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García de Herreros M, Laguna JC, Padrosa J, Barreto TD, Chicote M, Font C, Grafiá I, Llavata L, Seguí E, Tuca A, Viladot M, Zamora-Martínez C, Fernández-Méndez S, Téllez A, Nicolás JM, Prat A, Castro-Rebollo P, Marco-Hernández J. Characterisation and Outcomes of Patients with Solid Organ Malignancies Admitted to the Intensive Care Unit: Mortality and Impact on Functional Status and Oncological Treatment. Diagnostics (Basel) 2024; 14:730. [PMID: 38611643 PMCID: PMC11011727 DOI: 10.3390/diagnostics14070730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Despite the increasing number of ICU admissions among patients with solid tumours, there is a lack of tools with which to identify patients who may benefit from critical support. We aim to characterize the clinical profile and outcomes of patients with solid malignancies admitted to the ICU. METHODS Retrospective observational study of patients with cancer non-electively admitted to the ICU of the Hospital Clinic of Barcelona (Spain) between January 2019 and December 2019. Data regarding patient and neoplasm characteristics, ICU admission features and outcomes were collected from medical records. RESULTS 97 ICU admissions of 84 patients were analysed. Lung cancer (22.6%) was the most frequent neoplasm. Most of the patients had metastatic disease (79.5%) and were receiving oncological treatment (75%). The main reason for ICU admission was respiratory failure (38%). Intra-ICU and in-hospital mortality rates were 9.4% and 24%, respectively. Mortality rates at 1, 3 and 6 months were 19.6%, 36.1% and 53.6%. Liver metastasis, gastrointestinal cancer, hypoalbuminemia, elevated basal C-reactive protein, ECOG-PS greater than 2 at ICU admission, admission from ward and an APACHE II score over 14 were related to higher mortality. Functional status was severely affected at discharge, and oncological treatment was definitively discontinued in 40% of the patients. CONCLUSION Medium-term mortality and functional deterioration of patients with solid cancers non-electively admitted to the ICU are high. Surrogate markers of cachexia, liver metastasis and poor ECOG-PS at ICU admission are risk factors for mortality.
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Affiliation(s)
- Marta García de Herreros
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Juan Carlos Laguna
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Joan Padrosa
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Tanny Daniela Barreto
- Radiation Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain;
| | - Manoli Chicote
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
| | - Carme Font
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Ignacio Grafiá
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Lucía Llavata
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
| | - Elia Seguí
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Albert Tuca
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Margarita Viladot
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Carles Zamora-Martínez
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Sara Fernández-Méndez
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Adrián Téllez
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Josep Maria Nicolás
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Aleix Prat
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Pedro Castro-Rebollo
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Javier Marco-Hernández
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
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Bosch-Compte R, Visa L, Rios A, Duran X, Fernández-Real M, Gomariz-Vilaldach G, Masclans JR. Prognostic factors in oncological patients with solid tumours requiring intensive care unit admission. Oncol Lett 2023; 26:525. [PMID: 37927417 PMCID: PMC10623089 DOI: 10.3892/ol.2023.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
The aim of the present study was to identify factors predicting in-hospital mortality in patients with cancer admitted to a medical Intensive Care Unit (ICU), and to evaluate their functional status and survival during follow-up at the oncology service in the initial 12 months after hospital discharge. A retrospective observational study was performed on 129 consecutive oncological patients with solid tumours admitted to the medical ICU of the Hospital del Mar (Barcelona, Spain) between January 2016 and June 2018. Demographics, and clinical data in-ICU and in-hospital mortality were recorded. Post-hospital discharge follow-up was also carried out. ICU and hospital mortality rates were 24% (n=31) and 40.3% (n=52), respectively. Sequential Organ Failure Assessment (SOFA) score (HR, 1.20; 95% CI, 1.01-1.42; P=0.037), neutropenia on admission (HR, 8.53; 95% CI, 2.15-33.82; P=0.002), metastatic disease (HR, 3.92; 95% CI, 1.82-8.45; P<0.001), need for invasive mechanical ventilation (HR, 5.78; 95% CI, 1.61-20.73; P=0.007), surgery during hospital admission (HR, 0.23; 95% CI, 0.09-0.61; P=0.003) and ICU stay (>48 h) (HR, 0.11; 95% CI, 0.04-0.29; P<0.001) were the independent risk factors for ICU mortality. Overall, 59.5% of the survivors had good functional status at hospital discharge and 28.7% of patients with cancer admitted to the ICU were alive 1 year after hospital discharge, most of them (85.7%) with good functional status (Eastern Cooperative Oncology Group 0-1). In conclusion, hospital mortality may be associated with SOFA score at ICU admission, the need for invasive mechanical ventilation, neutropenia and metastatic disease. Only 40% of patients with oncological disease admitted to the ICU died during their hospital stay, and >50% of the survivors presented good functional status at hospital discharge. Notably, 1 year after hospital discharge, 28.7% of patients were alive, most of them with a good functional status.
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Affiliation(s)
- Raquel Bosch-Compte
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
- Network Biomedical Research Center in Cancer, Ministry of Science and Innovation, Government of Spain, 28029 Madrid, Spain
| | - Alejandro Rios
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
| | - Xavier Duran
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Maria Fernández-Real
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Gemma Gomariz-Vilaldach
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Joan Ramon Masclans
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, 08002 Barcelona, Spain
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Toffart AC, M'Sallaoui W, Jerusalem S, Godon A, Bettega F, Roth G, Pavillet J, Girard E, Galerneau LM, Piot J, Schwebel C, Payen JF. Quality of life of patients with solid malignancies at 3 months after unplanned admission in the intensive care unit: A prospective case-control study. PLoS One 2023; 18:e0280027. [PMID: 36603018 DOI: 10.1371/journal.pone.0280027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although short- and long-term survival in critically ill patients with cancer has been described, data on their quality of life (QoL) after an intensive care unit (ICU) stay are scarce. This study aimed to determine the impact of an ICU stay on QoL assessed at 3 months in patients with solid malignancies. METHODS A prospective case-control study was conducted in three French ICUs between February 2020 and February 2021. Adult patients with lung, colorectal, or head and neck cancer who were admitted in the ICU were matched in a 1:2 ratio with patients who were not admitted in the ICU regarding their type of cancer, curative or palliative anticancer treatment, and treatment line. The primary endpoint was the QoL assessed at 3 months from inclusion using the mental and physical components of the Short Form 36 (SF-36) Health Survey. The use of anticancer therapies at 3 months was also evaluated. RESULTS In total, 23 surviving ICU cancer patients were matched with 46 non-ICU cancer patients. Four patients in the ICU group did not respond to the questionnaire. The mental component score of the SF-36 was higher in ICU patients than in non-ICU patients: median of 54 (interquartile range: 42-57) vs. 47 (37-52), respectively (p = 0.01). The physical component score of the SF-36 did not differ between groups: 35 (31-47) vs. 42 (34-47) (p = 0.24). In multivariate analysis, no association was found between patient QoL and an ICU stay. A good performance status and a non-metastatic cancer at baseline were independently associated with a higher physical component score. The use of anticancer therapies at 3 months was comparable between the two groups. CONCLUSION In patients with solid malignancies, an ICU stay had no negative impact on QoL at 3 months after discharge when compared with matched non-ICU patients.
