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Gettleman BS, Richardson MK, Ayad M, Christ AB, Menendez LR. Complications of cryoprobe cryoablation as a surgical adjuvant for the treatment of metastatic carcinoma to bone, benign bone tumors, and soft tissue tumors: A series of 148 patients. J Surg Oncol 2024; 129:668-669. [PMID: 37970677 DOI: 10.1002/jso.27500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Brandon S Gettleman
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Mary K Richardson
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Mina Ayad
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Alexander B Christ
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Lawrence R Menendez
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Sonal S, Schneider D, Boudreau C, Kunitake H, Goldstone RN, Bordeianou LG, Cauley CE, Francone TD, Ricciardi R, Berger DL. Patient Factors Affecting Inpatient Mortality Following Colorectal Cancer Resection. Am Surg 2023; 89:5806-5812. [PMID: 37178013 DOI: 10.1177/00031348231175141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Our objective is to identify factors for inpatient death in patients undergoing resection for colorectal cancer (CRC). STUDY DESIGN Unmatched 1:3 case-control study of surgically resected CRC at a tertiary care institution between 2004 and 2018. Variables for multivariate analysis were selected using tetrachoric correlation followed by a least absolute shrinkage and selection operator (LASSO) penalized regression model. RESULTS A total of 140 patients were included (N = 35 patients who died inpatient, N = 105 patients who did not die). Patients who died were older, had higher Charlson Comorbidity Index (CCI), higher rates of preoperative anemia, hypoalbuminemia, emergency surgeries, blood transfusion, postoperative vasopressor requirement, anastomotic leak, and postoperative ICU admission than patients who underwent surgical resection without inpatient mortality. Anemia (aOR = 8.62, 1.44-91.58), emergency admission (aOR = 5.71, 1.46-24.36), and ICU admission (aOR 45.51, 8.31-448.4) significantly predicted inpatient mortality when controlled for CCI and hypoalbuminemia. CONCLUSIONS Surprisingly, it appears that pre-existing anemia and perioperative factors are more important in predicting inpatient mortality of patients undergoing CRC surgery than baseline comorbidity or nutritional status.
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Affiliation(s)
- Swati Sonal
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Derek Schneider
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chloe Boudreau
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Robert N Goldstone
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Todd D Francone
- Department of Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
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Outcomes for head and neck cancer patients admitted to intensive care in Australia and New Zealand between 2000 and 2016. The Journal of Laryngology & Otology 2021; 135:702-709. [PMID: 34154686 DOI: 10.1017/s0022215121001602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To report intensive care unit admission outcomes for head and neck cancer patients. METHODS A retrospective, observational cohort analysis of all Australian and New Zealander head and neck cancer patient intensive care unit admissions from January 2000 to June 2016, including data from 192 intensive care units. RESULTS There were 10 721 head and neck cancer patients, with a median age of 64 years (71.6 per cent male). Of admissions, 76.4 per cent were in public hospitals, 96.9 per cent were post-operative and 43.6 per cent required mechanical ventilation. Annual head and neck cancer admissions increased from 2000 to 2015 (from 348 to 1132 patients), but the overall proportion of intensive care unit admissions remained constant. In-hospital mortality was 2.7 per cent, and intensive care unit mortality was 0.7 per cent. The in-hospital mortality risk decreased three-fold (p < 0.001). CONCLUSION Head and neck cancer patients had low mortality in the intensive care unit and in hospital. Risk of dying decreased despite more intensive care unit admissions. This is the first large-scale cohort study quantifying intensive care unit utilisation by head and neck cancer patients. It informs future work investigating alternatives to the intensive care unit for these patients.
