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Characteristics and Outcome of Patients After Allogeneic Hematopoietic Stem Cell Transplantation Treated With Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome. Crit Care Med 2017; 45:e500-e507. [PMID: 28410318 DOI: 10.1097/ccm.0000000000002293] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The acute respiratory distress syndrome is a frequent condition following allogeneic hematopoietic stem cell transplantation. Extracorporeal membrane oxygenation may serve as rescue therapy in refractory acute respiratory distress syndrome but has not been assessed in allogeneic hematopoietic stem cell transplantation recipients. DESIGN Multicenter, retrospective, observational study. SETTING ICUs in 12 European tertiary care centers (Austria, Germany, France, and Belgium). PATIENTS All allogeneic hematopoietic stem cell transplantation recipients treated with venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome between 2010 and 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Thirty-seven patients, nine of whom underwent noninvasive ventilation at the time of extracorporeal membrane oxygenation initiation, were analyzed. ICU admission occurred at a median of 146 (interquartile range, 27-321) days after allogeneic hematopoietic stem cell transplantation. The main reason for acute respiratory distress syndrome was pneumonia in 81% of patients. All but one patient undergoing noninvasive ventilation at extracorporeal membrane oxygenation initiation had to be intubated thereafter. Overall, seven patients (19%) survived to hospital discharge and were alive and in remission of their hematologic disease after a follow-up of 18 (range, 5-30) months. Only one of 24 patients (4%) initiated on extracorporeal membrane oxygenation within 240 days after allogeneic hematopoietic stem cell transplantation survived compared to six of 13 (46%) of those treated thereafter (p < 0.01). Fourteen patients (38%) experienced bleeding events, of which six (16%) were associated with fatal outcomes. CONCLUSIONS Discouraging survival rates in patients treated early after allogeneic hematopoietic stem cell transplantation do not support the use of extracorporeal membrane oxygenation for acute respiratory distress syndrome in this group. On the contrary, long-term allogeneic hematopoietic stem cell transplantation recipients otherwise eligible for full-code ICU management may be potential candidates for extracorporeal membrane oxygenation therapy in case of severe acute respiratory distress syndrome failing conventional measures.
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102
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Auclin E, Charles-Nelson A, Abbar B, Guérot E, Oudard S, Hauw-Berlemont C, Thibault C, Monnier A, Diehl JL, Katsahian S, Fagon JY, Taieb J, Aissaoui N. Outcomes in elderly patients admitted to the intensive care unit with solid tumors. Ann Intensive Care 2017; 7:26. [PMID: 28265980 PMCID: PMC5339259 DOI: 10.1186/s13613-017-0250-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/23/2017] [Indexed: 12/28/2022] Open
Abstract
Background As the population ages and cancer therapies improve, there is an increased call for elderly cancer patients to be admitted to the intensive care unit (ICU). This study aimed to assess short-term survival and prognostic factors in critically ill patients with solid tumors aged ≥65 years. Methods We conducted a retrospective study. The primary endpoint was ICU mortality. Resumption of anticancer therapy in patients who survived the ICU stay and 90-day mortality were secondary endpoints. All patients aged ≥65 years admitted to the ICU of Georges Pompidou Hospital (Paris, France) between 2009 and 2014 were eligible. Results Of 2327 eligible elderly patients (EP), 262 (75.0 ± 6.7 years) with solid tumors were analyzed. These patients were extremely critically ill (SAPS 2 61.9 ± 22.5), and 60.3% had metastatic disease. Gastrointestinal, lung and genitourinary cancers were the most common types of tumors. Mechanical ventilation was required in 51.5% of patients, inotropes in 48.1% and dialysis in 12.6%. Most patients (66.7%) were admitted for reasons unrelated to cancer, including sepsis (30.5%), acute respiratory failure (28.2%) and neurological problems (8.0%). ICU mortality in patients with cancer was 33.6 versus 32.6% among patients without cancer (p = 0.75). Among the cancer EP, the 90-day mortality was 51.9% (n = 136). In multivariate analysis, increased SAPS 2 score and primary tumor site were associated with 90-day death, whereas previous anticancer therapies and poor performance status were not. Among survivor patients from ICU with anti-tumoral treatment indication, 77 (52.7%) had resumption of anticancer treatment. Conclusions Elderly solid tumor patients admitted to the ICU had a mortality rate similar to EP without cancer. Prognostic factors for 90-day mortality were more related to severity of clinical status at admission than the presence or stage of cancer, suggesting that early admission of EP with cancer to the ICU is appropriate. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0250-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edouard Auclin
- Gastrointestinal Oncology Department, European Georges Pompidou Hospital, Paris, France. .,Intensive Care Unit, European Georges Pompidou Hospital, Paris, France. .,Oncology Department, European Georges Pompidou Hospital, Paris, France. .,Université Paris Descartes, Paris, France.
| | | | - Baptiste Abbar
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France
| | - Emmanuel Guérot
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France
| | - Stéphane Oudard
- Oncology Department, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Caroline Hauw-Berlemont
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Constance Thibault
- Oncology Department, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Alexandra Monnier
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Jean-Luc Diehl
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Sandrine Katsahian
- Université Paris Descartes, Paris, France.,Clinical Research Unit, European Georges Pompidou Hospital, Paris, France
| | - Jean-Yves Fagon
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Julien Taieb
- Gastrointestinal Oncology Department, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Nadia Aissaoui
- Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.,Université Paris Descartes, Paris, France
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103
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Abstract
Since the inception of critical care as a formal discipline in the late 1950s, we have seen rapid specialization to many types of intensive care units (ICUs) to accommodate evolving life support technologies and novel therapies in various disciplines of medicine. Indeed, the field has expanded such that specialized ICUs currently exist to address critical care problems in medicine, cardiology, neurology and neurosurgery, trauma, burns, organ transplant and cardiothoracic surgeries. Specialization does not only need new infrastructure, but also training and staffing of health care providers, ancillary staff, and development and implementation of processes of care. Oncology is another branch of medicine with growing ICU needs. Given the rise in cancer incidence worldwide and better survival rates alongside advances in chemotherapeutic and surgical options, more cancer patients are nowadays requiring advanced life support for cancer-related complications, treatment-related toxicities and severe infections. Here we provide a brief summary of the current evidence supporting the specialization of critical care and explore three different models of care for critically ill cancer patients, including the development of a specialized oncological ICU. Finally, we also discuss recently published and future research related to the care of critically ill cancer patients.
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Affiliation(s)
- Abby Koch
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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104
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Vincent F, Pavese I, Gligorov J, Zamparini E, Bornstain C. Patients with delirium and advanced solid cancer in the emergency department: A challenge for the emergency practitioner, oncologist, and intensivist. Cancer 2017; 123:704-705. [PMID: 27861747 DOI: 10.1002/cncr.30452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/19/2016] [Indexed: 11/09/2022]
Affiliation(s)
- François Vincent
- Polyvalent Intensive Care Unit, Le-Raincy Montfermeil General Hospital, Montfermeil, France
| | - Ida Pavese
- Oncology Service, Le-Raincy Montfermeil Intermunicipal Hospital Group, Montfermeil, France
| | - Joseph Gligorov
- Oncology Service, Tenon Teaching Hospital, Public AP-HP; Institute-University Pierre & Marie Curie, Sorbonne University, Paris, France
| | | | - Caroline Bornstain
- Polyvalent Intensive Care Unit, Le-Raincy Montfermeil Intermunicipal Hospital Group, Montfermeil, France
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105
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Rodrigues CM, Pires EMC, Feliciano JPO, Vieira JM, Taniguchi LU. Admission factors associated with intensive care unit readmission in critically ill oncohematological patients: a retrospective cohort study. Rev Bras Ter Intensiva 2017; 28:33-9. [PMID: 27096674 PMCID: PMC4828089 DOI: 10.5935/0103-507x.20160011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 01/06/2016] [Indexed: 02/02/2023] Open
Abstract
Objective The purpose of our study was to determine the admission factors associated
with intensive care unit readmission among oncohematological patients. Methods Retrospective cohort study using an intensive care unit database from a
tertiary oncological center. The participants included 1,872 critically ill
oncohematological patients who were admitted to the intensive care unit from
January 2012 to December 2014 and who were subsequently discharged alive. We
used univariate and multivariate analysis to identify the admission risk
factors associated with later intensive care unit readmission. Results One hundred seventy-two patients (9.2% of 1,872 oncohematological patients
discharged alive from the intensive care unit) were readmitted after
intensive care unit discharge. The readmitted patients were sicker compared
with the non-readmitted group and had higher hospital mortality (32.6%
versus 3.7%, respectively; p < 0.001). In the multivariate analysis, the
independent risk factors for intensive care unit readmission were male sex
(OR: 1.5, 95% CI: 1.07 - 2.12; p = 0.019), emergency surgery as the
admission reason (OR: 2.91, 95%CI: 1.53 - 5.54; p = 0.001), longer hospital
length of stay before intensive care unit transfer (OR: 1.02, 95%CI: 1.007 -
1.035; p = 0.003), and mechanical ventilation (OR: 2.31, 95%CI: 1.57 - 3.40;
p < 0.001). Conclusions In this cohort of oncohematological patients, we identified some risk factors
associated with intensive care unit readmission, most of which are not
amenable to interventions. The identification of risk factors at intensive
care unit discharge might be a promising approach.
