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García Roche A, Díaz Lagares C, Élez E, Ferrer Roca R. Cytokine release syndrome. Reviewing a new entity in the intensive care unit. Med Intensiva 2019; 43:480-488. [PMID: 30922608 DOI: 10.1016/j.medin.2019.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/13/2019] [Accepted: 01/19/2019] [Indexed: 01/28/2023]
Abstract
Immunotherapy seeks to harness the power of the immune system to eradicate malignant tissues. Despite impressive therapeutic success, however, it can be accompanied by severe adverse effects such as cytokine release syndrome (CRS). These therapies cause the release of a great amount of cytokines, with IL-6 playing a central role, that can potentially lead to multiple organ dysfunction. The diagnosis is based on the presence of compatible clinical symptoms, elevated biomarkers and recent treatment with a biological agent. Mild cases can be managed through symptomatic treatment and fluids, while more severe episodes may need supportive therapy and specific care with the anti-IL-6 receptor monoclonal antibody tocilizumab. Although corticosteroids are also effective, they suppress T-cell activity, and so should only be considered as second line therapy or in cases of severe neurological involvement, since tocilizumab does not cross the blood-brain barrier. Cytokine release syndrome generally has a good prognosis, often being reversible and with a good response to specific treatment. Despite possible concerns about the admission of such patients (mainly with advanced oncological disease), we consider that the Intensive Care Unit should remain an option, since these individuals present a potentially reversible drug-related adverse event and are being treated with a new drug that could change the prognosis of the disorder. Intensive care medicine will become a key component in the management of the complications of modern cancer therapies, dealing with patients presenting an overactive immune system producing organ dysfunction while also trying to maintain treatment efficacy. This is the new paradigm.
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Affiliation(s)
- Alejandra García Roche
- Intensive Care Department. SODIR Research Group. Vall d́Hebron University Hospital, Barcelona, España
| | - Cándido Díaz Lagares
- Intensive Care Department. SODIR Research Group. Vall d́Hebron University Hospital, Barcelona, España.
| | - Elena Élez
- Medical Oncology Department. VHIO. Vall d́Hebron University Hospital, Barcelona, España
| | - Ricard Ferrer Roca
- Intensive Care Department. SODIR Research Group. Vall d́Hebron University Hospital, Barcelona, España
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Song JH, Kim S, Lee HW, Lee YJ, Kim MJ, Park JS, Kim YJ, Yoon HI, Lee JH, Lee JS, Lee CT, Cho YJ. Effect of intensivist involvement on clinical outcomes in patients with advanced lung cancer admitted to the intensive care unit. PLoS One 2019; 14:e0210951. [PMID: 30759088 PMCID: PMC6373899 DOI: 10.1371/journal.pone.0210951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/06/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose Intensive care unit (ICU)-related mortality for lung cancer is ranked highest among the solid tumors and little information exists on the role of intensivists on clinical outcomes. This study aimed to elucidate the intensivist’s contribution toward clinical outcomes. Materials and methods Data of advanced lung cancer patients, including stage IIIB or IV non-small cell lung cancer and extensive-stage small cell lung cancer, admitted to the ICU from 2005 to 2016 were analyzed. Multivariate logistic regression was performed to determine variables associated with ICU and in-hospital mortality. Autoregressive integrated moving average (ARIMA) for time-series was used to assess the intensivist’s impact. Results Of 264 patients, 85 (32.2%) were admitted to the ICU before and 179 (67.8%) after organized intensive care introduction in 2011. Before and after 2011, the changes observed were as follows: ICU mortality rate, 43.5% to 40.2%, respectively (p = 0.610); hospital mortality rate, 82.4% to 65. 9% (p = 0.006). The duration of ICU and hospital stay decreased after 2011 (14.5±16.5 vs. 8.3 ± 8.6, p < 0.001; 36.6 ± 37.2 vs. 22.0 ± 19.6, p < 0.001). On multivariate analysis, admission after 2011 was independently associated with decreased hospital mortality (Odds ratio 0.42, 95% confidence interval 0.21–0.77, p = 0.006). In ARIMA models, intensivist involvement was associated with significantly reduced hospital mortality. (Estimate -17.95, standard error 5.31, p = 0.001) Conclusion In patients with advanced lung cancer, organized intensive care could contribute to improved clinical outcomes.