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Yuan ZN, Wang HJ, Gao Y, Qu SN, Huang CL, Wang H, Zhang H, Yang QH, Xing XZ. The effect of the underlying malignancy on short- and medium-term survival of critically ill patients admitted to the intensive care unit: a retrospective analysis based on propensity score matching. BMC Cancer 2021; 21:417. [PMID: 33858357 PMCID: PMC8051069 DOI: 10.1186/s12885-021-08152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background Advances in oncology led to a substantial increase in the number of patients requiring admission to the ICU. It is significant to confirm which cancer critical patients can benefit from the ICU care like noncancer patients. Methods An observational retrospective cohort study using intensive care unit (ICU) admissions of Medical Information Mart for Intensive Care III from the Beth Israel Deaconess Medical Center in Boston, MA, USA between 2001 and 2012 was conducted. Propensity score matching was used to reduce the imbalance between two matched cohorts. ICU patients with cancer were compared with those without cancer in terms of patients’ characteristics and survival. Results There were 38,508 adult patients admitted to ICUs during the period. The median age was 65 years (IQR, 52–77) and 8308 (21.6%) had an underlying malignancy diagnosis. The noncancer group had a significant survive advantage at the point of 28-day, 90-day, 365-day and 1095-day after ICU admission compared with cancer group (P < 0.001 for all) after PSM. Subgroup analysis showed that the diagnosis of malignancy didn’t decrease 28-day and 90-day survive when patients’ age ≥ 65-year, patients in surgical intensive care unit or cardiac surgery recovery unit or traumatic surgical intensive care unit, elective admissions, patients with renal replacement therapy or vasopressor support (P > 0.05 for all). Conclusions Malignancy is a common diagnosis among ICU patients. Patients without cancer have a survive advantage compared with patients with cancer in the short- and medium-term. However, in selected groups, cancer critical patients can benefit from the ICU care service like noncancer patients in the short-term.
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Affiliation(s)
- Zhen-Nan Yuan
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Hai-Jun Wang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Yong Gao
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Shi-Ning Qu
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Chu-Lin Huang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Hao Wang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Hao Zhang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Quan-Hui Yang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Xue-Zhong Xing
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
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Gao S, Wang Y, Yang L, Wang Z, Huang W. Characteristics and clinical subtypes of cancer patients in the intensive care unit: a retrospective observational study for two large databases. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:13. [PMID: 33553306 PMCID: PMC7859733 DOI: 10.21037/atm-20-4634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Previous studies have reported very different mortality rates among cancer patients in the intensive care unit (ICU), implying different clinical subtypes. We aimed to reveal the clinical subtypes and demonstrate the importance of segregating the patients in clinical research, and to report the ICD-level mortality of cancer patients in the ICU. Methods Two ICU databases (MIMIC-III and eICU) were utilized to identify cancer patients. Mortality based on ICD-level diagnoses were calculated, and K-means clustering was used to identify different clinical subtypes in the MIMIC database. Clinical characteristics and outcomes were compared among subtypes, and the calibration of SAPS II and APACHE IV among different subtypes was evaluated. Results In total, 6,505 (13.8%) cancer patients of the MIMIC database and 7,351 (4.9%) ones in eICU database, were enrolled in the study. Metastasis involving pleura, metastasis involving the liver, and acute myeloid leukemia were in the top 5 diagnoses with the highest mortality in both databases. Clinical subtypes identified by K-means clustering were closely associated with admission type (elective or emergency) and clinical service provider (surgical or medical). In a four-cluster pattern, nearly all patients in the first cluster were elective admissions (99.1%), whereas in the rest of the clusters, most were emergency admissions (93.7%). Most surgical patients were in the 1+2 clusters (92.0%) and most medical patients were in the 3+4 clusters (93.5%). Most characteristics and outcomes as well as the calibration of SAPS II and APACHE IV scoring systems were significantly different among clinical subtypes. Conclusions Different clinical subtypes can be well identified by admission type and clinical service provider among ICU patients with cancer. Caution should be exercised when considering these patients as a whole population both in clinical practice and research. Moreover, APACHE IV has better calibration than SAPS II for cancer patients at low risk of mortality in the ICU.
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Affiliation(s)
- Shaowei Gao
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaqing Wang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lu Yang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhongxing Wang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenqi Huang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Al-Jabir A, Kerwan A, Nicola M, Alsafi Z, Khan M, Sohrabi C, O'Neill N, Iosifidis C, Griffin M, Mathew G, Agha R. Impact of the Coronavirus (COVID-19) pandemic on surgical practice - Part 1. Int J Surg 2020; 79:168-179. [PMID: 32407799 PMCID: PMC7214340 DOI: 10.1016/j.ijsu.2020.05.022] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 01/08/2023]
Abstract
The Coronavirus (COVID-19) pandemic has resulted in over 4.5 million confirmed cases and over 300,000 deaths. The impact of COVID-19 on surgical practice is widespread, ranging from workforce and staffing issues, procedural prioritisation, viral transmission risk intraoperatively, changes to perioperative practice and ways of working alongside the impact on surgical education and training. Whilst there has been a growing literature base describing the early clinical course of COVID-19 and on aspects of critical care related to treating these patients, there has been a dearth of evidence on how this pandemic will affect surgical practice. This paper seeks to review the current evidence and offers recommendations for changes to surgical practice to minimise the effect of the COVID-19 pandemic.