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Affiliation(s)
| | | | | | - Jose Mauro Vieira
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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106
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Strojnik K, Mahkovic-Hergouth K, Novakovic BJ, Seruga B. Outcome of severe infections in afebrile neutropenic cancer patients. Radiol Oncol 2016; 50:442-448. [PMID: 27904453 PMCID: PMC5120576 DOI: 10.1515/raon-2016-0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/05/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. PATIENTS AND METHODS We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher's exact test. RESULTS We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17). CONCLUSIONS Afebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy.
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Affiliation(s)
- Ksenija Strojnik
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | - Bostjan Seruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Medical Faculty, Ljubljana, Slovenia
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107
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Cheng Q, Tang Y, Yang Q, Wang E, Liu J, Li X. The prognostic factors for patients with hematological malignancies admitted to the intensive care unit. SPRINGERPLUS 2016; 5:2038. [PMID: 27995015 PMCID: PMC5127914 DOI: 10.1186/s40064-016-3714-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 11/21/2016] [Indexed: 12/15/2022]
Abstract
Owing to the nature of acute illness and adverse effects derived from intensive chemotherapy, patients with hematological malignancies (HM) who are admitted to the Intensive Care Unit (ICU) often present with poor prognosis. However, with advances in life-sustaining therapies and close collaborations between hematologists and intensive care specialists, the prognosis for these patients has improved substantially. Many studies from different countries have examined the prognostic factors of these critically ill HM patients. However, there has not been an up-to-date review on this subject, and very few studies have focused on the prognosis of patients with HM admitted to the ICU in Asian countries. Herein, we aim to explore the current situation and prognostic factors in patients with HM admitted to ICU, mainly focusing on studies published in the last 10 years.
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Affiliation(s)
- Qian Cheng
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Yishu Tang
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Qing Yang
- Department of Medicine, Yale New Haven Hospital, New Haven, CT USA
| | - Erhua Wang
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Jing Liu
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Xin Li
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
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108
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Waszczuk-Gajda A, Wiktor Jedrzejczak W. Prognostic factors in the survival of patients with blood disorders recovering from septic shock. Hematology 2016; 22:292-298. [DOI: 10.1080/10245332.2016.1253521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
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109
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Torres VBL, Vassalo J, Silva UVA, Caruso P, Torelly AP, Silva E, Teles JMM, Knibel M, Rezende E, Netto JJS, Piras C, Azevedo LCP, Bozza FA, Spector N, Salluh JIF, Soares M. Outcomes in Critically Ill Patients with Cancer-Related Complications. PLoS One 2016; 11:e0164537. [PMID: 27764143 PMCID: PMC5072702 DOI: 10.1371/journal.pone.0164537] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients. MATERIALS AND METHODS Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality. RESULTS Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P<0.001 for all analyses). ICU (47% vs. 27%) and hospital (63% vs. 38%) mortality rates were also higher in patients with cancer-related complications (P<0.001). Chemo/radiation therapy-induced toxicity (6%), venous thromboembolism (5%), respiratory failure (4%), gastrointestinal involvement (3%) and vena cava syndrome (VCS) (2%) were the most frequent cancer-related complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality [odds ratio (OR) = 1.25 (95% confidence interval, 0.94-1.66), P = 0.131]. However, among the individual cancer-related complications, VCS [OR = 3.79 (1.11-12.92), P = 0.033], gastrointestinal involvement [OR = 3.05 (1.57-5.91), P = <0.001] and respiratory failure [OR = 1.96(1.04-3.71), P = 0.038] were independently associated with in-hospital mortality. CONCLUSIONS The prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of an acute cancer-related complication per se should not guide decisions to admit a patient to ICU.
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Affiliation(s)
- Viviane B. L. Torres
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Juliana Vassalo
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Pedro Caruso
- ICU, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - André P. Torelly
- Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI), Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Eliezer Silva
- ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Marcos Knibel
- Hospital São Lucas, Travessa Frederico Pamplona 32, Rio de Janeiro, Brazil
| | - Ederlon Rezende
- ICU, Hospital do Servidor Público Estadual, São Paulo, Brazil
| | - José J. S. Netto
- ICU, Instituto Nacional de Câncer, Hospital do Câncer II, Rio de Janeiro, Brazil
| | | | | | - Fernando A. Bozza
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Nelson Spector
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jorge I. F. Salluh
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Marcio Soares
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- * E-mail:
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110
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Fisher R, Dangoisse C, Crichton S, Whiteley C, Camporota L, Beale R, Ostermann M. Short-term and medium-term survival of critically ill patients with solid tumours admitted to the intensive care unit: a retrospective analysis. BMJ Open 2016; 6:e011363. [PMID: 27797987 PMCID: PMC5073479 DOI: 10.1136/bmjopen-2016-011363] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Patients with cancer frequently require unplanned admission to the intensive care unit (ICU). Our objectives were to assess hospital and 180-day mortality in patients with a non-haematological malignancy and unplanned ICU admission and to identify which factors present on admission were the best predictors of mortality. DESIGN Retrospective review of all patients with a diagnosis of solid tumours following unplanned admission to the ICU between 1 August 2008 and 31 July 2012. SETTING Single centre tertiary care hospital in London (UK). PARTICIPANTS 300 adult patients with non-haematological solid tumours requiring unplanned admission to the ICU. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOMES Hospital and 180-day survival. RESULTS 300 patients were admitted to the ICU (median age 66.5 years; 61.7% men). Survival to hospital discharge and 180 days were 69% and 47.8%, respectively. Greater number of failed organ systems on admission was associated with significantly worse hospital survival (p<0.001) but not with 180-day survival (p=0.24). In multivariate analysis, predictors of hospital mortality were the presence of metastases (OR 1.97, 95% CI 1.08 to 3.59), Acute Physiology and Chronic Health Evaluation II (APACHE II) Score (OR 1.07, 95% CI 1.01 to 1.13) and a Glasgow Coma Scale Score <7 on admission to ICU (OR 5.21, 95% CI 1.65 to 16.43). Predictors of worse 180-day survival were the presence of metastases (OR 2.82, 95% CI 1.57 to 5.06), APACHE II Score (OR 1.07, 95% CI 1.01 to 1.13) and sepsis (OR 1.92, 95% CI 1.09 to 3.38). CONCLUSIONS Short-term and medium-term survival in patients with solid tumours admitted to ICU is better than previously reported, suggesting that the presence of cancer alone should not be a barrier to ICU admission.
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Affiliation(s)
- Richard Fisher
- Department of Critical Care, King's College London, Guy's & St Thomas’ Hospital NHS Foundation Trust, London, UK
- Department of Critical Care, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Carole Dangoisse
- Department of Critical Care, King's College London, Guy's & St Thomas’ Hospital NHS Foundation Trust, London, UK
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Siobhan Crichton
- Division of Health and Social Care Research, King's College London, London, UK
| | - Craig Whiteley
- Department of Critical Care, King's College London, Guy's & St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Critical Care, King's College London, Guy's & St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Richard Beale
- Department of Critical Care, King's College London, Guy's & St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas’ Hospital NHS Foundation Trust, London, UK
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111
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Sakhri L, Saint-Raymond C, Quetant S, Pison C, Lagrange E, Hamidfar Roy R, Janssens JP, Maindet-Dominici C, Garrouste-Orgeas M, Levy-Soussan M, Terzi N, Toffart AC. [Limitations of active therapeutic and palliative care in chronic respiratory disease]. Rev Mal Respir 2016; 34:102-120. [PMID: 27639947 DOI: 10.1016/j.rmr.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/29/2016] [Indexed: 11/16/2022]
Abstract
The issue of intensive and palliative care in patients with chronic disease frequently arises. This review aims to describe the prognostic factors of chronic respiratory diseases in stable and in acute situations in order to improve the management of these complex situations. The various laws on patients' rights provide a legal framework and define the concept of unreasonable obstinacy. For patients with chronic obstructive pulmonary disease, the most robust decision factors are good knowledge of the respiratory disease, the comorbidities, the history of previous exacerbations and patient preferences. In the case of idiopathic pulmonary fibrosis, it is necessary to know if there is a prospect of transplantation and to assess the reversibility of the respiratory distress. In the case of amyotrophic lateral sclerosis, treatment decisions depend on the presence of advance directives about the use of intubation and tracheostomy. For lung cancer patients, general condition, cancer history and the tumor treatment plan are important factors. A multidisciplinary discussion that takes into account the patient's medical history, wishes and the current state of knowledge permits the taking of a coherent decision.