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Affiliation(s)
- Jin Hwa Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Ihwa-dong, Jongno-gu, Seoul, South Korea
| | - Sooyeon Kim
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Ihwa-dong, Jongno-gu, Seoul, South Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Mi-jung Kim
- Medical Oncology, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University,Seo-gu, Incheon, South Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Jong Seok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
- * E-mail: ,
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53
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Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:326. [PMID: 30514339 PMCID: PMC6280476 DOI: 10.1186/s13054-018-2076-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/21/2018] [Indexed: 12/13/2022]
Abstract
Background The study objective was to assess the influence of neutropenia on outcome of critically ill cancer patients by meta-analysis of individual data. Secondary objectives were to assess the influence of neutropenia on outcome of critically ill patients in prespecified subgroups (according to underlying tumor, period of admission, need for mechanical ventilation and use of granulocyte colony stimulating factor (G-CSF)). Methods Data sources were PubMed and the Cochrane database. Study selection included articles focusing on critically ill cancer patients published in English and studies in humans from May 2005 to May 2015. For study selection, the study eligibility was assessed by two investigators. Individual data from selected studies were obtained from corresponding authors. Results Overall, 114 studies were identified and authors of 30 studies (26.3% of selected studies) agreed to participate in this study. Of the 7515 included patients, three were excluded due to a missing major variable (neutropenia or mortality) leading to analysis of 7512 patients, including 1702 neutropenic patients (22.6%). After adjustment for confounders, and taking study effect into account, neutropenia was independently associated with mortality (OR 1.41; 95% CI 1.23–1.62; P = 0.03). When analyzed separately, neither admission period, underlying malignancy nor need for mechanical ventilation modified the prognostic influence of neutropenia on outcome. However, among patients for whom data on G-CSF administration were available (n = 1949; 25.9%), neutropenia was no longer associated with outcome in patients receiving G-CSF (OR 1.03; 95% CI 0.70–1.51; P = 0.90). Conclusion Among 7512 critically ill cancer patients included in this systematic review, neutropenia was independently associated with poor outcome despite a meaningful survival. Neutropenia was no longer significantly associated with outcome in patients treated by G-CSF, which may suggest a beneficial effect of G-CSF in neutropenic critically ill cancer patients. Systematic review registration PROSPERO CRD42015026347. Date of registration: Sept 18 2015 Electronic supplementary material The online version of this article (10.1186/s13054-018-2076-z) contains supplementary material, which is available to authorized users.
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Darvall JN, Byrne T, Douglas N, Anstey JR. Intensive Care Practice in the Cancer Patient Population:
Special Considerations and Challenges. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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55
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Díaz-Díaz D, Villanova Martínez M, Palencia Herrejón E. Pacientes oncológicos ingresados en Unidad de Cuidados Intensivos. Análisis de factores predictivos de mortalidad. Med Intensiva 2018; 42:346-353. [DOI: 10.1016/j.medin.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/05/2018] [Accepted: 02/11/2018] [Indexed: 12/25/2022]
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Pravinkumar SE, Soubani AO, Esquinas AM, Karim HM. Critically ill haematological cancer patients: How far the severity index score can determine the outcome and duration of aggressive support? Aust Crit Care 2018; 31:337-338. [PMID: 30420034 DOI: 10.1016/j.aucc.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University, Detroit, MI, USA
| | | | - Habib Mr Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India.
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57
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Shimabukuro-Vornhagen A, Gödel P, Subklewe M, Stemmler HJ, Schlößer HA, Schlaak M, Kochanek M, Böll B, von Bergwelt-Baildon MS. Cytokine release syndrome. J Immunother Cancer 2018; 6:56. [PMID: 29907163 PMCID: PMC6003181 DOI: 10.1186/s40425-018-0343-9] [Citation(s) in RCA: 946] [Impact Index Per Article: 157.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/20/2018] [Indexed: 12/16/2022] Open
Abstract
During the last decade the field of cancer immunotherapy has witnessed impressive progress. Highly effective immunotherapies such as immune checkpoint inhibition, and T-cell engaging therapies like bispecific T-cell engaging (BiTE) single-chain antibody constructs and chimeric antigen receptor (CAR) T cells have shown remarkable efficacy in clinical trials and some of these agents have already received regulatory approval. However, along with growing experience in the clinical application of these potent immunotherapeutic agents comes the increasing awareness of their inherent and potentially fatal adverse effects, most notably the cytokine release syndrome (CRS). This review provides a comprehensive overview of the mechanisms underlying CRS pathophysiology, risk factors, clinical presentation, differential diagnoses, and prognostic factors. In addition, based on the current evidence we give practical guidance to the management of the cytokine release syndrome.