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Affiliation(s)
- Ahmed Al-Jabir
- GKT School of Medical Education, King's College London, United Kingdom.
| | - Ahmed Kerwan
- GKT School of Medical Education, King's College London, United Kingdom
| | - Maria Nicola
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Zaid Alsafi
- UCL Medical School, University College London, United Kingdom
| | - Mehdi Khan
- UCL Medical School, University College London, United Kingdom
| | - Catrin Sohrabi
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Niamh O'Neill
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Christos Iosifidis
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | | | - Ginimol Mathew
- UCL Medical School, University College London, United Kingdom
| | - Riaz Agha
- Barts Health NHS Trust, London, United Kingdom
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Acute Respiratory Failure in the Oncologic Patient: New Era, New Issues. ANNUAL UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 2019 2019. [PMCID: PMC7121650 DOI: 10.1007/978-3-030-06067-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Recent decades have seen an increase in the number of patients living with cancer. This trend has resulted in an increase in intensive care unit (ICU) utilization across this population [1]. Acute respiratory failure is the most frequent medical complication leading to critical illness in oncologic patients [2–4]. Historically, there had been a reluctance to admit cancer patients to the ICU given their poor outcomes, particularly in the setting of hematologic malignancy and invasive mechanical ventilation [5]. ICU treatment limitations or refusal of admission was advocated [6]. Major advances in oncologic care, critical care and more meticulous attention to where the conditions overlap, have resulted in marked improvement in short-term survival in this population [1, 7, 8]. Despite these major advances, acute respiratory failure in this population remains complex with unique challenges surrounding diagnosis and management compared to the general ICU population. This chapter provides a comprehensive overview of acute respiratory failure in the oncologic population and highlights specific considerations for the intensivist. We will focus on the important differences between the immunocompromised oncologic patient and general intensive care population, the spectrum of causes of acute respiratory failure with a specific focus on toxicities related to newer cancer therapies, diagnostic approach, management and an up-to-date overview of prognosis.
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Darvall JN, Byrne T, Douglas N, Anstey JR. Intensive Care Practice in the Cancer Patient Population:
Special Considerations and Challenges. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Puxty K, McLoone P, Quasim T, Sloan B, Kinsella J, Morrison DS. Characteristics and Outcomes of Surgical Patients With Solid Cancers Admitted to the Intensive Care Unit. JAMA Surg 2018; 153:834-840. [PMID: 29955801 PMCID: PMC6233642 DOI: 10.1001/jamasurg.2018.1571] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/25/2018] [Indexed: 12/13/2022]
Abstract
Importance Within the surgical population admitted to intensive care units (ICUs), cancer is a common condition. However, clinicians can be reluctant to admit patients with cancer to ICUs owing to concerns about survival. Objective To compare the clinical characteristics and outcomes of surgical patients with and without cancer who are admitted to ICUs. Design, Setting, and Participants An observational retrospective cohort study using ICU audit records linked to hospitalization discharge summaries, cancer registrations, and death records of all 16 general adult ICUs in the West of Scotland was conducted. All 25 017 surgical ICU admissions between January 1, 2000, and December 31, 2011, were included, and data analysis was conducted during that time. Exposures Patients were dichotomized based on a diagnosis of a solid malignant tumor as determined by its documentation in the Scottish Cancer Registry within the 2 years prior to ICU admission. Main Outcomes and Measures Intensive care unit patients with cancer were compared with ICU patients without cancer in terms of patient characteristics (age, sex, severity of illness, reason for admission, and organ support) and survival (ICU, hospital, 6 months, and 4 years). Results Within the 25 017 surgical ICU patients, 13 684 (54.7%) were male, the median (interquartile range [IQR]) age was 64 (50-74), and 5462 (21.8%) had an underlying solid tumor diagnosis. Patients with cancer were older (median [IQR] age, 68 [60-76] vs 62 [45-74] years; P < .001) with a higher proportion of elective hospitalizations (60.5% vs 19.8%; P < .001), similar Acute Physiology and Chronic Health Evaluation II scores (median for both, 17), but lower use of multiorgan support (57.9% vs 66.7%; P < .001). Intensive care unit and hospital mortality were lower for the cancer group, at 12.2% (95% CI, 11.3%-13.1%) vs 16.8% (95% CI, 16.3%-17.4%) (P < .001) and 22.9% (95% CI, 21.8%-24.1%) vs 28.1% (27.4%-28.7%) (P < .001). Patients with cancer had an adjusted odds ratio for hospital mortality of 1.09 (95% CI, 1.00-1.19). By 6 months, mortality in the cancer group was higher than that in the noncancer group at 31.3% compared with 28.2% (P < .001). Four years after ICU admission, mortality for those with and without cancer was 60.9% vs 39.7% (P < .001) respectively. Conclusions and Relevance Cancer is a common diagnosis among surgical ICU patients and this study suggests that initial outcomes compare favorably with those of ICU patients with other conditions. Consideration that a diagnosis of cancer should not preclude admission to the ICU in patients with surgical disease is suggested.