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Affiliation(s)
- Anne-Claire Toffart
- Institute for Advanced Biosciences INSERM U1209 CNRS UMR5309, Grenoble Alpes University, Grenoble, France
- Department of Pneumology and Physiology, Grenoble Alpes University, Grenoble, France
| | - Wassila M'Sallaoui
- Department of Pneumology and Physiology, Grenoble Alpes University, Grenoble, France
| | - Sophie Jerusalem
- Department of Anesthesia and Intensive Care, Grenoble Alpes University, Grenoble, France
| | - Alexandre Godon
- Department of Anesthesia and Intensive Care, Grenoble Alpes University, Grenoble, France
| | - Francois Bettega
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Gael Roth
- Institute for Advanced Biosciences, CNRS UMR 5309/INSERM U1209, Grenoble Alpes University, Grenoble, France
| | - Julien Pavillet
- Department of Oncology, Grenoble Alpes University, Grenoble, France
| | - Edouard Girard
- Department of Digestive and Emergency Surgery, Grenoble Alpes University, TIMC laboratory, CNRS, CHU Grenoble Alpes, Grenoble, France
| | | | - Juliette Piot
- Department of Anesthesia and Intensive Care, Grenoble Alpes University, Grenoble, France
| | - Carole Schwebel
- Department of Medical ICU, Grenoble Alpes University, Grenoble, France
| | - Jean Francois Payen
- Department of Anesthesia and Intensive Care, Grenoble Alpes University, Grenoble, France
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A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs. Crit Care Explor 2022; 4:e0757. [PMID: 36119395 PMCID: PMC9473777 DOI: 10.1097/cce.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The reported mortality rates of cancer patients admitted to ICUs vary widely. In addition, there are no studies that examined the outcomes of critically ill cancer patients based on the geographical regions. Therefore, we aimed to evaluate the mortality rates among critically ill cancer patients and provide a comparison based on geography.
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Nadkarni Y, Kukec I, Gruber P, Jhanji S, Droney J. Integrated palliative care: triggers for referral to palliative care in ICU patients. Support Care Cancer 2021; 30:2173-2181. [PMID: 34704155 DOI: 10.1007/s00520-021-06542-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Palliative care within intensive care units (ICU) benefits decision-making, symptom control, and end-of-life care. It has been shown to reduce the length of ICU stay and the use of non-beneficial and unwanted life-sustaining therapies. However, it is often initiated late or not at all. There is increasing evidence to support screening ICU patients using palliative care referral criteria or "triggers". The aim of the project was to assess the need for palliative care referral during ICU admission using "trigger" tools. METHODS Electronic record review of cancer patients who died in or within 30 days of discharge from oncology ICU, between 2016 and 2018. Patients referred to palliative care before or during ICU admission were identified. Three sets of palliative care referral "triggers" were applied: one that is being tested locally and two internationally derived tools. The proportion of patients who met any of these triggers during their final ICU admission was calculated. RESULTS Records of 149 patients were reviewed: median age 65 (range 20-83). Most admissions (89%) were unplanned, with the most common diagnoses being haemato-oncology (31%) and gastrointestinal (16%) cancers. Most (73%) were unknown to palliative care pre-ICU admission; 44% were referred between admission and death. The median time from referral to death was 0 day (range 0-19). On ICU admission, 97-99% warranted referral to palliative care using locally and internationally derived triggers. CONCLUSION All "trigger" tools identified a high proportion of patients who may have warranted a palliative care referral either before or during admission to ICU. The routine use of trigger tools could help streamline referral pathways and underpin the development of an effective consultative model of palliative care within the ICU setting to enhance decision-making about appropriate treatment and patient-centred care.
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Affiliation(s)
- Yashna Nadkarni
- Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK.
| | - Ivana Kukec
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Pascale Gruber
- Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK
| | - Shaman Jhanji
- Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK
| | - Joanne Droney
- Symptom Control and Palliative Care Team, Royal Marsden NHS Foundation Trust, London, UK
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Critically ill cancer patient's resuscitation: a Belgian/French societies' consensus conference. Intensive Care Med 2021; 47:1063-1077. [PMID: 34545440 PMCID: PMC8451726 DOI: 10.1007/s00134-021-06508-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
To respond to the legitimate questions raised by the application of invasive methods of monitoring and life-support techniques in cancer patients admitted in the ICU, the European Lung Cancer Working Party and the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique, set up a consensus conference. The methodology involved a systematic literature review, experts' opinion and a final consensus conference about nine predefined questions1. Which triage criteria, in terms of complications and considering the underlying neoplastic disease and possible therapeutic limitations, should be used to guide admission of cancer patient to intensive care units?2. Which ventilatory support [High Flow Oxygenation, Non-invasive Ventilation (NIV), Invasive Mechanical Ventilation (IMV), Extra-Corporeal Membrane Oxygenation (ECMO)] should be used, for which complications and in which environment?3. Which support should be used for extra-renal purification, in which conditions and environment?4. Which haemodynamic support should be used, for which complications, and in which environment?5. Which benefit of cardiopulmonary resuscitation in cancer patients and for which complications?6. Which intensive monitoring in the context of oncologic treatment (surgery, anti-cancer treatment …)?7. What specific considerations should be taken into account in the intensive care unit?8. Based on which criteria, in terms of benefit and complications and taking into account the neoplastic disease, patients hospitalized in an intensive care unit (or equivalent) should receive cellular elements derived from the blood (red blood cells, white blood cells and platelets)?9. Which training is required for critical care doctors in charge of cancer patients?
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Oud L. Critical illness in patients with metastatic cancer: a population-based cohort study of epidemiology and outcomes. J Investig Med 2021; 70:820-828. [PMID: 34535559 DOI: 10.1136/jim-2021-002032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/04/2022]
Abstract
The appropriateness of intensive care unit (ICU) admission of patients with metastatic cancer remains debated. We aimed to examine the short-term outcomes and their temporal pattern in critically ill patients with metastatic disease. We used state-wide data to identify hospitalizations aged ≥18 years with metastatic cancer admitted to ICU in Texas during 2010-2014. Multivariable logistic regression modeling was used to examine the factors associated with short-term mortality and its temporal trends among all ICU admissions and those undergoing mechanical ventilation. Among 136,644 ICU admissions with metastatic cancer, 50.8% were aged ≥65 years, with one or more organ failures present in 53.3% and mechanical ventilation was used in 11.1%. The crude short-term mortality among all ICU admissions and those mechanically ventilated was 28.1% and 62.0%, respectively. Discharge to home occurred in 57.1% of all ICU admissions. On adjusted analyses, short-term mortality increased with rising number of organ failures (adjusted OR (aOR) 1.399, 95% CI 1.374 to 1.425), while being lower with chemotherapy (aOR 0.467, 95% CI 0.432 to 0.506) and radiation therapy (aOR 0.832, 95% CI 0.749 to 0.924), and decreased over time (aOR 0.934 per year, 95% CI 0.924 to 0.945). Predictors of short-term mortality were largely similar among those undergoing mechanical ventilation. Most ICU admissions with metastatic cancer survived hospitalization, although short-term mortality was very high among those undergoing mechanical ventilation. Short-term mortality decreased over time and was lower among those receiving chemotherapy and radiation therapy. These findings support consideration of critical care in patients with metastatic cancer, but underscore the need to address patient-centered goals of care ahead of ICU admission.
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Affiliation(s)
- Lavi Oud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
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Neves MT, Eiriz I, Tomás TC, Gama F, Almeida G, Monteiro FB, Lamas T, Simões I, Gaspar I, Carmo E. The Reality of Critical Cancer Patients in a Polyvalent Intensive Care Unit. Cureus 2021; 13:e13581. [PMID: 33796424 PMCID: PMC8005787 DOI: 10.7759/cureus.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective With the increasing incidence of cancer and the rise in the survival rates of cancer patients, more and more oncological candidates are being considered for admission to intensive care units (ICU). Several studies have demonstrated no difference in the outcomes of cancer patients compared to non-cancer patients. Our study aimed to describe and analyze the outcomes related to cancer patients in a polyvalent ICU. Methods We conducted a retrospective study of consecutive oncological patients admitted to a polyvalent ICU (2013-2017). Cox model and receiver operating characteristic (ROC) curve analysis were performed to analyze the results. Results A total of 236 patients were included in the study; the mean age of the patients was 53.5 ± 15.3 years, and 65% of them were male. The main cancer types were those related to the central nervous system (CNS; 31%), as well as gastrointestinal (18%), genitourinary (17%), and hematological (15%). Curative/diagnostic surgeries (49%) and sepsis/septic shock (17%) were the main reasons for admission. The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores in hematological patients vs. solid tumors were as follows: 30 vs. 20 and 63 vs. 38, respectively (p<0.005). Vasopressors, invasive mechanical ventilation (IMV), and renal replacement therapy (RRT) were used more widely in hematological patients compared to solid-tumor patients. Length of stay was longer in hematological patients vs. solid-tumor patients (12.8 vs. 7 days, p=0.002). The median overall survival in hematological patients was one month and that in solid-tumor patients was 5.8 months (p<0.005). The survival rate at six months was better than described in the existing literature (48 vs. 32.4%). Conclusion Both SAPS II and APACHE II scores were reasonably accurate in predicting mortality, demonstrating their value in cancer patients.