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Affiliation(s)
- Alexander Shimabukuro-Vornhagen
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany. .,Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany. .,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany. .,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany.
| | - Philipp Gödel
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.,Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Translational Cancer Immunology, Gene Centre, University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Hans Joachim Stemmler
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Hans Anton Schlößer
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.,Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Max Schlaak
- Department of Dermatology/Venereology, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany.,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany
| | - Boris Böll
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany.,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany
| | - Michael S von Bergwelt-Baildon
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
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58
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Bello-Chavolla OY, Bahena-Lopez JP, Garciadiego-Fosass P, Volkow P, Garcia-Horton A, Velazquez-Acosta C, Vilar-Compte D. Bloodstream infection caused by S. aureus in patients with cancer: a 10-year longitudinal single-center study. Support Care Cancer 2018; 26:4057-4065. [PMID: 29948391 DOI: 10.1007/s00520-018-4275-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Staphylococcus aureus bloodstream infections (SABIs) represent a significant cause of morbidity and mortality in cancer patients. In this study, we compared infection characteristics and evaluated epidemiology and risk factors associated to SABIs and 30-day attributable mortality in cancer patients. METHODS Clinical and microbiological data from patients with cancer and positive blood cultures for S. aureus were retrieved during a 10-year period at an oncology reference center. Analyses were performed according to type of malignancy and infection with methicillin-resistant S. aureus (MRSA). Data was evaluated using competing risk analyses to identify risk factors associated to 30-day mortality and used to create a point system for mortality risk stratification. RESULTS We included 450 patients and MRSA was documented in 21.1%. Hospital-acquired infection, healthcare-associated pneumonia, and type-2 diabetes were associated to MRSA. In patients with hematologic malignancies, MRSA was more frequent if hospital-acquired, but less likely in primary bacteremia. Variables associated to mortality included abdominal source of infection, hematologic malignancy, MRSA, glucose levels > 140 mg/dL, and infectious endocarditis; catheter removal and initiation of adequate treatment within 48 h of positive blood culture were protective factors. From our designed mortality prediction scale, patients with a score > 3 had a 70.23% (95%CI 47.2-85.3%) probability of infection-related death at 30 days. CONCLUSION SABIs are a significant health burden for cancer patients. Risk factors for SABI-related mortality in this population are varied and impose a challenge for management to improve patient's outcomes. Risk stratification might be useful to evaluate 30-day mortality risk.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- PECEM, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Department of Infectious Diseases, Instituto Nacional de Cancerología, San Fernando 22, Sección XVI; Tlalpan, CP 14080,, Mexico City, Mexico
| | - Jessica Paola Bahena-Lopez
- PECEM, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Department of Infectious Diseases, Instituto Nacional de Cancerología, San Fernando 22, Sección XVI; Tlalpan, CP 14080,, Mexico City, Mexico
| | - Pamela Garciadiego-Fosass
- Department of Infectious Diseases, Instituto Nacional de Cancerología, San Fernando 22, Sección XVI; Tlalpan, CP 14080,, Mexico City, Mexico.,Department of Adult Intensive Care Unit, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | - Patricia Volkow
- Department of Infectious Diseases, Instituto Nacional de Cancerología, San Fernando 22, Sección XVI; Tlalpan, CP 14080,, Mexico City, Mexico
| | - Alejandro Garcia-Horton
- Department of Infectious Diseases, Instituto Nacional de Cancerología, San Fernando 22, Sección XVI; Tlalpan, CP 14080,, Mexico City, Mexico.,Department of Medicine, Division of Hematology, University of Western Ontario, London, ON, Canada
| | | | - Diana Vilar-Compte
- Department of Infectious Diseases, Instituto Nacional de Cancerología, San Fernando 22, Sección XVI; Tlalpan, CP 14080,, Mexico City, Mexico.