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Affiliation(s)
- Kathryn Puxty
- Department of Intensive Care, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Philip McLoone
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Tara Quasim
- School of Medicine, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Billy Sloan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Kinsella
- School of Medicine, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - David S. Morrison
- Consultant in Public Health Medicine, National Health Services Scotland, Glasgow, United Kingdom
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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de Nadal M, Pérez-Hoyos S, Montejo-González JC, Pearse R, Aldecoa C. Intensive care admission and hospital mortality in the elderly after non-cardiac surgery. Med Intensiva 2018; 42:463-472. [PMID: 29502889 DOI: 10.1016/j.medin.2018.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/08/2018] [Accepted: 01/20/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess whether patient age is independently associated to Intensive Care Unit (ICU) admission after non-cardiac surgery. DESIGN An observational cohort study of the Spanish subset of the European Surgical Outcome Study (EuSOS) was carried out. SETTING Hospitals of the public National Health Care System and private hospitals in Spain. INTERVENTION None. PATIENTS AND METHODS All patients over 16 years of age undergoing inpatient non-cardiac surgery in the participating hospitals during a 7-day period in the month of April 2011 were consecutively included. MAIN VARIABLES OF INTEREST ICU admission rate, factors associated with ICU admission and hospital mortality were assessed using logistic regression analysis and fractional polynomial regression. RESULTS Out of 5412 patients, 677 (12.5%) were admitted to the ICU after surgery. The adjusted odds ratio (95% confidence interval [CI]) for ICU admission was 1.1 (0.8-1.4) for patients aged 65-74 years, 0.7 (0.5-1) for patients aged 75-85 years, and 0.4 (0.2-0.8) for patients over 85 years, respectively. Age, ASA score, grade of surgery (minor, intermediate, major), urgent surgery, surgical specialty, laparoscopic surgery and metastatic disease were independent factors for ICU admission. Global risk-adjusted mortality was 1.4 (95% CI 0.9-2.2). The ASA score, urgent surgery, surgical specialty and diabetes were predictors of hospital mortality. CONCLUSIONS Elderly patients (over 80 years) appear less likely to be admitted to ICU after non-cardiac surgery in Spanish hospitals. There was no significant association between age and postoperative mortality in this cohort.
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Affiliation(s)
- M de Nadal
- Department of Anaesthesiology and Intensive Care, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - S Pérez-Hoyos
- Statistics and Bioinformatics Unit, Vall d'Hebron Research Institute, Barcelona, Spain
| | - J C Montejo-González
- Department of Intensive Care, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - R Pearse
- Department of Intensive Care Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - C Aldecoa
- Department of Anaesthesia and Surgical Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
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Shimabukuro-Vornhagen A, Böll B, Kochanek M, Azoulay É, von Bergwelt-Baildon MS. Critical care of patients with cancer. CA Cancer J Clin 2016; 66:496-517. [PMID: 27348695 DOI: 10.3322/caac.21351] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Answer questions and earn CME/CNE The increasing prevalence of patients living with cancer in conjunction with the rapid progress in cancer therapy will lead to a growing number of patients with cancer who will require intensive care treatment. Fortunately, the development of more effective oncologic therapies, advances in critical care, and improvements in patient selection have led to an increased survival of critically ill patients with cancer. As a consequence, critical care has become an important cornerstone in the continuum of modern cancer care. Although, in many aspects, critical care for patients with cancer does not differ from intensive care for other seriously ill patients, there are several challenging issues that are unique to this patient population and require special knowledge and skills. The optimal management of critically ill patients with cancer necessitates expertise in oncology, critical care, and palliative medicine. Cancer specialists therefore have to be familiar with key principles of intensive care for critically ill patients with cancer. This review provides an overview of the state-of-the-art in the individualized management of critically ill patients with cancer. CA Cancer J Clin 2016;66:496-517. © 2016 American Cancer Society.