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Affiliation(s)
- Maria Teresa Neves
- Oncology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Inês Eiriz
- Medical Oncology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, PRT
| | - Tiago C Tomás
- Medical Oncology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, PRT
| | - Francisco Gama
- Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Gabriela Almeida
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Filipa B Monteiro
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Tomás Lamas
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Isabel Simões
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Isabel Gaspar
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Eduarda Carmo
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
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Al Qahtani S, Alaklabi A, El-Saed A. Impact of critical care response team implementation on oncology patient outcomes: A retrospective cohort study. Int J Crit Illn Inj Sci 2020; 10:33-38. [PMID: 33376688 PMCID: PMC7759073 DOI: 10.4103/ijciis.ijciis_13_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 01/15/2020] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: The main goal of a critical care response team (CCRT) is to quickly assess and transfer, if required, rapidly deteriorating patients to an intensive care unit (ICU) to prevent cardiopulmonary arrest, stabilize patients' condition, and help in optimizing the care provided by the primary team. The objective of this study was to investigate the correlation between early intervention by CCRT and the outcome of oncology patients. Materials and Methods: This is a retrospective cohort study conducted at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. KAMC is a tertiary care facility with 1200-bed capacity. The study compared oncology patients to nononcology patients. Results: Over 4 years, a total number of 4941 patients were reviewed, of which 172 were oncology patients. The average age of patients in the oncology group was 48.8 ± 20.7, while the average age for nononcology was 52.8 ± 21.2 (P = 0.016). The average Acute Physiology and Chronic Health Evaluation II score on admission for oncology patients was higher than that for the nononcology group (27.8 ± 8.9 vs. 23.6 ± 9.3, respectively). Lower ICU mortality was seen after CCRT implementation (38.8% vs. 62.7%). The average duration of hospital stay and ICU stay increased after CCRT implementation (37.34 vs. 29.31 and 11.93 vs. 8.9, respectively). Conclusion: In this study, we identified that early intervention by implementing CCRT had a significant impact in reducing ICU mortality for oncology and nononcology patients.
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Affiliation(s)
- Saad Al Qahtani
- Department of Critical Care Medicine, College of Medicine, King Saud Bin AbdulAziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Intensive Care, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Saudi Arabia
| | - Ali Alaklabi
- Department of Internal Medicine and Thrombosis, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Saudi Arabia
| | - Aiman El-Saed
- Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Saudi Arabia.,Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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10
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Intensive Care Outcomes of Patients after High Dose Chemotherapy and Subsequent Autologous Stem Cell Transplantation: A Retrospective, Single Centre Analysis. Cancers (Basel) 2020; 12:cancers12061678. [PMID: 32599837 PMCID: PMC7352739 DOI: 10.3390/cancers12061678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
High dose chemotherapy (HDT) followed by autologous peripheral blood stem cell transplantation (ASCT) is standard of care including a curative treatment option for several cancers. While much is known about the management of patients with allogenic SCT at the intensive care unit (ICU), data regarding incidence, clinical impact, and outcome of critical illness following ASCT are less reported. This study included 256 patients with different cancer entities. Median age was 56 years (interquartile ranges (IQR): 45–64), and 67% were male. One-year survival was 89%; 15 patients (6%) required treatment at the ICU following HDT. The main reason for ICU admission was septic shock (80%) with the predominant focus being the respiratory tract (53%). Three patients died, twelve recovered, and six (40%) were alive at one-year, resulting in an immediate treatment-related mortality of 1.2%. Independent risk factors for ICU admission were age (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.00–1.09; p = 0.043), duration of aplasia (OR: 1.37; CI: 1.07–1.75; p = 0.013), and Charlson comorbidity score (OR: 1.64; CI: 1.20–2.23; p = 0.002). HDT followed by ASCT performed at an experienced centre is generally associated with a low risk for treatment related mortality. ICU treatment is warranted mainly due to infectious complications and has a strong positive impact on intermediate-term survival.
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11
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Kalicińska E, Kuszczak B, Dębski J, Szukalski Ł, Wątek M, Strzała J, Rybka J, Czyż J, Lech-Marańda E, Zaucha J, Wróbel T. Hematological malignancies in Polish population: what are the predictors of outcome in patients admitted to Intensive Care Unit? Support Care Cancer 2020; 29:323-330. [PMID: 32361829 DOI: 10.1007/s00520-020-05480-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/17/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Patients with hematological malignancies (HM) require intensive chemotherapy with curative intent, especially in case of AML that results in more frequent admissions to Intensive Care Units (ICU). Due to our knowledge, this study is the first multicenter retrospective analysis in Polish population. METHODS A total of 200 patients with HM hospitalized in 4 Polish hematological centers. Data concerning clinical indices and outcomes during admission and ICU stay were collected retrospectively. RESULTS The most common hematological malignancy was acute leukemia (55%). The main cause of ICU admission was respiratory failure (88.5%), often accompanied by sepsis (58.5%) and acute renal failure (51.5%). In patients with hematological malignancies, the following factors were associated with ICU mortality: prolonged ICU stay (odd ratio [OR] = 6.98, 95% confidence interval [CI]: 1.38-35.33, χ2 = 5.61, p = 0.02), the presence of acute respiratory failure (odd ratio [OR] = 5.35, 95% confidence interval [CI]: 1.01-28.46, χ2 = 3.93, p = 0.04), and the need for renal replacement therapy (odd ratio [OR] = 8.75, 95% confidence interval [CI]: 1.23-62.11, χ2 = 4.78, p = 0.03). There were following associations with in-hospital mortality in patients with hematological malignancies: prolonged ICU stay (odd ratio [OR] = 10.12, 95% confidence interval [CI]: 1.85-55.37, χ2 = 7.21, p = 0.008), the presence of acute respiratory failure (odd ratio [OR] =5.24, 95% confidence interval [CI]: 1.36-20.16, χ2 = 5.87, p = 0.02), the need for catecholamine support (odd ratio [OR] =3.43, 95% confidence interval [CI]: 1.06-11.05, χ2 = 4.32, p = 0.04), and renal replacement therapy (odd ratio [OR] =5.55, 95% confidence interval [CI]: 1.14-26.92, χ2 = 4.59, p = 0.03). CONCLUSIONS We have demonstrated that ICU and in-hospital mortalities among patients with hematological malignancies are still poor, but easier access to the intensive care unit and close cooperation between hematologists and intensivists may improve outcomes. We have found that acute failure of key organs (acute respiratory failure, end-stage renal failure requires renal replacement therapy) and length of ICU stay (but probably no comorbidities and illness severity) may have impact on mortality (both ICU and in-hospital).