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[Cancer patients in operative intensive care medicine]. ACTA ACUST UNITED AC 2018; 21:68-77. [PMID: 32288864 PMCID: PMC7138133 DOI: 10.1007/s00740-018-0218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Die Prävalenz onkologischer Erkrankungen ist in den vergangenen Jahrzehnten stetig angestiegen. Durch neue Therapieoptionen können immer mehr Patienten mit einem kurativen Therapieansatz behandelt werden. Diese individualisierten und teilweise sehr aggressiven Therapien können jedoch auch zu schweren Nebenwirkungen führen. Diese sollten als wichtige Differenzialdiagnosen zu anderen vitalbedrohlichen Krankheitsbildern auch dem im OP und als Intensivmediziner tätigen Anästhesisten bekannt sein. Krebspatienten werden häufig auf operativen Intensivstationen aufgenommen, um Komplikationen der malignen Grunderkrankung oder auch Nebenwirkungen einer operativen oder konservativen Therapie zu behandeln. Aktuelle Untersuchungen zeigen, dass die maligne Grunderkrankung entgegen bisheriger Annahme keinen wesentlichen Einfluss auf das Intensivüberleben hat. Bei der Aufnahme eines onkologischen Patienten sollte daher die akut vorliegende Organdysfunktion zunächst im Vordergrund stehen. Bei der Therapiezielplanung gilt es, nicht zu übersehen, wann ein kuratives in ein palliatives Konzept übergehen muss. Hierfür müssen neue Aufnahmestrategien und -kriterien entwickelt und evaluiert werden. In diesem Übersichtsartikel werden Diagnosen und Therapien häufiger intensivmedizinischer Krankheitsbilder von onkologischen Patienten sowie Nebenwirkungen moderner onkologischer Therapien dargelegt und Aufnahmestrategien für Patienten mit malignen Erkrankungen vorgestellt.
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60
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Reis AMD, Fruchtenicht AVG, Athaydes LCDE, Loss S, Moreira LF. Biomarkers as predictors of mortality in critically ill patients with solid tumors. AN ACAD BRAS CIENC 2017; 89:2921-2929. [PMID: 29236864 DOI: 10.1590/0001-3765201720170601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/03/2017] [Indexed: 02/01/2023] Open
Abstract
Biochemical markers produced by the affected organ or body in response to disease have gained high clinical value due to assess disease development and being excellent predictors of morbidity and mortality. The aim of this study is to analyze different biochemical markers in critically cancer patients and to determine which of them can be used as predictors of mortality. This is a prospective, cross-sectional study conducted at a University Hospital in Porto Alegre - RS. Screening was done to include patients in the study. Serum biochemical markers obtained in the first 24 hours of Intensive Care Unit hospitalization were analyzed. A second review of medical records occurred after three months objected to identify death or Unit discharged. A sample of 130 individuals was obtained (control group n = 65, study group n = 65). In the multivariate model, serum magnesium values OR = 3.97 (1.17; 13.5), presence of neoplasia OR = 2.68 (95% CI 1.13; 6.37) and absence of sepsis OR = 0.31 (95% CI 0.12; 0.79) were robust predictors of mortality. The association of solid tumors, sepsis presence and alteration in serum magnesium levels resulted in an increased chance of mortality in critically ill patients.
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Affiliation(s)
- Audrey M Dos Reis
- Programa de Pós-Graduação em Nutrição, Departamento de Nutrição, Universidade Federal do Rio Grande do Sul/UFRGS, FAMED, HCPA, Rua Ramiro Barcelos, 2400, 91035-095 Porto Alegre, RS, Brazil
| | - Ana V G Fruchtenicht
- Programa de Pós-Graduação em Cirurgia, Departamento de Medicina, Universidade Federal do Rio Grande do Sul/UFRGS, FAMED, HCPA, Rua Ramiro Barcelos, 2400, 91035-095 Porto Alegre, RS, Brazil
| | - Luiza C DE Athaydes
- Departamento de Nutrição, Universidade Federal do Rio Grande do Sul/UFRGS, FAMED, Rua Ramiro Barcelos, 2400, 91035-095 Porto Alegre, RS, Brazil
| | - Sérgio Loss
- Programa de Pós-Graduação em Medicina, Departamento de Medicina, FAMED, HCPA, Universidade Federal do Rio Grande do Sul/UFRGS, Rua Ramiro Barcelos, 2400, 91035-095 Porto Alegre, RS, Brazil
| | - Luis Fernando Moreira
- Programa de Pós-Graduação em Cirurgia, Departamento de Medicina, Universidade Federal do Rio Grande do Sul/UFRGS, FAMED, HCPA, Rua Ramiro Barcelos, 2400, 91035-095 Porto Alegre, RS, Brazil
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Palliative Care Communication in the ICU: Implications for an Oncology-Critical Care Nursing Partnership. Semin Oncol Nurs 2017; 33:544-554. [PMID: 29107532 DOI: 10.1016/j.soncn.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To describe the development, launch, implementation, and outcomes of a unique multisite collaborative (ie, IMPACT-ICU [Integrating Multidisciplinary Palliative Care into the ICU]) to teach ICU nurses communication skills specific to palliative care. To identify options for collaboration between oncology and critical care nurses when integrating palliation into nursing care planning. DATA SOURCES Published literature and collective experiences of the authors in the provision of onco-critical-palliative care. CONCLUSION While critical care nurses were the initial focus of education, oncology, telemetry, step-down, and medical-surgical nurses within five university medical centers subsequently participated in this learning collaborative. Participants reported enhanced confidence in communicating with patients, families, and physicians, offering emotional support and involvement in family meetings. IMPLICATIONS FOR NURSING PRACTICE Communication education is a vital yet missing element of undergraduate nursing education. Programs should be offered in the work setting to address this gap in needed nurse competency, particularly within the context of onco-critical-palliative care.