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Affiliation(s)
- Alexander Shimabukuro-Vornhagen
- Consultant, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Boris Böll
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Head of Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Program Director, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Éli Azoulay
- Director, Medical Intensive Care Unit, St. Louis Hospital, Paris, France
- Professor of Medicine, Teaching and Research Unit, Department of Medicine, Paris Diderot University, Paris, France
- Chair, Study Group for Respiratory Intensive Care in Malignancies, St. Louis Hospital, Paris, France
| | - Michael S von Bergwelt-Baildon
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Program Director, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Professor, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
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13
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Haapio E, Kinnunen I, Airaksinen JKE, Irjala H, Kiviniemi T. Excessive intravenous fluid therapy in head and neck cancer surgery. Head Neck 2016; 39:37-41. [PMID: 27299857 DOI: 10.1002/hed.24525] [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] [Accepted: 05/16/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The purpose of this retrospective study was to present our assessment of modifiable perioperative factors for major cardiac and cerebrovascular events (MACCE). METHODS This study included an unselected cohort of patients with head and neck cancer (n = 456) treated in Turku University Hospital between 1999 and 2008. RESULTS Perioperative and postoperative univariate predictors of MACCE at 30-day follow-up were: total amount of fluids (during 24 hours) over 4000 mL, any red blood cell (RBC) infusion, treatment in the intensive care unit (ICU), tracheostomy, and microvascular reconstruction surgery. Median time from operation to MACCE was 3 days. Patients receiving >4000 mL of fluids had MACCE more often compared with those receiving <4000 mL (10.8% vs 2.4%; p < .001, respectively). Moreover, every RBC unit transfused or every liter of fluid administered over 4000 mL/24h increased the risk of MACCE 18% per unit/liter, respectively. CONCLUSION Patients with head and neck cancer receiving excessive intravenous fluid administration perioperatively and postoperatively are at high risk for cardiac complications, especially heart failure. © 2016 Wiley Periodicals, Inc. Head Neck 39: 37-41, 2017.
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Affiliation(s)
- Eeva Haapio
- Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilpo Kinnunen
- Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Heikki Irjala
- Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
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Della Rocca G, Vetrugno L, Coccia C, Pierconti F, Badagliacca R, Vizza CD, Papale M, Melis E, Facciolo F. Preoperative Evaluation of Patients Undergoing Lung Resection Surgery: Defining the Role of the Anesthesiologist on a Multidisciplinary Team. J Cardiothorac Vasc Anesth 2015; 30:530-8. [PMID: 27013123 DOI: 10.1053/j.jvca.2015.11.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Giorgio Della Rocca
- Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, Institute of Oncology "Regina Elena" IRE-IRCCS, Rome, Italy
| | - Federico Pierconti
- Department of Anesthesia and Critical Care Medicine, Institute of Oncology "Regina Elena" IRE-IRCCS, Rome, Italy
| | | | | | | | - Enrico Melis
- Thoracic Surgery Unit, Department of Surgical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Department of Surgical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
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15
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van de Klundert N, Holman R, Dongelmans DA, de Keizer NF. Data Resource Profile: the Dutch National Intensive Care Evaluation (NICE) Registry of Admissions to Adult Intensive Care Units. Int J Epidemiol 2015; 44:1850-1850h. [DOI: 10.1093/ije/dyv291] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 01/04/2023] Open
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16
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Preoperative and surgical factors associated with postoperative intensive care unit admission following operative treatment for degenerative lumbar spine disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:843-9. [DOI: 10.1007/s00586-015-4175-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 01/16/2023]
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17
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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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18
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Betten J, Roness AK, Endreseth BH, Trønnes H, Tyvold SS, Klepstad P, Nordseth T. Assessment of the time-dependent need for stay in a high dependency unit (HDU) after major surgery by using data from an anesthesia information management system. J Clin Monit Comput 2015; 30:235-41. [PMID: 26013979 DOI: 10.1007/s10877-015-9707-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
Admittance to a high dependency unit (HDU) is expensive. Patients who receive surgical treatment with 'low anterior resection of the rectum' (LAR) or 'abdominoperineal resection of the rectum' (APR) at our hospital are routinely treated in an HDU the first 16-24 h of the postoperative (PO) period. The aim of this study was to describe the extent of HDU-specific interventions given. We included patients treated with LAR or APR at the St. Olav University Hospital (Trondheim, Norway) over a 1-year period. Physiologic data and HDU-interventions recorded during the PO-period were obtained from the anesthesia information management system (AIMS). HDU-specific interventions were defined as the need for respiratory support, fluid replacement therapy >500 ml/h, vasoactive medications, or a need for high dose opioids (morphine >7.5 mg/h i.v.). Sixty-two patients were included. Most patients needed HDU-specific interventions during the first 6 h of the PO period. After this, one-third of the patients needed one or more of the HDU-specific interventions for shorter periods of time. Another one-third of the patients had a need for HDU-specific therapies for more than ten consecutive hours, primarily an infusion of nor-epinephrine. Most patients treated with LAR or APR was in need of an HDU-specific intervention during the first 6 h of the PO-period, with a marked decline after this time period. The applied methodology, using an AIMS, demonstrates that there is great variability in individual patients' postoperative needs after major surgery, and that these needs are dynamic in their nature.