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Affiliation(s)
- Elżbieta Kalicińska
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland.
| | - Bartłomiej Kuszczak
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Dębski
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Szukalski
- Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Marzena Wątek
- Department of Hematology, Institute of Hematology and Transfusion Medicine in Warsaw, Warsaw, Poland
| | - Judyta Strzała
- Department of Hematology, Medical University of Gdańsk, Gdańsk, Poland
| | - Justyna Rybka
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Jarosław Czyż
- Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Ewa Lech-Marańda
- Department of Hematology, Institute of Hematology and Transfusion Medicine in Warsaw, Warsaw, Poland
| | - Jan Zaucha
- Department of Hematology, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Wróbel
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
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12
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Acute and Chronic Respiratory Failure in Cancer Patients. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7123817 DOI: 10.1007/978-3-319-74588-6_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 2016, there was an estimated 1.8 million new cases of cancer diagnosed in the United States. Remarkable advances have been made in cancer therapy and the 5-year survival has increased for most patients affected by malignancy. There are growing numbers of patients admitted to intensive care units (ICU) and up to 20% of all patients admitted to an ICU carry a diagnosis of malignancy. Respiratory failure remains the most common reason for ICU admission and remains the leading causes of death in oncology patients. There are many causes of respiratory failure in this population. Pneumonia is the most common cause of respiratory failure, yet there are many causes of respiratory insufficiency unique to the cancer patient. These causes are often a result of immunosuppression, chemotherapy, radiation treatment, or hematopoietic stem cell transplant (HCT). Treatment is focused on supportive care and specific therapy for the underlying cause of respiratory failure. Noninvasive modalities of respiratory support are available; however, careful patient selection is paramount as indiscriminate use of noninvasive positive pressure ventilation is associated with a higher mortality if mechanical ventilation is later required. Historically, respiratory failure in the cancer patient had a grim prognosis. Outcomes have improved over the past 20 years. Survivors are often left with significant disability.
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13
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Tan AC, Jacques SK, Oatley M, Guminski AD. Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit. Intern Med J 2019; 49:734-739. [DOI: 10.1111/imj.14160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Aaron C. Tan
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
| | - Sarah K. Jacques
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
| | - Meredith Oatley
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
| | - Alexander D. Guminski
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
- Melanoma Institute Australia Sydney New South Wales Australia
- Northern Clinical School, University of Sydney Sydney New South Wales Australia
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14
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Kuo WK, Hua CC, Yu CC, Liu YC, Huang CY. The cancer control status and APACHE II score are prognostic factors for critically ill patients with cancer and sepsis. J Formos Med Assoc 2019; 119:276-281. [PMID: 31153724 DOI: 10.1016/j.jfma.2019.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 05/01/2019] [Accepted: 05/14/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/PURPOSE Patients with cancer are eligible for hospice care when their life expectancy is 180 days or shorter. This study investigated the prognostic factors of patients with cancer and sepsis who were admitted to an intensive care unit (ICU) to assist with clinical decisions of hospice care. METHODS A series of 279 patients admitted to the medical ICU with cancer and sepsis were included. Another series of 109 patients with cancer and sepsis admitted to the other medical ICU in the different branch of our hospital was included to verify the results. RESULTS Among 279 patients, the 30-, 90-, and 180-day mortality rates were 47.3%, 72.0%, and 81.0%, respectively. APACHE II score and the cancer control status (controlled or remission (CR), active newly diagnosed (AND) and active recurrent or progressive (ARP)) were significant predictors of 30- and 90-day mortality(30-day: AND(odds ratio: 5.66; 95% confidence interval: 2.12-15.15), ARP(6.24; 2.92-13.33), APACHE II( 1.07; 1.03-1.11); 90-day: AND(4.78; 1.91-11.99), ARP( 24.03; 11.11-51.99), APACHE II( 1.07; 1.02-1.19)) and were associated with a poor 180-day outcome. The 180-day mortality were significantly different among the patients with different cancer control status in the series of 279 patients (CR: 29.8%; AND: 69.4%; and ARP: 98.9 %) and that of 109 patients (46.4%; 96.8%; and 94.0%). CONCLUSION APACHE II score and the cancer control status may be the prognostic factors for critically ill patients with cancer and sepsis, and they may be helpful for evaluating hospice care.
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Affiliation(s)
- Wei-Ke Kuo
- Division of Pulmonary, Critical Care, and Sleep Medicine Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Chung-Ching Hua
- Division of Pulmonary, Critical Care, and Sleep Medicine Chang Gung Memorial Hospital, Keelung, Taiwan, ROC; Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC
| | - Chung-Chieh Yu
- Division of Pulmonary, Critical Care, and Sleep Medicine Chang Gung Memorial Hospital, Keelung, Taiwan, ROC; Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC
| | - Yu-Chih Liu
- Division of Pulmonary, Critical Care, and Sleep Medicine Chang Gung Memorial Hospital, Keelung, Taiwan, ROC; Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC
| | - Chih-Yu Huang
- Division of Pulmonary, Critical Care, and Sleep Medicine Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.
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15
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Darmon M, Bourmaud A, Georges Q, Soares M, Jeon K, Oeyen S, Rhee CK, Gruber P, Ostermann M, Hill QA, Depuydt P, Ferra C, Toffart AC, Schellongowski P, Müller A, Lemiale V, Mokart D, Azoulay E. Changes in critically ill cancer patients' short-term outcome over the last decades: results of systematic review with meta-analysis on individual data. Intensive Care Med 2019; 45:977-987. [PMID: 31143998 DOI: 10.1007/s00134-019-05653-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/20/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The number of averted deaths due to therapeutic advances in oncology and hematology is substantial and increasing. Survival of critically ill cancer patients has also improved during the last 2 decades. However, these data stem predominantly from unadjusted analyses. The aim of this study was to assess the impact of ICU admission year on short-term survival of critically ill cancer patients, with special attention on those with neutropenia. METHODS Systematic review and meta-analysis of individual data according to the guidelines of meta-analysis of observational studies in epidemiology. DATASOURCE Pubmed and Cochrane databases. ELIGIBILITY CRITERIA Adult studies published in English between May 2005 and May 2015. RESULTS Overall, 7354 patients were included among whom 1666 presented with neutropenia at ICU admission. Median ICU admission year was 2007 (IQR 2004-2010; range 1994-2012) and median number of admissions per year was 693 (IQR 450-1007). Overall mortality was 47.7%. ICU admission year was associated with a progressive decrease in hospital mortality (OR per year 0.94; 95% CI 0.93-0.95). After adjustment for confounders, year of ICU admission was independently associated with hospital mortality (OR for hospital mortality per year: 0.96; 95% CI 0.95-0.97). The association was also seen in patients with neutropenia but not in allogeneic stem cell transplant recipients. CONCLUSION After adjustment for patient characteristics, severity of illness and clustering, hospital mortality decreased steadily over time in critically ill oncology and hematology patients except for allogeneic stem cell transplant recipients.
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Affiliation(s)
- Michaël Darmon
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France. .,Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France. .,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris, France.
| | - Aurélie Bourmaud
- Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,Public Health Department, Robert Debré University Hospital, AP-HP, Paris, France.,UMRS 1123, Clinical Epidemiology and Economic Evaluation Applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
| | - Quentin Georges
- Medical-Surgical ICU, Saint-Etienne University Hospital, Saint-Étienne, France
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sandra Oeyen
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Pascale Gruber
- Department of Critical Care, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Marlies Ostermann
- Department of Critical Care and Nephrology, King's College London, Guy's and St Thomas' NHS Foundation Hospital, London, UK
| | - Quentin A Hill
- Department of Haematology, Leeds Teaching Hospitals, Leeds, UK
| | - Pieter Depuydt
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Christelle Ferra
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Anne-Claire Toffart
- Thoracic Oncology Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alice Müller
- Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
| | - Virginie Lemiale
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Djamel Mokart
- Anesthesiology and Intensive Care Unit, Institut Paoli Calmette, Marseille, France
| | - Elie Azoulay
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France.,Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris, France
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16
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Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:326. [PMID: 30514339 PMCID: PMC6280476 DOI: 10.1186/s13054-018-2076-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/21/2018] [Indexed: 12/13/2022]
Abstract
Background The study objective was to assess the influence of neutropenia on outcome of critically ill cancer patients by meta-analysis of individual data. Secondary objectives were to assess the influence of neutropenia on outcome of critically ill patients in prespecified subgroups (according to underlying tumor, period of admission, need for mechanical ventilation and use of granulocyte colony stimulating factor (G-CSF)). Methods Data sources were PubMed and the Cochrane database. Study selection included articles focusing on critically ill cancer patients published in English and studies in humans from May 2005 to May 2015. For study selection, the study eligibility was assessed by two investigators. Individual data from selected studies were obtained from corresponding authors. Results Overall, 114 studies were identified and authors of 30 studies (26.3% of selected studies) agreed to participate in this study. Of the 7515 included patients, three were excluded due to a missing major variable (neutropenia or mortality) leading to analysis of 7512 patients, including 1702 neutropenic patients (22.6%). After adjustment for confounders, and taking study effect into account, neutropenia was independently associated with mortality (OR 1.41; 95% CI 1.23–1.62; P = 0.03). When analyzed separately, neither admission period, underlying malignancy nor need for mechanical ventilation modified the prognostic influence of neutropenia on outcome. However, among patients for whom data on G-CSF administration were available (n = 1949; 25.9%), neutropenia was no longer associated with outcome in patients receiving G-CSF (OR 1.03; 95% CI 0.70–1.51; P = 0.90). Conclusion Among 7512 critically ill cancer patients included in this systematic review, neutropenia was independently associated with poor outcome despite a meaningful survival. Neutropenia was no longer significantly associated with outcome in patients treated by G-CSF, which may suggest a beneficial effect of G-CSF in neutropenic critically ill cancer patients. Systematic review registration PROSPERO CRD42015026347. Date of registration: Sept 18 2015 Electronic supplementary material The online version of this article (10.1186/s13054-018-2076-z) contains supplementary material, which is available to authorized users.
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17
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Outcomes for Critically Ill Cancer Patients in the ICU: Current Trends and Prediction. Int Anesthesiol Clin 2018; 54:e62-75. [PMID: 27623129 DOI: 10.1097/aia.0000000000000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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18
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Predictors of outcome in patients with hematologic malignancies admitted to the intensive care unit. Hematol Oncol Stem Cell Ther 2018; 11:206-218. [PMID: 29684341 DOI: 10.1016/j.hemonc.2018.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/02/2018] [Accepted: 03/10/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Several studies showed conflicting results about prognosis and predictors of outcome of critically ill patients with hematological malignancies (HM). The aim of this study is to determine the hospital outcome of critically ill patients with HM and the factors predicting the outcome. METHODS AND MATERIALS All patients with HM admitted to MICU at a tertiary academic medical center were enrolled. Clinical data upon admission and during ICU stay were collected. Hospital, ICU, and 6 months outcomes were documented. RESULTS There were 130 HM patients during the study period. Acute Leukemia was the most common malignancy (31.5%) followed by Non-Hodgkin's Lymphoma (28.5%). About 12.5% patients had autologous HSCT and 51.5% had allogeneic HSCT. Sepsis was the most common ICU diagnosis (25.9%). ICU mortality and hospital mortality were 24.8% and 45.3%, respectively. Six months mortality (available on 80% of patients) was 56.7%. Hospital mortality was higher among mechanically ventilated patients (75%). Using multivariate analysis, only mechanical ventilation (OR of 19.0, CI: 3.1-117.4, P: 0.001) and allogeneic HSCT (OR of 10.9, CI: 1.8-66.9, P: 0.01) predicted hospital mortality. CONCLUSION Overall hospital outcome of critically ill patients with HM is improving. However those who require mechanical ventilation or underwent allogeneic HSCT continue to have poor outcome.
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19
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Bouteloup M, Perinel S, Bourmaud A, Azoulay E, Mokart D, Darmon M. Outcomes in adult critically ill cancer patients with and without neutropenia: a systematic review and meta-analysis of the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH). Oncotarget 2018; 8:1860-1870. [PMID: 27661125 PMCID: PMC5352103 DOI: 10.18632/oncotarget.12165] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/14/2016] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Whether neutropenia has an impact on the mortality of critically ill cancer patients remains controversial, yet it is widely used as an admission criterion and prognostic factor. METHODS Systematic review and meta-analysis. Studies on adult cancer patients and intensive care units were searched on PubMed and Cochrane databases (2005-2015). Summary estimates of mortality risk differences were calculated using the random-effects model. RESULTS Among the 1,528 citations identified, 38 studies reporting on 6,054 patients (2,097 neutropenic patients) were included. Median mortality across the studies was 54% [45–64], with unadjusted mortality in neutropenic and non-neutropenic critically ill patients of 60% [53–74] and 47% [41–68], respectively. Overall, neutropenia was associated with a 10% increased mortality risk (6%-14%; I2 = 50%). The admission period was not associated with how neutropenia affected mortality. Mortality significantly dropped throughout the study decade [−11% (−13.5 to −8.4)]. This mortality drop was observed in non-neutropenic patients [−12.1% (−15.2 to −9.0)] but not in neutropenic patients [−3.8% (−8.1 to +5.6)]. Sensitivity analyses disclosed no differences in underlying malignancy, mechanical ventilation use, or Granulocyte-colony stimulating factor use. Seven studies allowed the adjustment of severity results (1,350 patients). Although pooled risk difference estimates were similar to non-adjusted results, there was no significant impact of neutropenia on mortality (risk difference of mortality, 9%; 95% CI, −15 to +33) CONCLUSION Although the unadjusted mortality of neutropenic patients was 11% higher, this effect disappeared when adjusted for severity. Therefore, when cancer patients become critically ill, neutropenia cannot be considered as a decision-making criterion.
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Affiliation(s)
- Marie Bouteloup
- Medical-Surgical ICU, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France
| | - Sophie Perinel
- Medical-Surgical ICU, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France
| | - Aurélie Bourmaud
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Elie Azoulay
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France.,Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - Djamel Mokart
- Anesthesiology and Intensive Care Unit, Institut Paoli Calmette, Marseille Cedex 9, France
| | - Michael Darmon
- Medical-Surgical ICU, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France.,Thrombosis Research Group, EA 3065, Saint-Etienne University Hospital and Saint-Etienne Medical School, Saint-Etienne, France
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20
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Koutsoukou A. Admission of critically ill patients with cancer to the ICU: many uncertainties remain. ESMO Open 2017; 2:e000105. [PMID: 29259818 PMCID: PMC5652547 DOI: 10.1136/esmoopen-2016-000105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- Antonia Koutsoukou
- ICU, 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens Medical School, 'Sotiria' Hospital, Athens, Greece
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21
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Ng K, Joury S, Gillmore R. Oncology admissions to the intensive care unit: what factors should influence the decision? Clin Med (Lond) 2017; 17:375. [PMID: 28765423 PMCID: PMC6297651 DOI: 10.7861/clinmedicine.17-4-375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Advances in cancer treatment and patient survival are associated with increasing number of these patients requiring intensive care. Over the last 2 decades, there has been a steady improvement in the outcomes of critically ill patients with cancer. This review provides data on the use of the intensive care unit (ICU) and short and long-term outcomes of critically ill patients with cancer, the ICU system practices that influence patients outcomes, and the role of the different clinical variables in predicting the prognosis of these patients.
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Affiliation(s)
- Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R- 3 Hudson, Detroit, MI 48201, USA.
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Richards S, Wibrow B, Anstey M, Sidiqi H, Chee A, Ho KM. Determinants of 6-month survival of critically ill patients with an active hematologic malignancy. J Crit Care 2016; 36:252-258. [PMID: 27637467 DOI: 10.1016/j.jcrc.2016.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/18/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE This study assessed the determinants of 6-month survival of critically ill patients with an active hematologic malignancy (HM). METHODS All patients with an active HM defined by either receiving ongoing or due to receive antineoplastic therapy, admitted to 2 tertiary intensive care units between 2010 and 2015, were included in this retrospective cohort study. RESULTS Of the 273 patients included in the study (median age, 63[interquartile range, 54-71] years; 40.7% female), 116 (42.5%; 95% confidence interval, 36.8-48.4) died in hospital. The 6-month mortality was 56.4% (95% confidence interval, 50.5-62.2). Mechanical ventilation, intensive care unit admission source, and the type of active HM were significantly associated with hospital mortality and 6-month survival, after adjusting for severity of acute illness. The type of active HM was the most important prognostic factor, with over a 10-fold difference in 6-month survival between HM with the best and worst prognosis. In addition, recent hematopoietic stem cell transplant (<30 days) was associated with a better 6-month survival. CONCLUSION Differences in 6-month survival between critically ill patients with different types of active HM were substantial. Recent hematopoietic stem cell transplant, severity of illness, and use of mechanical ventilation were additional important determinants of 6-month survival in patients with an active HM.
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Affiliation(s)
- Stephen Richards
- Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia 6009, Australia.
| | - Bradley Wibrow
- Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia 6009, Australia.
| | - Matthew Anstey
- Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia 6009, Australia.
| | - Hasib Sidiqi
- Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia 6009, Australia.
| | - Ashlyn Chee
- Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia 6847, Australia.
| | - Kwok M Ho
- Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia 6847, Australia.
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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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Kruse JM, Jenning T, Rademacher S, Arnold R, Schmitt CA, Jörres A, Enghard P, Oppert M. Neutropenic Sepsis in the ICU: Outcome Predictors in a Two-Phase Model and Microbiology Findings. Crit Care Res Pract 2016; 2016:8137850. [PMID: 27195148 PMCID: PMC4852357 DOI: 10.1155/2016/8137850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/01/2016] [Accepted: 02/07/2016] [Indexed: 12/29/2022] Open
Abstract
Objective. Patients with neutropenic sepsis have a poor prognosis. We aimed to identify outcome predictors and generate hypotheses how the care for these patients may be improved. Methods. All 12.352 patients admitted between 2006 and 2011 to the medical ICUs of our tertiary university center were screened for neutropenia; out of 558 patients identified, 102 fulfilled the inclusion criteria and were analyzed. Severity markers and outcome predictors were assessed. Results. The overall ICU mortality was 54.9%. The severity of sepsis and the number of organ failures predicted survival of the primary septic episode (APACHE II 22.8 and 29.0; SOFA 7.3 and 10.1, resp.). In the recovery phase, persistent organ damage and higher persistent C-reactive protein levels were associated with a poor outcome. Blood transfusions and CMV infection correlated with an unfavorable prognosis. Ineffective initial antibiotic therapy, fungal infections, and detection of multiresistant bacteria displayed a particularly poor outcome. Infections with coagulase-negative staphylococci and enterococci were associated with a significantly higher mortality and a high degree of systemic inflammation. Conclusion. Patients with persistent organ dysfunction show an increased mortality in the further course of their ICU stay. Early antimicrobial treatment of Gram-positive cocci may improve the outcome of these patients.
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Affiliation(s)
- Jan M. Kruse
- Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin Berlin, Germany
| | - Thomas Jenning
- Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin Berlin, Germany
| | - Sibylle Rademacher
- Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin Berlin, Germany
| | - Renate Arnold
- Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Universitätsmedizin Berlin, Germany
| | - Clemens A. Schmitt
- Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Universitätsmedizin Berlin, Germany
| | - Achim Jörres
- Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin Berlin, Germany
| | - Philipp Enghard
- Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin Berlin, Germany
| | - Michael Oppert
- Abteilung für Notfall- und Intensivmedizin, Klinikum Ernst von Bergmann Potsdam, Germany
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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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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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Marín M, Gudiol C, Ardanuy C, Garcia-Vidal C, Jimenez L, Domingo-Domenech E, Pérez FJ, Carratalà J. Factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection. Clin Microbiol Infect 2015; 21:583-90. [PMID: 25680311 DOI: 10.1016/j.cmi.2015.01.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/09/2015] [Accepted: 01/30/2015] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to identify factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection (BSI). All episodes of BSI occurring in adult neutropenic patients with haematologic malignancies or solid tumours were prospectively recorded from January 2006 to December 2013. We analysed the factors influencing mortality in both groups of patients. We documented 602 consecutive episodes of BSI; 510 occurred in patients with haematologic malignancies and 92 in patients with solid tumours. The overall case-fatality rates were 12% and 36%, respectively. Independent risk factors associated with a higher case-fatality rate in patients with haematologic malignancies were: intensive care unit admission (odds ratio (OR), 15.2; 95% confidence interval (CI), 5.4-42.7), advanced neoplasm (OR, 8.7; 95% CI, 2.9-25.7), corticosteroid therapy (OR, 7.0; 95% CI, 3-16.4), multidrug-resistant Gram-negative BSI (OR, 3.8; 95% CI, 1.2-11.8) and a Multinational Association for Supportive Care in Cancer risk score of <21 (OR, 3.1; 95% CI, 1.3-7.4). By contrast, coagulase-negative staphylococci BSI (OR, 0.04; 95% CI, 0.004-0.5) and empirical antibiotic combination therapy (OR, 0.1; 95% CI, 0.05-0.3) were found to be protective. Independent risk factors for overall case-fatality rate in patients with solid tumours were: shock at presentation (OR, 14.3; 95% CI, 3.2-63.8), corticosteroid therapy (OR, 10; 95% CI, 2.3-44) and advanced neoplasm (OR, 7.8; 95% CI, 1.4-41.4). Prognostic factors identified in this study may help to detect those patients at higher risk of death in each group. Medical intervention addressing some of these factors might improve the outcome of BSI in neutropenic patients with haematologic malignancies or solid tumours.
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Affiliation(s)
- M Marín
- Oncology Department, Institut Català d'Oncologia-ICO, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain.
| | - C Gudiol
- Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain
| | - C Ardanuy
- Microbiology Department, IDIBELL, Hospital Universitari de Bellvitge, Spain
| | - C Garcia-Vidal
- Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain
| | - L Jimenez
- Oncology Department, Institut Català d'Oncologia-ICO, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - E Domingo-Domenech
- Hematology Department, Institut Català d'Oncologia-ICO, IDIBELL, University of Barcelona, Barcelona, Spain
| | - F J Pérez
- Clinical Research Unit, Institut Català d'Oncologia-ICO, IDIBELL, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain
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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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30
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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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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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Bloodstream infections in neutropenic patients with cancer: Differences between patients with haematological malignancies and solid tumours. J Infect 2014; 69:417-23. [DOI: 10.1016/j.jinf.2014.05.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/05/2014] [Accepted: 05/22/2014] [Indexed: 11/23/2022]
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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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Puxty K, McLoone P, Quasim T, Kinsella J, Morrison D. Survival in solid cancer patients following intensive care unit admission. Intensive Care Med 2014; 40:1409-28. [PMID: 25223853 DOI: 10.1007/s00134-014-3471-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 08/26/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE One in seven patients admitted to intensive care units (ICU) has a cancer diagnosis but evidence on their expected outcomes after admission has not been synthesised. METHODS Systematic literature review of solid cancer adult patients admitted to ICU from 2000 onwards using EMBASE and MEDLINE electronic databases. RESULTS There were 48 papers identified that reported survival in ICU patients with solid cancers. ICU mortality was reported in 35 studies comprising a total sample of 25,339 patients and ranging from 4.5 to 85 %. The average mortality of the distribution of reported mortality rates within ICU was 31.2 % (95 % CI 24.0-39.0 %). Hospital mortality was reported in 31 studies across a total sample of 74,061 patients. The average hospital mortality was 38.2 % (33.8-42.7 %) and ranged from 4.6 to 76.8 %. Poorer physiological score, invasive mechanical ventilation and poor functional status were associated with higher mortality. CONCLUSIONS Several factors have been associated with poor survival in ICU cancer patients; however, primary research is still needed to describe outcomes in cancer patients with sufficient case mix and treatment details to be of prognostic value to clinicians.
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Affiliation(s)
- Kathryn Puxty
- NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK,
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Abstract
Critically ill cancer patients on intensive units with hematological or oncological underlying diseases are a special situation: the underlying disease may be incurable, acute problems are often therapy associated and immunosuppression is regularly present. Due to evolving knowledge about special aspects of these patients and optimized supportive therapy, the prognosis has substantially improved during the last decades. General reluctance to admit cancer patients to an intensive care unit is therefore no longer justified. Reasons for admission are often infections and/or respiratory failure. Extensive diagnostic measures, causal and supportive therapy of sepsis according to current guidelines has led to improved outcome even in cancer patients. In respiratory failure, non-invasive ventilation is the key to improved prognosis if used early enough and indications, contraindications and break-off criteria are strictly followed. The prognosis of critically ill cancer patients is determined by the severity of the acute problem and not by the underlying disease.
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36
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Intensive care unit mortality in solid tumor patients: is this predictable and preventable? Support Care Cancer 2014; 22:289-90. [DOI: 10.1007/s00520-013-1977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/11/2013] [Indexed: 11/27/2022]
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Prognostic factors in critically ill cancer patients admitted to the intensive care unit. J Crit Care 2014; 29:618-26. [PMID: 24612762 DOI: 10.1016/j.jcrc.2014.01.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/12/2014] [Accepted: 01/18/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of this study is to identify factors predicting intensive care unit (ICU) mortality in cancer patients admitted to a medical ICU. PATIENTS AND METHODS We conducted a retrospective study in 162 consecutive cancer patients admitted to the medical ICU of a 1000-bed university hospital between January 2009 and June 2012. Medical history, physical and laboratory findings on admission, and therapeutic interventions during ICU stay were recorded. The study end point was ICU mortality. Logistic regression analysis was performed to identify independent risk factors for ICU mortality. RESULTS The study cohort consisted of 104 (64.2%) patients with solid tumors and 58 patients (35.8%) with hematological malignancies. The major causes of ICU admission were sepsis/septic shock (66.7%) and respiratory failure (63.6%), respectively. Overall ICU mortality rate was 55 % (n=89). The ICU mortality rates were similar in patients with hematological malignancies and solid tumors (57% vs 53.8%; P=.744). Four variables were independent predictors for ICU mortality in cancer patients: the remission status of the underlying cancer on ICU admission (odds ratio [OR], 0.113; 95% confidence interval [CI], 0.027-0.48; P=.003), Acute Physiology and Chronic Health Evaluation II score (OR, 1.12; 95% CI, 1.032-1.215; P=.007), sepsis/septic shock during ICU stay (OR, 8.94; 95% CI, 2.28-35; P=.002), and vasopressor requirement (OR 16.84; 95% CI, 3.98-71.24; P=.0001). Although Acute Physiology and Chronic Health Evaluation II score (OR, 1.30; 95% CI, 1.054-1.61; P=.014), admission through emergency service (OR, 0.005; 95% CI, 0.00-0.69; P=.035), and vasopressor requirement during ICU stay (OR, 140.64; 95% CI, 3.59-5505.5; P=.008) were independent predictors for ICU mortality in patients with hematological malignancies, Sequential Organ Failure Assessment score (OR, 1.83; 95% CI, 1.29-2.6; P=.001), lactate dehydrogenase level on admission (OR, 1.002; 95% CI, 1-1.005; P=.028), sepsis/septic shock during ICU stay (OR, 138.4; 95% CI, 12.54-1528.4; P=.0001), and complete or partial remission of the underlying cancer (OR, 0.026; 95% CI, 0.002-0.3; P=.004) were the independent risk factors in patients with solid tumors. CONCLUSION Intensive care unit mortality rate was 55% in our cancer patients, which suggests that patients with cancer can benefit from ICU admission. We also found that ICU mortality rates of patients with hematological malignancies and solid tumors were similar.
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Lofaro T, Easdale S, Rowe S, Ostermann M, Carr R. Outcome of critically ill patients with haematological malignancy admitted to the ICU as an emergency. Crit Care 2013. [PMCID: PMC3643159 DOI: 10.1186/cc12454] [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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[Infections in hemato-oncology patients in intensive care. An interdisciplinary challenge]. Med Klin Intensivmed Notfmed 2013; 108:197-202. [PMID: 23525488 DOI: 10.1007/s00063-012-0179-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 01/24/2013] [Indexed: 01/23/2023]
Abstract
Infections are among the most common complications in patients with hematologic neoplasms. Due to changes in demographics, the number of hematologic patients with severe infections who require intensive care is expected to increase. Treatment of these patients requires knowledge of multiple specialties. This review summarizes key aspects for the optimal management of infections in critical care patients with hematologic malignancies.
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[Chronic critically ill patients from the perspective of hematologists/oncologists]. Med Klin Intensivmed Notfmed 2013; 108:295-302. [PMID: 23443518 DOI: 10.1007/s00063-012-0196-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/28/2013] [Indexed: 12/20/2022]
Abstract
Many factors contribute to making critically ill patients with underlying hematological or oncological diseases into a special collective on intensive care units, such as an often incurable or at least doubtfully curable underlying disease, therapy associated complications and a commonly present immunosuppression. The prognosis of these patients has clearly improved in recent years so that a general reluctance in deciding to treat these patients in intensive care units can no longer be justified. Comprehensive infection diagnostics and a guideline oriented causal and supportive treatment can improve the prognosis of sepsis even in hematology/oncology patients. In the therapy of respiratory failure non-invasive ventilation is of great importance for a reduction in mortality if used early and contraindications, such as termination criteria are considered. Considerations on long-term prognosis, quality of life and palliative care are increasingly becoming topics in intensive care medicine.
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McCaughey C, Blackwood B, Glackin M, Brady M, McMullin MF. Characteristics and outcomes of haematology patients admitted to the intensive care unit. Nurs Crit Care 2013; 18:193-9. [PMID: 23782113 DOI: 10.1111/nicc.12005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/01/2012] [Accepted: 11/03/2012] [Indexed: 12/23/2022]
Abstract
AIM To profile the characteristics and outcomes of adult haematology patients admitted to the intensive care unit (ICU). BACKGROUND The role of intensive care support for haematology patients is contentious due to high mortality rates thus generating debate regarding the inappropriate use of limited resources versus denial of effective care. METHODS Medical notes, laboratory records and Intensive Care National Audit and Research Centre (ICNARC) data for all adult haematology patients admitted to Belfast City Hospital ICU in 2009 were analysed. RESULTS Twenty one patients were admitted to the ICU; mean age was 56 years (SD 12·5), 52% were male and 82% (n=19) had a malignant diagnosis. The main indication for admission was neutropenic sepsis with associated organ impairment (n=18, 85%). ICU mortality was 43%. Three-month and six-month mortality rates were 62% and 67%, respectively. ICU survivors had lower acute physiology and chronic health evaluation (APACHE II) scores, and decreased requirements for invasive ventilation and inotropic support. Of the post-six-month survivors, one had a relapse, one had responding disease and five remained in remission. Two patients have subsequently undergone a reduced intensity conditioning transplant. CONCLUSION One third of patients survived for >6 months indicating that critically ill haematology patients can benefit from ICU admission, allowing progression to potentially curative therapies. RELEVANCE TO CLINICAL PRACTICE This study highlights the necessity of individualized assessment regarding patient suitability for admission to a critical care facility, incorporating the perspective of both the haematologist and the intensivist.
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Affiliation(s)
- Caroline McCaughey
- Belfast Health and Social Care Trust and School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
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Ostermann M, Raimundo M, Williams A, Whiteley C, Beale R. Retrospective analysis of outcome of women with breast or gynaecological cancer in the intensive care unit. JRSM SHORT REPORTS 2013; 4:2. [PMID: 23413404 PMCID: PMC3572657 DOI: 10.1258/shorts.2012.012036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Advances in oncological care have led to improved short and long-term outcomes of female patients with breast and gynecological cancer but little is known about their prognosis when admitted to the intensive care unit (ICU). Our aim was to describe the epidemiology of patients with women's cancer in ICU. DESIGN Retrospective analysis of data of patients with breast and gynecological cancer in ICU between February 2004 and July 2008. SETTING ICU in a tertiary referral centre in London. PARTICIPANTS Nineteen critically ill women with breast or gynaecological cancer. MAIN OUTCOME MEASURES ICU and six-month outcome. RESULTS Eleven women had breast cancer and eight patients had gynaecological cancer. Twelve patients were known to have metastatic disease. The main reasons for admission to ICU were sepsis (94.7%), respiratory failure (36.8%) and need for vasoactive support (26.3%). ICU mortality was 31.6%. There was no difference in age and Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) score on admission to ICU between ICU survivors and non-survivors. During their stay in ICU, non-survivors had significantly more organ failure. Six-month mortality was 68.4%. Four patients had >1 admission to ICU. CONCLUSIONS ICU outcome of critically ill women with breast or gynaecological cancer was similar to that of other non-cancer patient cohorts but six-month mortality was significantly higher. The decision to admit patients with women's cancer to the ICU should depend on the severity of the acute illness rather than factors related to the underlying malignancy. More research is needed to explore the outcome of patients with women's cancer after discharge from ICU.