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62
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Benekli M. Challenging decision: ICU admission of critically ill elderly solid tumor patients. J Thorac Dis 2017; 9:3564-3567. [PMID: 29268342 PMCID: PMC5723797 DOI: 10.21037/jtd.2017.09.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 08/30/2023]
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63
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Understanding cytokine release syndrome. Intensive Care Med 2017; 44:371-373. [PMID: 28956093 DOI: 10.1007/s00134-017-4943-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/14/2017] [Indexed: 12/30/2022]
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Characteristics and Outcome of Cancer Patients Admitted to the ICU in England, Wales, and Northern Ireland and National Trends Between 1997 and 2013. Crit Care Med 2017; 45:1668-1676. [PMID: 28682838 DOI: 10.1097/ccm.0000000000002589] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To describe trends in outcomes of cancer patients with an unplanned admission to the ICU between 1997 and 2013 and to identify risk factors for mortality of those admitted between 2009 and 2013. DESIGN Retrospective analysis. SETTING Intensive Care National Audit & Research Centre Case Mix Programme Database including data of ICUs in England, Wales, and Northern Ireland. PATIENTS Patients (99,590) with a solid tumor and 13,538 patients with a hematological malignancy with an unplanned ICU admission between 1997 and 2013; 39,734 solid tumor patients and 6,652 patients with a hematological malignancy who were admitted between 2009 and 2013 were analyzed in depth. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In solid tumor patients admitted between 2009 and 2013, hospital mortality was 26.4%. Independent risk factors for hospital mortality were metastatic disease (odds ratio, 1.99), cardiopulmonary resuscitation before ICU admission (odds ratio, 1.63), Intensive Care National Audit & Research Centre Physiology score (odds ratio, 1.14), admission for gastrointestinal (odds ratio, 1.12), respiratory (odds ratio, 1.48) or neurological (odds ratio, 1.65) reasons, and previous ICU admission (odds ratio, 1.18). In patients with a hematological malignancy admitted between 2009 and 2013, hospital mortality was 53.6%. Independent risk factors for hospital mortality were age (odds ratio, 1.02), cardiopulmonary resuscitation before ICU admission (odds ratio, 1.90), Intensive Care National Audit & Research Centre Physiology Score (odds ratio, 1.12), admission for hematological (odds ratio, 1.48) or respiratory (odds ratio, 1.56) reasons, bone marrow transplant (odds ratio, 1.53), previous ICU admission (odds ratio, 1.43), and mechanical ventilation within 24 hours of admission (odds ratio, 1.33). Trend analysis showed a significant decrease in ICU and hospital mortality and length of stay between 1997 and 2013 despite little change in severity of illness during this time. CONCLUSIONS Between 1997 and 2013, the outcome of cancer patients with an unplanned admission to ICU improved significantly. Among those admitted between 2009 and 2013, independent risk factors for hospital mortality were age, severity of illness, previous cardiopulmonary resuscitation, previous ICU admission, metastatic disease, and admission for respiratory reasons.
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Vincent F, Bouguerba A, Ayed S. Regarding "Emergencies in Hematology and Oncology"-II. Mayo Clin Proc 2017; 92:1453-1454. [PMID: 28870361 DOI: 10.1016/j.mayocp.2017.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 11/20/2022]
Affiliation(s)
- François Vincent
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal, Le-Raincy Montfermeil, Montfermeil, France
| | - Abdelaziz Bouguerba
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal, Le-Raincy Montfermeil, Montfermeil, France
| | - Soufia Ayed
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal, Le-Raincy Montfermeil, Montfermeil, France
| | -
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal, Le-Raincy Montfermeil, Montfermeil, France
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66
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Vincent F, Chapuis L, Ayed S, Bouguerba A, Yaacoubi S, Bornstain C. Palliative care should be extended to the intensive care unit cancer patients. Support Care Cancer 2017; 25:2365-2366. [PMID: 28283806 DOI: 10.1007/s00520-017-3669-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- François Vincent
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France.
| | - Laurent Chapuis
- Mobile Palliative Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, Montfermeil, France
| | - Soufia Ayed
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France
| | - Abdelaziz Bouguerba
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France
| | - Sondes Yaacoubi
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France
| | - Caroline Bornstain
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France
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67
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Azoulay E, Schellongowski P, Darmon M, Bauer PR, Benoit D, Depuydt P, Divatia JV, Lemiale V, van Vliet M, Meert AP, Mokart D, Pastores SM, Perner A, Pène F, Pickkers P, Puxty KA, Vincent F, Salluh J, Soubani AO, Antonelli M, Staudinger T, von Bergwelt-Baildon M, Soares M. The Intensive Care Medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med 2017; 43:1366-1382. [PMID: 28725926 DOI: 10.1007/s00134-017-4884-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
Abstract
Over the coming years, accelerating progress against cancer will be associated with an increased number of patients who require life-sustaining therapies for infectious or toxic chemotherapy-related events. Major changes include increased number of cancer patients admitted to the ICU with full-code status or for time-limited trials, increased survival and quality of life in ICU survivors, changing prognostic factors, early ICU admission for optimal monitoring, and use of noninvasive diagnostic and therapeutic strategies. In this review, experts in the management of critically ill cancer patients highlight recent changes in the use and the results of intensive care in patients with malignancies. They seek to put forward a standard of care for the management of these patients and highlight important updates that are required to care for them. The research agenda they suggest includes important studies to be conducted in the next few years to increase our understanding of organ dysfunction in this population and to improve our ability to appropriately use life-saving therapies or select new therapeutic approaches that are likely to improve outcomes. This review aims to provide more guidance for the daily management of patients with cancer, in whom outcomes are constantly improving, as is our global ability to fight against what is becoming the leading cause of mortality in industrialized and non-industrialized countries.
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Affiliation(s)
- Elie Azoulay
- ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France. .,Medical Intensive Care Unit, Hôpital Saint-Louis, Paris, France.
| | | | - Michael Darmon
- Saint-Etienne University Hospital, Saint-Etienne, France
| | | | | | | | | | | | | | | | | | | | | | | | - Peter Pickkers
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Jorge Salluh
- Instituto de Ensino e Perquisa da Santa Casa de Belo Horizonte, Rio de Janeiro, Brazil
| | | | | | | | | | - Marcio Soares
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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68
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Nassar AP, Dettino ALA, Amendola CP, Dos Santos RA, Forte DN, Caruso P. Oncologists' and Intensivists' Attitudes Toward the Care of Critically Ill Patients with Cancer. J Intensive Care Med 2017; 34:811-817. [PMID: 28675982 DOI: 10.1177/0885066617716105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with cancer represent an important proportion of intensive care unit (ICU) admissions. Oncologists and intensivists have distinct knowledge backgrounds, and conflicts about the appropriate management of these patients may emerge. METHODS We surveyed oncologists and intensivists at 2 academic cancer centers regarding their management of 2 hypothetical patients with different cancer types (metastatic pancreatic cancer and metastatic breast cancer with positive receptors for estrogen, progesterone, and HER-2) who develop septic shock and multiple organ failure. RESULTS Sixty intensivists and 46 oncologists responded to the survey. Oncologists and intensivists similarly favored withdrawal of life support measures for the patient with pancreatic cancer (33/46 [72%] vs 48/60 [80%], P = .45). On the other hand, intensivists favored more withdrawal of life support measures for the patient with breast cancer compared to oncologists (32/59 [54%] vs 9/44 [21%], P < .001). In the multinomial logistic regression, the oncology specialists were more likely to advocate for a full-code status for the patient with breast cancer (OR = 5.931; CI 95%, 1.762-19.956; P = .004). CONCLUSIONS Oncologists and intensivists share different views regarding life support measures in critically ill patients with cancer. Oncologists tend to focus on the cancer characteristics, whereas intensivists focus on multiple organ failure when weighing in on the same decisions. Regular meetings between oncologists and intensivists may reduce possible conflicts regarding the critical care of patients with cancer.