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Affiliation(s)
- L Sakhri
- Institut de cancérologie Daniel-Hollard, groupe hospitalier Mutualiste, 38000 Grenoble, France
| | - C Saint-Raymond
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - S Quetant
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - C Pison
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Laboratoire de bioénergétique fondamentale et appliquée, Inserm 1055, 38400 Saint-Martin-d'Hères, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France
| | - E Lagrange
- Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France
| | - R Hamidfar Roy
- Pôle urgences médecine aiguë, clinique de réanimation médicale, CHU de Grenoble, 38000 Grenoble, France
| | - J-P Janssens
- Service de pneumologie, hôpital Cantonal universitaire, Genève, Suisse
| | - C Maindet-Dominici
- Pôle anesthésie réanimation, centre de la douleur, CHU de Grenoble, 38000 Grenoble, France
| | - M Garrouste-Orgeas
- Service de médecine intensive et de réanimation, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - M Levy-Soussan
- Unité mobile d'accompagnement et de soins palliatifs, hôpital universitaire Pitié-Salpêtrière, 75006 Paris, France
| | - N Terzi
- Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France; Inserm U1042, université Grenoble Alpes, HP2, CHU de Grenoble, 38000 Grenoble, France
| | - A-C Toffart
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Institut pour l'avancée des biosciences, centre de recherche UGA, Inserm U 1209, CNRS UMR 5309, 38000 Grenoble, France.
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112
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Schellongowski P, Sperr WR, Wohlfarth P, Knoebl P, Rabitsch W, Watzke HH, Staudinger T. Critically ill patients with cancer: chances and limitations of intensive care medicine-a narrative review. ESMO Open 2016; 1:e000018. [PMID: 27843637 PMCID: PMC5070251 DOI: 10.1136/esmoopen-2015-000018] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 12/14/2022] Open
Abstract
This narrative review deals with the challenge of defining adequate therapy goals and intensive care unit (ICU) admission criteria for critically ill patients with cancer. Several specific complications of critically ill patients with cancer require close collaborations of intensive care and cancer specialists. Intensivists require a basic understanding of the pathophysiology, diagnosis and therapy of common cancer-specific problems. Cancer specialists must be knowledgeable in preventing, detecting and treating imminent or manifest organ failures. In case of one or more organ dysfunctions, ICU admissions must be evaluated early. In order to properly define the therapy goals for critically ill patients with cancer, decision-makers must be aware of the short-term intensive care prognosis as well as the long-term oncological options and perspectives. Multidisciplinary teamwork is key when it comes down to decisions on ICU admission, planning of therapeutic aims, patient management in the ICU and tailored therapy limiting with smooth transition into a palliative care (PC) setting, whenever appropriate.
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Affiliation(s)
- Peter Schellongowski
- Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria
| | - Wolfgang R Sperr
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria
| | - Philipp Wohlfarth
- Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria
| | - Paul Knoebl
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria
| | - Werner Rabitsch
- Department of Medicine I, Bone Marrow Transplantation , Medical University of Vienna , Vienna , Austria
| | - Herbert H Watzke
- Department of Internal Medicine I, Division of Palliative Medicine , Medical University of Vienna , Vienna , Austria
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria
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113
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Tavares M, Neves I, Chacim S, Coelho F, Afonso O, Martins A, Mariz JM, Faria F. Withdrawing and Withholding Life Support in Patients With Cancer in an ICU Setting: A 5-Year Experience at a European Cancer Center. J Intensive Care Med 2016; 33:415-419. [PMID: 27509916 DOI: 10.1177/0885066616664321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This was an observational retrospective study aimed to examine the frequency and associated factors of withdrawing or withholding life support (WWLS) in the intensive care unit (ICU) of a comprehensive cancer center. METHODS Medical records of adult patients with cancer admitted to the ICU between January 2010 and December 2014 were reviewed. Patients who died during that period were classified into 2 groups: full life support and withdrawing and withholding life support. The relative impact of demographic and clinical factors was assessed using logistic regression. RESULTS A total of 247 patients died in our unit (mortality rate of 16.3%). Their median age was 62 (interquartile range [IQR] 51-73) years, there were 142 (57.5%) male patients, and they had predominantly solid malignancies (62.3%). The median Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation scores were 67 (IQR 54-80) and 29 (IQR 23-55), respectively. Ninety-six (38.9%) patients died after WWLS with no statistically significant differences in decisions to limit therapy during the study period. Patients with advanced age, solid malignancies, nonneutropenic, and longer duration of mechanical ventilation were more likely to die after WWLS. In multivariate analysis, presenting with neutropenia was independently associated with a lower likelihood of dying after WWLS (odds ratio: 0.34, 95% confidence interval: 0.15-0.80). CONCLUSION Limitation of therapy has been a common practice in oncologic ICUs over recent years. Neutropenia is an independent predictor of limitation of therapy.
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Affiliation(s)
- Márcio Tavares
- 1 Department of Onco-Hematology, Portuguese Institute of Oncology, Porto, Portugal
| | - Inês Neves
- 2 Department of Anesthesiology, Portuguese Institute of Oncology, Porto, Portugal
| | - Sérgio Chacim
- 1 Department of Onco-Hematology, Portuguese Institute of Oncology, Porto, Portugal
| | - Fernando Coelho
- 3 Department of Anesthesiology, Intensive Care Unit, Portuguese Institute of Oncology, Porto, Portugal
| | - Ofélia Afonso
- 3 Department of Anesthesiology, Intensive Care Unit, Portuguese Institute of Oncology, Porto, Portugal
| | - Anabela Martins
- 3 Department of Anesthesiology, Intensive Care Unit, Portuguese Institute of Oncology, Porto, Portugal
| | - J Mário Mariz
- 1 Department of Onco-Hematology, Portuguese Institute of Oncology, Porto, Portugal
| | - Filomena Faria
- 3 Department of Anesthesiology, Intensive Care Unit, Portuguese Institute of Oncology, Porto, Portugal
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114
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Fischler R, Meert AP, Sculier JP, Berghmans T. Continuous Renal Replacement Therapy for Acute Renal Failure in Patients with Cancer: A Well-Tolerated Adjunct Treatment. Front Med (Lausanne) 2016; 3:33. [PMID: 27536658 PMCID: PMC4972010 DOI: 10.3389/fmed.2016.00033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/25/2016] [Indexed: 01/08/2023] Open
Abstract
Introduction Acute renal failure (ARF) has a poor prognosis in patients with cancer requiring intensive care unit (ICU) admission. Our aim is finding prognostic factors for hospital mortality in patients with cancer with ARF requiring renal replacement therapy (RRT). Methods In this retrospective study, all patients with cancer with ARF treated with continuous venovenous filtration (CVVHDF) in the ICU of the Institut Jules Bordet, between January 1, 2003 and December 31, 2012, were included. Results One hundred and three patients are assessed: men/women 69/34, median age 62 years, solid/hematologic tumors 68/35, median SAPS II 56. Mortality rate was 63%. Seven patients required chronic renal dialysis. After multivariate analysis, two variables were statistically associated with hospital mortality: more than one organ failure (including kidney) (OR 5.918; 95% CI 2.184–16.038; p < 0.001) and low albumin level (OR 3.341; 95% CI 1.229–9.077; p = 0.02). Only minor complications related to CVVHDF have been documented. Conclusion Despite the poor prognosis associated with ARF, CVVHDF is an effective and tolerable renal replacement technique in patients with cancer admitted to the ICU. Multiple organ failure and hypoalbuminemia, two independent prognostic factors for hospital mortality have to be considered when deciding for introducing RRT.
