg Building. This unique 6-bed unit provides care for all critically ill patients in the cancer center in a closed intensive care unit model. Typical patients have life-threatening complications of malignancies or treatments for malignancies, and include patients with acute leukemia, patients undergoing hematopoietic stem cell transplant, and patients with solid tumors. Patients with life-threatening complications of “benign” hematologic disease such as aplastic anemia, hemophilia, sickle cell disease, thrombocytopenic thrombotic purpura, and hemolytic uremic syndrome are also frequently admitted to this unit. Typical patient diagnoses include acute respiratory failure, neutropenic sepsis and septic shock, seizures and encephalopathy, intracranial hemorrhage, acute liver failure and acute kidney failure.

Patient care is directed by an attending faculty member from the Division of Pulmonary and Critical Care Medicine with expertise in the critical care of patients with hematologic and oncologic disorders. The critical care team, consisting of the attending, a pulmonary and critical care fellow, and an experienced nurse practitioner or physician assistant, works in close collaboration with the solid tumor, hematologic malignancies, bone marrow transplant, and hematology faculty to provide outstanding and integrated critical care. Nursing care is provided by highly trained nurses who are cross-trained in critical care, oncology nursing, and bone marrow transplant nursing. Unit capabilities include basic and advanced respiratory support (mechanical ventilation, neuromuscular blockade, prone positioning, pulmonary vasodilators), hemodynamic support, invasive hemodynamic monitoring, continuous renal replacement therapy, transvenous pacing, bronchoscopy, video laryngoscopy, rapid infusion, critical care ultrasound and ultrasound-guided procedures.

In addition to working closely with the hematology and oncology teams, the critical care team works in close collaboration with other specialties such as nephrology, transfusion medicine, interventional pulmonology, anesthesia, thoracic surgery, cardiology, neurocritical care, and gastroenterology to provide comprehensive critical care to patients. The oncology critical care team is also responsible for seeing all inpatient pulmonary consultations within the cancer center and is frequently called to evaluate pulmonary infiltrates in neutropenic hosts, suspected chemotherapy/immunotherapy toxicity, pleural disease, pulmonary nodules, and dyspnea or hypoxia.

Patient Admissions and Transfers

Patients are admitted to the Oncology/BMT Critical Care Service from the following sources:

• Oncology and BMT units
• Emergency Department
• Medicine and surgical units (initiation of urgent chemotherapy in a critically ill patient)
• Oncology Outpatient clinics, Hematologic Malignancies and BMT Inpatient Outpatient (IPOP) Clinic
• Outside hospitals: to request transfer, the requesting physician should call the Hopkins Access Line (HAL: 410-955-9444 or 1-800-765-5447) and ask to speak to the Solid Tumor or Hematologic Malignancies Triage Attending, as appropriate.

Patient Resources

• Oncology Critical Care Research Network (ONCCC-R-NET)
• American Thoracic Society Resources for Patients
• Society of Critical Care Medicine Resources for Patients
• Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins