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Intensive Care Management of the Patient With Cystic Fibrosis

Department of Pediatrics, University of Massachusetts Medical Center, Worcester, Massachusetts, kremert{at}ummhc.org

Robert G. Zwerdling, MD

Department of Pediatrics, University of Massachusetts Medical Center, Worcester, Massachusetts

Peter H. Michelson, MD

Division of Pulmonary Medicine, Children's Hospital of Pittsburgh, Pennsylvania

Brian P. O'Sullivan, MD

Department of Pediatrics, University of Massachusetts Medical Center, Worcester, Massachusetts

Cystic fibrosis was previously thought to be a disease of childhood. With a better understanding of this condition along with improvements in therapy, patients with cystic fibrosis are now living well into adulthood. The aim of this article is to familiarize the intensive care unit physician with cystic fibrosis care, to discuss complications associated with cystic fibrosis specifically related to the intensive care unit, and to detail the current recommendations for the clinical management of the patient with cystic fibrosis. With advancing disease, the most severely affected organs are the lungs. Obstruction, infection, and inflammation contribute to the decline of pulmonary function, ultimately leading to death. Some patients may be eligible for lung transplantation, but choosing wisely will affect posttransplant survival. Because other organs are affected by the genetic defect and associated treatments, serious complications related to the liver, pancreas, intestines, and kidneys must be considered by the intensivist faced with a patient with cystic fibrosis. As practitioners, the fact that not all patients will survive and help our patients and families gracefully through the end-of-life process should be accepted.

Key Words: cystic fibrosis • pseudomonas aeruginosa • lung transplantation • extrapulmonary complications • end-of-life care

This version was published on May 1, 2008

Journal of Intensive Care Medicine, Vol. 23, No. 3, 159-177 (2008)
DOI: 10.1177/0885066608315679


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