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Affiliation(s)
- Rebecca Fischler
- Department of Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Anne-Pascale Meert
- Department of Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Jean-Paul Sculier
- Department of Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Thierry Berghmans
- Department of Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
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115
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Gupta R, Heshami N, Jay C, Ramesh N, Song J, Lei X, Rose EJ, Carter K, Araujo DM, Benjamin RS, Patel S, Nates JL, Ravi V. Predictors of survival in patients with sarcoma admitted to the intensive care unit. Clin Sarcoma Res 2016; 6:12. [PMID: 27437097 PMCID: PMC4950117 DOI: 10.1186/s13569-016-0051-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advances in treatment of sarcoma patients has prolonged survival but has led to increased disease- or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU). Survival and long-term outcome information about such critically ill patients with sarcoma is unknown. METHODS The primary objective of the study was to determine the ICU and post-ICU survival rates of critically ill sarcoma patients. Secondary objectives included determining the modifiable and non-modifiable predictors of poor survival. We performed a retrospective chart review of sarcoma patients admitted to the ICU at The University of Texas MD Anderson Cancer Center between January 1, 2005, and December 31, 2012. Main outcome measures were ICU mortality, in-hospital mortality and 1, 2, and 6-month survival rates. Covariates such as histological diagnosis, disease characteristics, chemotherapy use, Charlson comorbidity index, Sequential Organ Failure Assessment (SOFA) scores, and clinical findings leading to ICU admission were analyzed for their effects on survival. RESULTS We identified 172 admissions over the 8-year study period hat met our inclusion criteria. The study population was 45.9 % males with a median age of 52 years. The most common sarcoma subgroups were high-grade unclassified sarcoma (25 %) and bone tumors (17.4 %). The ICU mortality rate was 23.3 % (95 % confidence interval [CI], 16.9-29.6 %), and an additional 6.4 % of patients died before hospital discharge (95 % CI, 22.9-37.1 %). 6-month OS rates were 41 %. The median SOFA scores on admission were 6 (inter quartile range (IQR), 3.5-9) in ICU survivors and 10 (IQR, 6.5-14) in ICU non-survivors. Increase in SOFA scores ≥6 led to poor outcomes (ICU survival 13.3 %, OS 6.7 %). Charlson comorbidity index (HR 1.139, 95 % CI 1.023-1.268, p = 0.02) and discharge SOFA scores (HR 1.210, 95 % CI 1.141-1.283, p < 0.0001) correlated with overall survival. CONCLUSIONS Our results suggest that patients that are admitted to the ICU for respiratory failure, cardiac arrest, septic shock, acute renal failure or acidosis and also have a high SOFA score with subsequent worsening in the ICU have poor prognosis. Based on the retrospective data which needs further validation we can recommend that judicious approach should be taken in patients with predictors of poor survival before subjecting them to aggressive treatment.
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Affiliation(s)
- Rohan Gupta
- The University of Texas at Houston Internal Medicine Residency Program, Houston, TX USA
| | - Neda Heshami
- The University of Texas at Houston Internal Medicine Residency Program, Houston, TX USA
| | - Chouhan Jay
- The University of Texas at Houston Internal Medicine Residency Program, Houston, TX USA
| | - Naveen Ramesh
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX USA
| | - Juhee Song
- Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Xiudong Lei
- Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Erfe Jean Rose
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Kristen Carter
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
| | - Dejka M Araujo
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
| | - Robert S Benjamin
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
| | - Joseph L Nates
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA
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116
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Soares M, Bozza FA, Azevedo LCP, Silva UVA, Corrêa TD, Colombari F, Torelly AP, Varaschin P, Viana WN, Knibel MF, Damasceno M, Espinoza R, Ferez M, Silveira JG, Lobo SA, Moraes APP, Lima RA, de Carvalho AGR, do Brasil PEAA, Kahn JM, Angus DC, Salluh JIF. Effects of Organizational Characteristics on Outcomes and Resource Use in Patients With Cancer Admitted to Intensive Care Units. J Clin Oncol 2016; 34:3315-24. [PMID: 27432921 DOI: 10.1200/jco.2016.66.9549] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate the impact of organizational characteristics and processes of care on hospital mortality and resource use in patients with cancer admitted to intensive care units (ICUs). PATIENTS AND METHODS We performed a retrospective cohort study of 9,946 patients with cancer (solid, n = 8,956; hematologic, n = 990) admitted to 70 ICUs (51 located in general hospitals and 19 in cancer centers) during 2013. We retrieved patients' clinical and outcome data from an electronic ICU quality registry. We surveyed ICUs regarding structure, organization, staffing patterns, and processes of care. We used mixed multivariable logistic regression analysis to identify characteristics associated with hospital mortality and efficient resource use in the ICU. RESULTS Median number of patients with cancer per center was 110 (interquartile range, 58 to 154), corresponding to 17.9% of all ICU admissions. ICU and hospital mortality rates were 15.9% and 25.4%, respectively. After adjusting for relevant patient characteristics, presence of clinical pharmacists in the ICU (odds ratio [OR], 0.67; 95% CI, 0.49 to 0.90), number of protocols (OR, 0.92; 95% CI, 0.87 to 0.98), and daily meetings between oncologists and intensivists for care planning (OR, 0.69; 95% CI, 0.52 to 0.91) were associated with lower mortality. Implementation of protocols (OR, 1.52; 95% CI, 1.11 to 2.07) and meetings between oncologists and intensivists (OR, 4.70; 95% CI, 1.15 to 19.22) were also independently associated with more efficient resource use. Neither admission to ICUs in cancer centers compared with general hospitals nor annual case volume had an impact on mortality or resource use. CONCLUSION Organizational aspects, namely the implementation of protocols and presence of clinical pharmacists in the ICU, and close collaboration between oncologists and ICU teams are targets to improve mortality and resource use in critically ill patients with cancer.
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Affiliation(s)
- Marcio Soares
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Fernando A Bozza
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Luciano C P Azevedo
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ulysses V A Silva
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thiago D Corrêa
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Fernando Colombari
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - André P Torelly
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Pedro Varaschin
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - William N Viana
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Marcos F Knibel
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Moyzés Damasceno
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rodolfo Espinoza
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Marcus Ferez
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Juliana G Silveira
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Suzana A Lobo
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ana Paula P Moraes
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ricardo A Lima
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alexandre G R de Carvalho
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Pedro E A A do Brasil
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jeremy M Kahn
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Derek C Angus
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jorge I F Salluh
- Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Gudiol C, Royo-Cebrecos C, Laporte J, Ardanuy C, Garcia-Vidal C, Antonio M, Arnan M, Carratalà J. Clinical features, aetiology and outcome of bacteraemic pneumonia in neutropenic cancer patients. Respirology 2016; 21:1411-1418. [PMID: 27417156 DOI: 10.1111/resp.12848] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/06/2016] [Accepted: 05/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE We aimed to assess the clinical features, aetiology and outcomes of bacteraemic pneumonia in neutropenic cancer patients (NCP) in the current era of increasing antimicrobial resistance. METHODS All episodes of bacteraemia occurring in hospitalized patients with cancer, including haematopoietic stem cell transplant recipients, from January 2006 to April 2015 were included. RESULTS We identified 1723 episodes of bacteraemia, of which 795 occurred in neutropenic patients with cancer, and among them, 55 episodes were identified as bacteraemic pneumonia. The most frequent causative agents were Pseudomonas aeruginosa (39.6%), Streptococcus pneumoniae (20.6%) and Escherichia coli (8.6%). Among the Gram-negative organisms, 12.8% were multidrug resistant (MDR). Eleven patients (20%) required admission to intensive care, and eight (14.8%) underwent invasive mechanical ventilation. Nine patients (16.3%) received inadequate empirical antibiotic therapy, of whom six (66.6%) died; eight of these nine patients had pneumonia caused by resistant microorganisms. The early (48 h) case-fatality rate was 24% and the overall (30 day) case-fatality rate was 46.2%. CONCLUSION Bacteraemic pneumonia is a frequent complication among NCP and is mainly caused by P. aeruginosa and S. pneumoniae. The emergence of MDR organisms is of special concern. Despite the improvement in the management of cancer patients, case-fatality rates of NCP with bacteraemic pneumonia remain high. Urgent assessment is needed to identify a better approach for the management and support of these patients.
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Affiliation(s)
- Carlota Gudiol
- Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. .,Catalan Institute of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. .,REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain.
| | - Cristina Royo-Cebrecos
- Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain
| | - Júlia Laporte
- Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Ardanuy
- Departments of Microbiology of Bellvitge Univesity Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,CIBERes (CIBEr Respiratory Diseases), ISCIII, Madrid, Spain
| | - Carolina Garcia-Vidal
- Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain
| | - Maite Antonio
- Departments of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Catalan Institute of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Arnan
- Departments of Haematology Duran i Reynals Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Catalan Institute of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Carratalà
- Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain
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Outcomes and Predictors of Mortality for Patients with Acute Leukemia Admitted to the Intensive Care Unit. Can Respir J 2016; 2016:3027656. [PMID: 27445524 PMCID: PMC4944052 DOI: 10.1155/2016/3027656] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/03/2016] [Accepted: 06/09/2016] [Indexed: 01/05/2023] Open
Abstract
Purpose. The objectives were to describe the management and outcomes of acute leukemia (AL) patients admitted to the ICU and to identify predictors of ICU mortality. Methods. Data was retrospectively collected from the medical records of all patients with AML or ALL admitted to the Mount Sinai Hospital ICU from August 2009 to December 2012. Results. 151 AL patients (117 AML, 34 ALL) were admitted to the ICU. Mean age was 54 (SD 15) years, median APACHE II score was 27 (IQR 22–33), and 50% were female. While in ICU, 128 (85%) patients had sepsis and 56 (37%) had ARDS. The majority of patients required invasive organ support: 94 (62%) required mechanical ventilation while 23 (15%) received renal replacement therapy. Multivariable analysis identified SOFA score (OR 1.18, 95% CI 1.01–1.38) and invasive ventilation (OR 9.64, 95% CI 3.39–27.4) as independent predictors of ICU mortality. Ninety-four (62%) patients survived to ICU discharge. Only 39% of these 94 patients discharged were alive 12 months after ICU admission. Conclusions. AL patients admitted to the ICU had a 62% ICU survival rate; yet only 25% of cohort patients were alive 12 months after ICU admission. Higher admission SOFA scores and invasive ventilation are independently associated with a greater risk of dying in the ICU.