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Affiliation(s)
- Jan Betten
- Faculty of Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | | | - Birger Henning Endreseth
- Department of Surgery, St. Olav Hospital, 7006, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | - Håkon Trønnes
- Department of Anesthesia and Intensive Care Medicine, St. Olav Hospital, 7006, Trondheim, Norway
| | - Stig Sverre Tyvold
- Department of Anesthesia and Intensive Care Medicine, St. Olav Hospital, 7006, Trondheim, Norway
| | - Pål Klepstad
- Department of Anesthesia and Intensive Care Medicine, St. Olav Hospital, 7006, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | - Trond Nordseth
- Department of Anesthesia and Intensive Care Medicine, St. Olav Hospital, 7006, Trondheim, Norway. .,Regional Center for Health Care Research, St. Olav Hospital, 7006, Trondheim, Norway.
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19
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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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20
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Camus MF, Ameye L, Berghmans T, Paesmans M, Sculier JP, Meert AP. Rate and patterns of ICU admission among colorectal cancer patients: a single-center experience. Support Care Cancer 2014; 23:1779-85. [PMID: 25471179 DOI: 10.1007/s00520-014-2524-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/14/2014] [Indexed: 01/31/2023]
Abstract
PURPOSE The purposes of this study were to evaluate, in colorectal cancer patients, the cause of ICU admission and to find predictors of death during and after hospitalization. METHODS This is a retrospective study including all patients with colorectal cancer admitted in the ICU of a cancer hospital from January 1st 2003 to December 31 2012. RESULTS Among 3721 ICU admissions occurring during the study period, 119 (3.2 %) admissions dealt with colorectal cancer, of whom 89 were eligible and assessable. The main reasons for admission were of metabolic (24 %), hemodynamic (19 %), cardiovascular (18 %), gastrointestinal (16 %), respiratory (13 %), or neurologic (6 %) origin. These complications were due to cancer in 43 %, to the antineoplastic treatment in 25 %, or were unrelated to the cancer or its treatment in 33 %. A quarter of the patients died during hospitalization. Independent predictors of death were the Sequential Organ Failure Assessment (SOFA) score (with risk of dying increasing by 42 % per unit of SOFA score), fever (with risk of dying multiplied by three per °C), and high values of GOT (with risk of dying multiplied by 1 % per unit increase), while cancer control (i.e., stage progression or not), compliance to the initial cancer treatment plan, and LDH ≤ median levels had prognostic significance for further longer survival after hospital discharge. CONCLUSION This is the first study looking at specific causes for unplanned ICU admission of patients with colorectal cancer. Hospital mortality was influenced by the characteristics of the complication that entailed the ICU admission while cancer characteristics retained their prognostic influence on survival after hospital discharge.
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Affiliation(s)
- M F Camus
- Service des soins intensifs et urgences oncologiques and oncologie thoracique, Institut Jules Bordet, Université Libre de Bruxelles (ULB), 1, rue Héger Bordet, 1000, Bruxelles, Belgium
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Kostakou E, Rovina N, Kyriakopoulou M, Koulouris NG, Koutsoukou A. Critically ill cancer patient in intensive care unit: Issues that arise. J Crit Care 2014; 29:817-22. [DOI: 10.1016/j.jcrc.2014.04.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 03/01/2014] [Accepted: 04/16/2014] [Indexed: 12/15/2022]
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