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Affiliation(s)
- Antonio Paulo Nassar
- 1 Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil.,2 Intensive Care Unit, Discipline of Medical Emergencies, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | | | - Rodrigo Alves Dos Santos
- 4 Intensive Care Unit, Pio XII Foundation, Barretos Cancer Hospital, Barretos, Brazil.,5 Barretos School of Health Sciences, Barretos, Brazil
| | - Daniel Neves Forte
- 2 Intensive Care Unit, Discipline of Medical Emergencies, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.,6 Department of Palliative Care, Hospital Sírio Libanês, São Paulo, Brazil
| | - Pedro Caruso
- 1 Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil.,7 Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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69
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Calderón-Pelayo R, León P, Monedero P, Calderón-Breñosa P, Vives M, Panadero A. Influence of Chemotherapy Within 30 Days Before ICU Admission on Mortality in Critically Ill Medical Patients With Cancer. J Intensive Care Med 2017; 34:732-739. [PMID: 28578599 DOI: 10.1177/0885066617711894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The main objective was to determine whether the administration of chemotherapy (CT) during the month before intensive care unit (ICU) admission of medical patients with cancer influences the survival rate. The design was a single-institution observational cohort study in an ICU of a tertiary university hospital. METHODS Our cohort included 248 oncology patients admitted to the ICU from 2005 to 2014 due to nonsurgical problems. Seventy-six (30.6%) patients had received CT in the month before admission (CT group) and 172 did not receive CT (control group). The main outcome measures were ICU, hospital, 30-day, 90-day, and 1-year mortalities. We performed survival analysis using the Kaplan-Meier estimator, comparing both groups using the log-rank test, and multivariate analysis using Cox regression adjusted for gender, age, maximum Sequential Organ Failure Assessment (SOFA), and delta maximum SOFA to calculate the hazard ratios (HRs) and their respective 95% confidence intervals. This association was also evaluated by a graphic representation of survival. RESULTS The CT group presented an ICU mortality rate of 27.6% versus 25.5% in the control group. The multivariate analysis adjusted for age, sex, and delta maximum SOFA showed significant differences between the groups (HR: 2.12; P = .009). The hospital mortality rate was 55.3% in the CT group compared to 45.4% in the control group (adjusted HR: 1.81; P = .003). At 30 days, the mortality rate was 56.6% in the CT group compared to 46.5% in the control group (adjusted HR: 1.69; P = .008). Mortality at 90 days was 65.8% in the CT group versus 59.9% in the control group (adjusted HR: 1.47; P = .03). One-year mortality was also higher in the CT group (79% vs 72.7%, adjusted HR: 1.44; P = .02). CONCLUSION The administration of CT in the month before ICU admission in patients with cancer was associated with higher mortality in the ICU, in the hospital, and 30 and 90 days after admission when adjusted for the increase in organ failure measured by delta maximum SOFA. We provide useful new information for decision-making about ICU management of patients with cancer.
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Affiliation(s)
- Ricardo Calderón-Pelayo
- 1 Department of Anesthesia and Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
| | - Pilar León
- 2 Department of Biomedical Humanities, School of Medicine, University of Navarra, Pamplona, Spain
| | - Pablo Monedero
- 1 Department of Anesthesia and Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
| | - Pilar Calderón-Breñosa
- 3 Department of Anesthesia, Resuscitation and Pain Management, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marc Vives
- 4 Department of Anesthesia and Intensive Care, Hospital Universitari Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Alfredo Panadero
- 1 Department of Anesthesia and Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
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Abstract
Advances in cancer treatment and patient survival are associated with increasing number of these patients requiring intensive care. Over the last 2 decades, there has been a steady improvement in the outcomes of critically ill patients with cancer. This review provides data on the use of the intensive care unit (ICU) and short and long-term outcomes of critically ill patients with cancer, the ICU system practices that influence patients outcomes, and the role of the different clinical variables in predicting the prognosis of these patients.
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Affiliation(s)
- Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R- 3 Hudson, Detroit, MI 48201, USA.
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