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Torres VBL, Soares M. Patients with hematological malignancies admitted to intensive care units: new challenges for the intensivist. Rev Bras Ter Intensiva 2016; 27:193-5. [PMID: 26465241 PMCID: PMC4592109 DOI: 10.5935/0103-507x.20150040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Marcio Soares
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
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Aydoğdu M, Esquinas AM. Survival of Allogeneic Hematopoietic Stem Cell Recipients Admitted to the Intensive Care Unit: Have We Reached the Limits? Acta Haematol 2016; 135:224-5. [PMID: 26974223 DOI: 10.1159/000444628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/10/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Müge Aydoğdu
- Department of Pulmonary and Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
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Wallet F, Maucort Boulch D, Malfroy S, Ledochowski S, Bernet C, Kepenekian V, Passot G, Vassal O, Piriou V, Glehen O, Friggeri A. No impact on long-term survival of prolonged ICU stay and re-admission for patients undergoing cytoreductive surgery with HIPEC. Eur J Surg Oncol 2016; 42:855-60. [PMID: 27061789 DOI: 10.1016/j.ejso.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/27/2016] [Accepted: 03/04/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) are promising new approaches of peritoneal metastases. However these surgical procedures are associated with a high morbidity rate thus intensive care (IC) management following serious complications may be warranted for these patients. The impact of the prolonged IC stay or re-admission on long-term survival remains unknown. METHODS We retrospectively analysed 122 consecutive HIPEC procedures over a one year period (2010-2011) in a single academic hospital. We analysed complications that would lead to prolonged stay or re-admission into ICU and analysed long term follow-up in patients whether they required intensive care (ICU group) or not (Control group). RESULTS ICU group represented 26.2% of the cohort mainly due to septic or haemorrhagic shock. Among them acute kidney injury and respiratory failure were present in 50% and 47% respectively. Cohort overall mortality rate was of 5.7%. Patients were followed for 4 years and survival analysis was performed adjusting for main confounding factors in a Cox survival model. Survival was not different between groups, with a median survival of 38 months [32; 44] vs. 33 months [26; 39] in the ICU group and Control group respectively. CONCLUSION Prolonged stay or re-admission into ICU does not seem to statistically impact long term prognosis of patients undergoing CRS with HIPEC.
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Affiliation(s)
- F Wallet
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France; Laboratoire des Pathogènes Emergents, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, France.
| | - D Maucort Boulch
- Université de Lyon, Lyon, France; Hospices Civils de Lyon, Service de Biostatistique, Lyon, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, F-69100, France
| | - S Malfroy
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - S Ledochowski
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - C Bernet
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - V Kepenekian
- Department of Surgical Oncology, CHU Lyon Sud, Université Lyon 1, EMR 3738, Pierre Bénite, France
| | - G Passot
- Department of Surgical Oncology, CHU Lyon Sud, Université Lyon 1, EMR 3738, Pierre Bénite, France
| | - O Vassal
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - V Piriou
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - O Glehen
- Department of Surgical Oncology, CHU Lyon Sud, Université Lyon 1, EMR 3738, Pierre Bénite, France
| | - A Friggeri
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France; Laboratoire des Pathogènes Emergents, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, France
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Intensive care for cancer patients: An interdisciplinary challenge for cancer specialists and intensive care physicians. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2016; 9:39-44. [PMID: 27069513 PMCID: PMC4786590 DOI: 10.1007/s12254-016-0256-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/05/2016] [Indexed: 12/12/2022]
Abstract
Every sixth to eighth European intensive care unit patient suffers from an underlying malignant disease. A large proportion of these patients present with cancer-related complications. This review explains why the prognosis of critically ill cancer patients has improved substantially over the last decades and which risk factors are of prognostic importance. Furthermore, the main reasons for intensive care unit admission – acute respiratory failure and septic complications – are discussed with regard to diagnostic and therapeutic specifics. In addition, we discuss potential intensive care unit admission criteria with respect to cancer prognosis. The successful management of critically ill cancer patients requires a close collaboration of intensivists with hematologists, oncologists and colleagues from other disciplines, such as infectious disease specialists, microbiologists, radiologists, surgeons, pharmacists, and others.
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Xia R, Wang D. Intensive care unit prognostic factors in critically ill patients with advanced solid tumors: a 3-year retrospective study. BMC Cancer 2016; 16:188. [PMID: 26946297 PMCID: PMC4779224 DOI: 10.1186/s12885-016-2242-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 03/01/2016] [Indexed: 12/15/2022] Open
Abstract
Background The objective of this study was to identify risk factors predicting prognosis of critically ill medical patients with advanced solid tumors in the intensive care unit (ICU). Methods We retrospectively analyzed all ICU unplanned medical admissions to the ICU of patients with advanced solid cancer in Tianjin Medical University Cancer Institute and Hospital between October 1, 2012 and March 1, 2015. Approval was obtained from the Ethical Commission of Tianjin Medical University Cancer Institute and Hospital to review and publish information from patients’ records. Results One hundred and forty-one patients with full code status met the criteria for inclusion from among 813 ICU admissions. ICU mortality was 14.9 % and in-hospital mortality was 29.8 %. The major reasons for unplanned ICU admission were respiratory failure (38.3 %) and severe sepsis or septic shock (27.7 %). The ICU mortality in patients who required vasopressors, mechanical ventilation or renal replacement therapy for >24 h was 25, 25.9 and 40 %, respectively. The mean overall survival was 28.6 months. After adjusting for hypertension, type of solid cancer, intervention time, need for mechanical ventilation and Acute Physiology and Chronic Health Evaluation II score, only Sepsis-related Organ Failure Assessment (SOFA) score on day 7 of ICU treatment remained a significant predictor of ICU mortality (adjusted odds ratio 1.612, 95 % confidence interval 1.137–2.285, P = 0.007). Conclusions We suggest broadening the criteria for ICU admission. The patients should be allowed an ICU trial consisting of unlimited ICU support, including invasive hemodynamic monitoring, mechanical ventilation and renal replacement therapy. An interdisciplinary meeting, including an ethics consultation, should be held to make end-of-life decisions if the SOFA score on day 7 shows clinical deterioration with no available therapeutic options.
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Affiliation(s)
- Rui Xia
- Key Laboratory of Cancer Prevention and Therapy, Intensive Care Unit, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, China.
| | - Donghao Wang
- Key Laboratory of Cancer Prevention and Therapy, Intensive Care Unit, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, China
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Torres da Costa e Silva V, Costalonga EC, Oliveira APL, Hung J, Caires RA, Hajjar LA, Fukushima JT, Soares CM, Bezerra JS, Oikawa L, Yu L, Burdmann EA. Evaluation of Intermittent Hemodialysis in Critically Ill Cancer Patients with Acute Kidney Injury Using Single-Pass Batch Equipment. PLoS One 2016; 11:e0149706. [PMID: 26938932 PMCID: PMC4777515 DOI: 10.1371/journal.pone.0149706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 02/04/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Data on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) is scarce. The aim of this study was to assess the safety and the adequacy of intermittent hemodialysis (IHD) in critically ill cancer patients with AKI. METHODS AND FINDINGS In this observational prospective cohort study, 149 ICU cancer patients with AKI were treated with 448 single-pass batch IHD procedures and evaluated from June 2010 to June 2012. Primary outcomes were IHD complications (hypotension and clotting) and adequacy. A multiple logistic regression was performed in order to identify factors associated with IHD complications (hypotension and clotting). Patients were 62.2 ± 14.3 years old, 86.6% had a solid cancer, sepsis was the main AKI cause (51%) and in-hospital mortality was 59.7%. RRT session time was 240 (180-300) min, blood/dialysate flow was 250 (200-300) mL/min and UF was 1000 (0-2000) ml. Hypotension occurred in 25% of the sessions. Independent risk factors (RF) for hypotension were dialysate conductivity (each ms/cm, OR 0.81, CI 0.69-0.95), initial mean arterial pressure (each 10 mmHg, OR 0.49, CI 0.40-0.61) and SOFA score (OR 1.16, CI 1.03-1.30). Clotting and malfunctioning catheters (MC) occurred in 23.8% and 29.2% of the procedures, respectively. Independent RF for clotting were heparin use (OR 0.57, CI 0.33-0.99), MC (OR 3.59, CI 2.24-5.77) and RRT system pressure increase over 25% (OR 2.15, CI 1.61-4.17). Post RRT blood tests were urea 71 (49-104) mg/dL, creatinine 2.71 (2.10-3.8) mg/dL, bicarbonate 24.1 (22.5-25.5) mEq/L and K 3.8 (3.5-4.1) mEq/L. CONCLUSION IHD for critically ill patients with cancer and AKI offered acceptable hemodynamic stability and provided adequate metabolic control.
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Affiliation(s)
| | - Elerson C. Costalonga
- Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Ana Paula Leandro Oliveira
- Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - James Hung
- Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Renato Antunes Caires
- Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Ludhmila Abrahão Hajjar
- Intensive Care Unit Department, Sao Paulo State Cancer Institute, University of Sao Paulo School Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Julia T. Fukushima
- Intensive Care Unit Department, Sao Paulo State Cancer Institute, University of Sao Paulo School Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Cilene Muniz Soares
- Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Juliana Silva Bezerra
- Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Luciane Oikawa
- Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Luis Yu
- LIM 12, Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Emmanuel A. Burdmann
- LIM 12, Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Barbas CSV, Serpa Neto A. New puzzles for the use of non-invasive ventilation for immunosuppressed patients. J Thorac Dis 2016; 8:E100-3. [PMID: 26904233 DOI: 10.3978/j.issn.2072-1439.2016.01.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
On October 27, 2015, Lemile and colleagues published an article in JAMA entitled "Effect of Noninvasive Ventilation vs. Oxygen Therapy on Mortality among Immunocompromised Patients with Acute Respiratory Failure: A Randomized Clinical Trial", which investigated the effects of non-invasive ventilation (NIV) in 28-day mortality of 374 critically ill immunosuppressed patients. The authors found that among immunosuppressed patients admitted to the intensive care unit (ICU) with hypoxemic acute respiratory failure, early NIV compared with oxygen therapy alone did not reduce 28-day mortality. Furthermore, different from the previous publications, there were no significant differences in ICU-acquired infections, duration of mechanical ventilation, or lengths of ICU or hospital stays. The study power was limited, median oxygen flow used was higher than used before or 9 L/min, NIV settings provided tidal volumes higher than what is considered protective nowadays or from 7 to 10 mL/kg of ideal body weight and the hypoxemic respiratory failure was moderate to severe (median PaO2/FIO2 was around 140), a group prone to failure in noninvasive ventilatory support. Doubts arose regarding the early use of NIV in immunosuppressed critically ill patients with non-hypercapnic hypoxemic respiratory failure that need to be solved in the near future.
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Affiliation(s)
- Carmen Sílvia Valente Barbas
- 1 Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil ; 2 Pulmonary Division, Heart Institute and Hospital das Clinicas of University of São Paulo Medical School, São Paulo, Brazil ; 3 Program of Post-Graduation, Research and Innovation, Faculdade de Medicina do ABC, São Paulo, Brazil ; 4 Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ary Serpa Neto
- 1 Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil ; 2 Pulmonary Division, Heart Institute and Hospital das Clinicas of University of São Paulo Medical School, São Paulo, Brazil ; 3 Program of Post-Graduation, Research and Innovation, Faculdade de Medicina do ABC, São Paulo, Brazil ; 4 Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Wohlfarth P, Carlström A, Staudinger T, Clauss S, Hermann A, Rabitsch W, Bojic A, Skrabs C, Porpaczy E, Schiefer AI, Valent P, Knöbl P, Agis H, Hauswirth A, Jäger U, Kundi M, Sperr WR, Schellongowski P. Incidence of intensive care unit admission, outcome and post intensive care survival in patients with diffuse large B-cell lymphoma. Leuk Lymphoma 2016; 57:1831-8. [DOI: 10.3109/10428194.2015.1106537] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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127
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Jeong SH, Um SW, Lee H, Jeon K, Lee KJ, Suh GY, Chung MP, Kim H, Kwon OJ, Choi YL. Successful Treatment with Empirical Erlotinib in a Patient with Respiratory Failure Caused by Extensive Lung Adenocarcinoma. Korean J Crit Care Med 2016. [DOI: 10.4266/kjccm.2016.31.1.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Suk Hyeon Jeong
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Jong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon La Choi
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Nassar AP, Caruso P. ICU physicians are unable to accurately predict length of stay at admission: a prospective study. Int J Qual Health Care 2015; 28:99-103. [DOI: 10.1093/intqhc/mzv112] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2015] [Indexed: 12/12/2022] Open
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The authors reply. Crit Care Med 2015; 43:e467. [PMID: 26376270 DOI: 10.1097/ccm.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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130
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Toffart AC, Duruisseaux M, Sakhri L, Giaj Levra M, Moro-Sibilot D, Timsit JF. Indications de réanimation en oncologie thoracique. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/s1877-1203(16)30039-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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131
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Affiliation(s)
- Bhakti K Patel
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois
| | - John P Kress
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois
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132
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Risk factors for noninvasive ventilation failure in cancer patients in the intensive care unit: A retrospective cohort study. J Crit Care 2015; 30:1003-7. [DOI: 10.1016/j.jcrc.2015.04.121] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/07/2015] [Accepted: 04/28/2015] [Indexed: 01/08/2023]
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133
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Ethical Challenges in Caring for Cancer Patients in the Intensive Care Unit: Advanced Care Pathways and Avoidance of Futility. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-015-0116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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134
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Effect of Early Intervention on Long-Term Outcomes of Critically Ill Cancer Patients Admitted to ICUs. Crit Care Med 2015; 43:1439-48. [PMID: 25803653 DOI: 10.1097/ccm.0000000000000989] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this observational study was to evaluate whether early intervention was associated with improved long-term outcomes in critically ill patients with cancer. DESIGN Retrospective analysis with prospectively collected data. SETTING A university-affiliated, tertiary referral hospital. PATIENTS Consecutive critically ill cancer patients who were managed by a medical emergency team before ICU admission between January 2010 and December 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During the study period, 525 critically ill cancer patients were admitted to the ICU with respiratory failure (41.7%) and severe sepsis or septic shock (40.6%) following medical intervention by a medical emergency team. Of 356 ICU survivors, 161 (45.2%) received additional treatment for cancer after ICU discharge. Mortality was 66.1% at 6 months and 72.8% at 1 year. Median time from physiological derangement to intervention before ICU admission was significantly shorter in 1-year survivors (1.3 hr; interquartile range, 0.5-4.8 hr) than it was in nonsurvivors (2.9 hr; interquartile range, 0.8-9.6 hr) (p< 0.001). Additionally, the early intervention (≤ 1.5 hr) group had a lower 30-day mortality rate than the late intervention (> 1.5 hr) group (29.0% vs 55.3%; p < 0.001) and a similar difference in mortality rate was observed up to 1 year. Other factors associated with 1-year mortality were illness severity, performance status, malignancy status, presence of more than three abnormal physiological variables, time from derangement to ICU admission, and the need for mechanical ventilation. Even after adjusting for potential confounding factors, early intervention was significantly associated with 1-year mortality (adjusted hazard ratio, 0.456; 95% CI, 0.348-0.597; p < 0.001). CONCLUSION Early intervention for clinical derangement on general wards was significantly associated with long-term outcomes in critically ill cancer patients.
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135
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Miller SJ, Desai N, Pattison N, Droney JM, King A, Farquhar-Smith P, Gruber PC. Quality of transition to end-of-life care for cancer patients in the intensive care unit. Ann Intensive Care 2015. [PMID: 26205668 PMCID: PMC4513017 DOI: 10.1186/s13613-015-0059-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background There have been few studies that have evaluated the quality of end-of-life
care (EOLC) for cancer patients in the ICU. The aim of this study was to explore the quality of transition to EOLC for cancer patients in ICU. Methods The study was undertaken on medical patients admitted to a specialist cancer hospital ICU over 6 months. Quantitative and qualitative methods were used to explore quality of transition to EOLC using documentary evidence. Clinical parameters on ICU admission were reviewed to determine if they could be used to identify patients who were likely to transition to EOLC during their ICU stay. Results Of 85 patients, 44.7% transitioned to EOLC during their ICU stay. Qualitative and quantitative analysis of the patients’ records demonstrated that there was collaborative decision-making between teams, patients and families during transition to EOLC. However, 51.4 and 40.5% of patients were too unwell to discuss transition to EOLC and DNACPR respectively. In the EOLC cohort, 76.3% died in ICU, but preferred place of death known in only 10%. Age, APACHE II score, and organ support, but not cancer diagnosis, were identified as associated with transition to EOLC (p = 0.017, p < 0.0001 and p = 0.001). Conclusions Advanced EOLC planning in patients with progressive disease prior to acute deterioration is warranted to enable patients’ wishes to be fulfilled and ceiling of treatments agreed. Better documentation and development of validated tools to measure the quality EOLC transition on the ICU are needed.
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Affiliation(s)
- Sophie J Miller
- Palliative Care Department, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, London, UK,
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Champigneulle B, Merceron S, Lemiale V, Geri G, Mokart D, Bruneel F, Vincent F, Perez P, Mayaux J, Cariou A, Azoulay E. What is the outcome of cancer patients admitted to the ICU after cardiac arrest? Results from a multicenter study. Resuscitation 2015; 92:38-44. [DOI: 10.1016/j.resuscitation.2015.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/06/2015] [Accepted: 04/11/2015] [Indexed: 11/30/2022]
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137
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Avancées dans les tumeurs cérébrales primitives malignes de l’adulte : quels patients transférer en réanimation médicale? ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13546-015-1073-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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138
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Azoulay E, Pène F, Darmon M, Lengliné E, Benoit D, Soares M, Vincent F, Bruneel F, Perez P, Lemiale V, Mokart D. Managing critically Ill hematology patients: Time to think differently. Blood Rev 2015; 29:359-67. [PMID: 25998991 DOI: 10.1016/j.blre.2015.04.002] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/19/2015] [Accepted: 04/20/2015] [Indexed: 12/12/2022]
Abstract
The number of patients living with hematological malignancies (HMs) has increased steadily over time. This is the result of intensive and effective treatments that also increase the probability of infiltrative, infectious or toxic life threatening event. Over the last two decades, the number of patients with HMs admitted to the ICU increased and their mortality has dropped sharply. ICU patients with HMs require an extensive diagnostic workup and the optimal use of ICU treatments to identify the reason for ICU admission and the nature of the complication that explains organ dysfunctions. Mortality of ARDS or septic shock is up to 50%, respectively. In this review, the authors share their experience with managing critically ill patients with HMs. They discuss the main aspects of the diagnostic and therapeutic management of critically ill patients with HMs and argue that outcomes have improved over time and that many classic determinants of mortality have become irrelevant.
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Affiliation(s)
| | | | | | | | | | - Marcio Soares
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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139
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Bos MMEM, Verburg IWM, Dumaij I, Stouthard J, Nortier JWR, Richel D, van der Zwan EPA, de Keizer NF, de Jonge E. Intensive care admission of cancer patients: a comparative analysis. Cancer Med 2015; 4:966-76. [PMID: 25891471 PMCID: PMC4529335 DOI: 10.1002/cam4.430] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to obtain insight into which proportion of cancer patients is admitted to an Intensive Care Unit (ICU) and how their survival, demographic, and clinical characteristics relate to cancer patients not admitted to the ICU. Data from patients registered with cancer between 2006 and 2011 in four hospitals in the Netherlands were linked to the Dutch National Intensive Care Evaluation registry. About 36,860 patients with cancer were identified, of whom 2,374 (6.4%) were admitted to the ICU. Fifty-six percent of ICU admissions were after surgery, whereas 44% were for medical reasons. The risk for ICU admission was highest among cancer patients treated with surgery either alone or combined with chemotherapy and/or radiation therapy. Only 80 of 1,073 medical ICU admissions (3.3%) were for cancer-specific reasons. Although more women (54.0%) than men were registered with cancer, the proportion of male cancer patients admitted to an ICU was much higher (9.3 vs. 4.0%, P < 0.001). Five-year survival of cancer patients admitted to the ICU was substantial (41%) although median survival was much lower (1,104 days) than in patients not admitted to the ICU (median survival time not reached, P < 0.001). These results show that one out of 16 cancer patients was admitted to an ICU and that ICU support for this group should not be considered futile.
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Affiliation(s)
- Monique M E M Bos
- Department of Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Ilona W M Verburg
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ineke Dumaij
- Department of Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Jacqueline Stouthard
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital, Dutch Cancer Institute, Amsterdam, The Netherlands
| | - Johannes W R Nortier
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Richel
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric P A van der Zwan
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert de Jonge
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
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Clinical outcomes and microbiological characteristics of severe pneumonia in cancer patients: a prospective cohort study. PLoS One 2015; 10:e0120544. [PMID: 25803690 PMCID: PMC4372450 DOI: 10.1371/journal.pone.0120544] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/23/2015] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Pneumonia is the most frequent type of infection in cancer patients and a frequent cause of ICU admission. The primary aims of this study were to describe the clinical and microbiological characteristics and outcomes in critically ill cancer patients with severe pneumonia. METHODS Prospective cohort study in 325 adult cancer patients admitted to three ICUs with severe pneumonia not acquired in the hospital setting. Demographic, clinical and microbiological data were collected. RESULTS There were 229 (71%) patients with solid tumors and 96 (29%) patients with hematological malignancies. 75% of all patients were in septic shock and 81% needed invasive mechanical ventilation. ICU and hospital mortality rates were 45.8% and 64.9%. Microbiological confirmation was present in 169 (52%) with a predominance of Gram negative bacteria [99 (58.6%)]. The most frequent pathogens were methicillin-sensitive S. aureus [42 (24.9%)], P. aeruginosa [41(24.3%)] and S. pneumonia [21 (12.4%)]. A relatively low incidence of MR [23 (13.6%)] was observed. Adequate antibiotics were prescribed for most patients [136 (80.5%)]. In multivariate analysis, septic shock at ICU admission [OR 5.52 (1.92-15.84)], the use of invasive MV [OR 12.74 (3.60-45.07)] and poor Performance Status [OR 3.00 (1.07-8.42)] were associated with increased hospital mortality. CONCLUSIONS Severe pneumonia is associated with high mortality rates in cancer patients. A relatively low rate of MR pathogens is observed and severity of illness and organ dysfunction seems to be the best predictors of outcome in this population.
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141
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Lengliné E, Chevret S, Moreau AS, Pène F, Blot F, Bourhis JH, Buzyn A, Schlemmer B, Socié G, Azoulay E. Changes in intensive care for allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2015; 50:840-5. [PMID: 25798675 DOI: 10.1038/bmt.2015.55] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 12/14/2014] [Accepted: 12/28/2014] [Indexed: 01/01/2023]
Abstract
Intensive care unit (ICU) admission is associated with high mortality in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Whether mortality has decreased recently is unknown. The 497 adult allogeneic HSCT recipients admitted to three ICUs between 1997 and 2011 were evaluated retrospectively. Two hundred and nine patients admitted between 1997 and 2003 were compared with the 288 patients admitted from 2004 to 2011. Factors associated with 90-day mortality were identified. The recent cohort was characterized by older age, lower conditioning intensity, and greater use of peripheral blood or unrelated-donor graft. In the recent cohort, ICU was used more often for patients in hematological remission (67% vs 44%; P<0.0001) and without GVHD (73% vs 48%; P<0.0001) or invasive fungal infection (85% vs 73%; P=0.0003) despite a stable admission rate (21.7%). These changes were associated with significantly better 90-day survival (49% vs 31%). Independent predictors of hospital mortality were GVHD, mechanical ventilation (MV) and renal replacement therapy (RRT). Among patients who required MV or RRT, survival was 29% and 18%, respectively, but dropped to 18% and 6% in those with GVHD. The use of ICU admission has changed and translated into improved survival, but advanced life support in patients with GVHD usually provides no benefits.
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Affiliation(s)
- E Lengliné
- 1] Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France [2] Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France
| | - S Chevret
- 1] Biostatistic Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France [2] ECSTRA team, CRESS (UMR 1153), Inserm, Université Paris Diderot Paris, France
| | - A-S Moreau
- Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France
| | - F Pène
- Medical Intensive Care Unit, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris France
| | - F Blot
- Intensive Care Unit, Institut Gustave Rousy, Villejuif, France
| | - J-H Bourhis
- Hematology Department, Institut Gustave Roussy, Villejuif, France
| | - A Buzyn
- 1] Hematology Department, Hôpital Necker, AP-HP, Université Paris Descartes, Paris France [2] Institut National du Cancer, Boulogne Billancourt, France
| | - B Schlemmer
- Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France
| | - G Socié
- 1] Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France [2] INSERM UMR 1160, Paris France
| | - E Azoulay
- 1] Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France [2] ECSTRA team, CRESS (UMR 1153), Inserm, Université Paris Diderot Paris, France
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143
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Fisher R, Dangoisse C, Crichton S, Slanova S, Starsmore L, Manickavasagar T, Whiteley C, Ostermann M. Factors associated with short-term and long-term mortality in solid cancer patients admitted to the ICU. Crit Care 2015. [PMCID: PMC4470625 DOI: 10.1186/cc14620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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144
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Toffart AC, Sakhri L, Girard N, Couraud S, Merle P, Fournel P, Perol M, Souquet PJ, Timsit JF, Moro-Sibilot D. Évaluation d’une fiche d’aide à la décision en cas d’aggravation d’un patient cancéreux. Rev Mal Respir 2015; 32:66-72. [DOI: 10.1016/j.rmr.2014.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/28/2013] [Indexed: 11/25/2022]
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145
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Aslaner MA, Akkaş M, Eroğlu S, Aksu NM, Özmen MM. Admissions of critically ill patients to the ED intensive care unit. Am J Emerg Med 2014; 33:501-5. [PMID: 25737412 DOI: 10.1016/j.ajem.2014.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 11/27/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Many emergency departments (EDs) have established units capable of providing critical care because of increasing need for critical care, called as ED intensive care unit (EDICU). However, prolonged critical care leads to crowding, resulting in poor quality of care and high mortality rates. We aimed to determine which type of critically ill patients play a main role for crowding in the EDICU, and how to manage these patients. METHOD Patients aged older than 18 years who presented to the ED and presented for consultation to the ICU were eligible for inclusion in this study. Patients were classified into 4 priority groups by the Society of Critical Care Medicine. RESULT Four hundred medical patients were enrolled in the study. Sixty-one patients were not admitted to hospital (15.2% of all patients) and were treated in the EDICU. These patients were older (mean age, 66.6 years) and had a higher percentage belonging to the priority 3 group (82.0%-unstable with reduced likelihood of recovery due to chronic illness) in comparison with other ICUs patients (mean age, 60.4 years and 11.9%, respectively) (P < .05). In priority 3 patients, the length of stay was median 120 hours, and also, length of invasive mechanical ventilations duration was median 19 hours in the EDICU. CONCLUSIONS Emergency department intensive care unit occupancy appears driven by categorized as "reduced benefit" patients, and these units tend to become alternative dumping grounds for palliative care services. Hospitals and health care administrators should take special care to develop policies for improving the management of these patients.
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Affiliation(s)
- Mehmet Ali Aslaner
- Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Meltem Akkaş
- Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sercan Eroğlu
- Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nalan M Aksu
- Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Mahir Özmen
- Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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146
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Prediction of short- and long-term survival for advanced cancer patients after ICU admission. Support Care Cancer 2014; 23:1647-55. [DOI: 10.1007/s00520-014-2519-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/10/2014] [Indexed: 12/12/2022]
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147
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Parakh S, Piggin A, Neeman T, Mitchell I, Crispin P, Davis A. Outcomes of haematology/oncology patients admitted to intensive care unit at The Canberra Hospital. Intern Med J 2014; 44:1087-94. [DOI: 10.1111/imj.12545] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/28/2014] [Indexed: 01/09/2023]
Affiliation(s)
- S. Parakh
- Medical Oncology Unit; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - A. Piggin
- Medical Oncology Unit; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - T. Neeman
- School of Medicine; The Australian National University; Canberra Australian Capital Territory Australia
| | - I. Mitchell
- School of Medicine; The Australian National University; Canberra Australian Capital Territory Australia
- Intensive Care Unit; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - P. Crispin
- School of Medicine; The Australian National University; Canberra Australian Capital Territory Australia
- Haematology Unit; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - A. Davis
- Medical Oncology Unit; The Canberra Hospital; Canberra Australian Capital Territory Australia
- School of Medicine; The Australian National University; Canberra Australian Capital Territory Australia
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148
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Azevedo LCP, Caruso P, Silva UVA, Torelly AP, Silva E, Rezende E, Netto JJ, Piras C, Lobo SMA, Knibel MF, Teles JM, Lima RA, Ferreira BS, Friedman G, Rea-Neto A, Dal-Pizzol F, Bozza FA, Salluh JIF, Soares M. Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest 2014; 146:257-266. [PMID: 24480886 DOI: 10.1378/chest.13-1870] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study was undertaken to evaluate the clinical characteristics and outcomes of patients with cancer requiring nonpalliative ventilatory support. METHODS This was a secondary analysis of a prospective cohort study conducted in 28 Brazilian ICUs evaluating adult patients with cancer requiring invasive mechanical ventilation (MV) or noninvasive ventilation (NIV) during the first 48 h of their ICU stay. We used logistic regression to identify the variables associated with hospital mortality. RESULTS Of 717 patients, 263 (37%) (solid tumors = 227; hematologic malignancies = 36) received ventilatory support. NIV was initially used in 85 patients (32%), and 178 (68%) received MV. Additionally, NIV followed by MV occurred in 45 patients (53%). Hospital mortality rates were 67% in all patients, 40% in patients receiving NIV only, 69% when NIV was followed by MV, and 73% in patients receiving MV only (P < .001). Adjusting for the type of admission, newly diagnosed malignancy (OR, 3.59; 95% CI, 1.28-10.10), recurrent or progressive malignancy (OR, 3.67; 95% CI, 1.25-10.81), tumoral airway involvement (OR, 4.04; 95% CI, 1.30-12.56), performance status (PS) 2 to 4 (OR, 2.39; 95% CI, 1.24-4.59), NIV followed by MV (OR, 3.00; 95% CI, 1.09-8.18), MV as initial ventilatory strategy (OR, 3.53; 95% CI, 1.45-8.60), and Sequential Organ Failure Assessment score (each point except the respiratory domain) (OR, 1.15; 95% CI, 1.03-1.29) were associated with hospital mortality. Hospital survival in patients with good PS and nonprogressive malignancy and without tumoral airway involvement was 53%. Conversely, patients with poor functional capacity and cancer progression had unfavorable outcomes. CONCLUSIONS Patients with cancer with good PS and nonprogressive disease requiring ventilatory support should receive full intensive care, because one-half of these patients survive. On the other hand, provision of palliative care should be considered the main goal for patients with poor PS and progressive underlying malignancy.
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Affiliation(s)
- Luciano C P Azevedo
- ICU, Hospital Sirio-Libanes, Criciúma, Brazil; Programa de Pós-Graduação em Oncologia, Criciúma, Brazil
| | | | - Ulysses V A Silva
- ICU, Universidade Federal do Rio Grande do Sul, Porto Alegre, Criciúma, Brazil
| | - André P Torelly
- ICU, Santa Casa de Misericórdia de Porto Alegre, Criciúma, Brazil
| | - Eliézer Silva
- ICU, Hospital Israelita Albert Einstein, Criciúma, Brazil; ICU, Fundação Pio XII, Hospital do Câncer de Barretos, Barretos, Criciúma, Brazil
| | - Ederlon Rezende
- ICU, Hospital do Servidor Público Estadual, São Paulo, Criciúma, Brazil
| | - José J Netto
- ICU, Instituto Nacional de Câncer, Hospital do Câncer II, Criciúma, Brazil
| | - Claudio Piras
- ICU, Vitória Apart Hospital, Vitória, Criciúma, Brazil
| | - Suzana M A Lobo
- Division of Critical Care Medicine, Department of Internal Medicine, Medical School and Hospital de Base, São José do Rio Preto, Criciúma, Brazil
| | | | - José M Teles
- ICU, Hospital Português, Salvador, Criciúma, Brazil
| | | | | | - Gilberto Friedman
- ICU, Universidade Federal do Rio Grande do Sul, Porto Alegre, Criciúma, Brazil
| | - Alvaro Rea-Neto
- ICU, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Criciúma, Brazil
| | - Felipe Dal-Pizzol
- Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rio de Janeiro, Criciúma, Brazil
| | | | - Márcio Soares
- Programa de Pós-Graduação em Oncologia, Criciúma, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Criciúma, Brazil
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Toffart AC, Pizarro CA, Schwebel C, Sakhri L, Minet C, Duruisseaux M, Azoulay E, Moro-Sibilot D, Timsit JF. Selection criteria for intensive care unit referral of lung cancer patients: a pilot study. Eur Respir J 2014; 45:491-500. [DOI: 10.1183/09031936.00118114] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The decision-making process for the intensity of care delivered to patients with lung cancer and organ failure is poorly understood, and does not always involve intensivists. Our objective was to describe the potential suitability for intensive care unit (ICU) referral of lung cancer in-patients with organ failures.We prospectively included consecutive lung cancer patients with failure of at least one organ admitted to the teaching hospital in Grenoble, France, between December 2010 and October 2012.Of 140 patients, 121 (86%) were evaluated by an oncologist and 49 (35%) were referred for ICU admission, with subsequent admission for 36 (73%) out of those 49. Factors independently associated with ICU referral were performance status ⩽2 (OR 10.07, 95% CI 3.85–26.32), nonprogressive malignancy (OR 7.00, 95% CI 2.24–21.80), and no explicit refusal of ICU admission by the patient and/or family (OR 7.95, 95% CI 2.39–26.37). Factors independently associated with ICU admission were the initial ward being other than the lung cancer unit (OR 6.02, 95% CI 1.11–32.80) and an available medical ICU bed (OR 8.19, 95% CI 1.48–45.35).Only one-third of lung cancer patients with organ failures were referred for ICU admission. The decision not to consider ICU admission was often taken by a non-intensivist, with advice from an oncologist rather than an intensivist.
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150
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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. Adv Hematol 2014; 2014:704318. [PMID: 25349612 PMCID: PMC4199072 DOI: 10.1155/2014/704318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 11/26/2022] Open
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.
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