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Affiliation(s)
- Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Foundation Trust , Westminster Bridge Road, London SE1 7EH , UK
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García-Salido A, Iglesias-Bouzas MI, Nieto-Moro M, Lassaleta-Atienza A, Serrano-González A, Casado-Flores J. Management of unstable pediatric hemato-oncology patient: results of a Web-based survey to pediatric oncologists in Spain. Eur J Pediatr 2013; 172:51-8. [PMID: 23015044 DOI: 10.1007/s00431-012-1840-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 09/10/2012] [Indexed: 12/21/2022]
Abstract
UNLABELLED The current management and monitoring of unstable pediatric hemato-oncology patient (UPHOP) in the oncology ward is not well defined. To evaluate this concept, an anonymous Web-based survey was sent to the 150 Spanish pediatric oncologists registered in the Spanish Society of Pediatric Hemato-Oncology. The response rate was 57 %, with the following main results: Pediatric intensive consulting was available for 97 %, and it was made in case of UPHOP by 37 % of oncologists, up to 65 % if hemodynamic instability. In case of inotropic support initiation, 32 % of respondents never consulted the intensivist. Dopamine is first chosen inotropic; 28 % of surveyed considered there is no limit in its dosage or it is superior to 20 μg/kg/min before an intensivist consulting. Pediatric intensive care admission was considered necessary in case of fever with hemodynamic instability by 15 % of respondents. Respiratory monitoring was mainly done by clinical signs (67 %). In case of respiratory insufficiency, the noninvasive respiratory support by high-flow ventilation with nasal cannula was applied by 57 % in the oncology ward. In case of acute kidney injury, diuretics were generally the initial therapy. The anticonvulsive drugs most frequently applied were valproic acid (93 %), diazepam (88 %), and phenytoin (81 %). CONCLUSION A consensus should be achieved among oncologists and intensivists. The creation and training of rapid response teams could be useful to improve the UPHOP management.
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Affiliation(s)
- Alberto García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, Madrid, Spain.
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Oeyen SG, Benoit DD, Annemans L, Depuydt PO, Van Belle SJ, Troisi RI, Noens LA, Pattyn P, Decruyenaere JM. Long-term outcomes and quality of life in critically ill patients with hematological or solid malignancies: a single center study. Intensive Care Med 2012; 39:889-98. [PMID: 23248039 DOI: 10.1007/s00134-012-2791-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Data concerning long-term outcomes and quality of life (QOL) in critically ill cancer patients are scarce. The aims of this study were to assess long-term outcomes and QOL in critically ill patients with hematological (HM) or solid malignancies (SM) 3 months and 1 year after intensive care unit (ICU) discharge, to compare these with QOL before ICU admission, and to identify prognostic indicators of long-term QOL. METHODS During a 1 year prospective observational cohort analysis, consecutive patients with HM or SM admitted to the medical or surgical ICU of a university hospital were screened for inclusion. Cancer data, demographics, co-morbidity, severity of illness, organ failures, and outcomes were collected. The QOL before ICU admission, 3 months, and 1 year after ICU discharge was assessed using standardized questionnaires (EuroQoL-5D, Medical Outcomes Study 36-item Short Form Health Survey). Statistical significance was attained at P < 0.05. RESULTS There were 483 patients (85 HM, 398 SM) (64% men) with a median age of 62 years included. Mortality rates of HM compared to SM were, respectively: hospital (34 vs. 13%), 3 months (42 vs. 17%), and 1 year (66 vs. 36%) (P < 0.001). QOL declined at 3 months, but improved at 1 year although it remained under baseline QOL, particularly in HM. Older age (P = 0.007), severe comorbidity (P = 0.035), and HM (P = 0.041) were independently associated with poorer QOL at 1 year. CONCLUSIONS Long-term outcomes and QOL were poor, particularly in HM. Long-term expectations should play a larger role during multidisciplinary triage decisions upon referral to the ICU.
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Affiliation(s)
- S G Oeyen
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
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Immunocompromised Patients. INFECTIONS IN THE ADULT INTENSIVE CARE UNIT 2012. [PMCID: PMC7121735 DOI: 10.1007/978-1-4471-4318-5_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The ominous prognosis of cancer patients with or without neutropenia in need of critical care has led to reservations with regard to admission of cancer patients to the ICU. However, significant improvements in ICU and in-hospital survival of cancer patients in ICU have been demonstrated in studies in recent years [1–4]. Risk factors for mortality have shifted from those related to the underlying condition to those related to the severity of acute illness similar to other critically-ill patients. Neutropenia per se and the underlying malignancy (solid and hematological) do not have an impact on the outcome of patients in ICU. Recent chemotherapy is associated rather with improved survival [3, 5–7], while organ dysfunction, severity of disease scores, need for vasopressor treatment, need for mechanical ventilation immediately or after noninvasive ventilation, no definite diagnosis and a non-infectious diagnosis are associated with mortality [1–3, 8]. Invasive aspergillosis is also associated with very high mortality rates in ICU (see below). In several studies, admission to ICU in the early stages of sepsis or other acute event was associated with better survival than admission later, after development of organ dysfunction. Performance status is perhaps the most important and only variable relating to the underlying condition that is correlated with ICU death. The prognosis remains guarded for certain cancer patients, including patients after allogeneic hematopoietic stem cell transplantation (HSCT) with active uncontrolled graft versus host disease, those with relapse of the primary disease after allogeneic HSCT and special cases of solid cancer including pulmonary carcinomatous lymphangitis and carcinomatous meningitis with coma [9].
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Patterns of depressive symptoms in caregivers of mechanically ventilated critically ill adults from intensive care unit admission to 2 months postintensive care unit discharge: a pilot study. Crit Care Med 2012; 40:1546-53. [PMID: 22430242 DOI: 10.1097/ccm.0b013e3182451c58] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine trajectories of depressive symptoms in caregivers of critically ill adults from intensive care unit admission to 2 months postintensive care unit discharge and explore patient and caregiver characteristics associated with differing trajectories. DESIGN Longitudinal descriptive study. SETTING Medical intensive care unit in a tertiary university hospital. SUBJECTS Fifty caregivers and 47 patients on mechanical ventilation for ≥4 days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Caregivers completed measures assessing depressive symptoms (Short version Center for Epidemiologic Studies-Depression Scale 10-items), burden (Brief Zarit Burden Interview), and health risk behaviors (caregiver health behaviors) during intensive care unit admission, at intensive care unit discharge, and 2 months postintensive care unit discharge. Group-based trajectory analysis was used to identify patterns of change in shortened Center for Epidemiologic Studies-Depression Scale scores over time. Two trajectory groups emerged: 1) caregivers who had clinically significant depressive symptoms (21.0±4.1) during intensive care unit admission that remained high (13.6±5) at 2 months postintensive care unit discharge (high trajectory group, 56%); and 2) caregivers who reported scores that were lower (10.6±5.7) during intensive care unit admission and decreased further (5.7±3.6) at 2 months postintensive care unit discharge (low trajectory group, 44%). Caregivers in the high trajectory group tended to be younger, female, an adult child living with financial difficulty, and less likely to report a religious background or preference. More caregivers in the high trajectory group reported greater burden and more health risk behaviors at all time points; patients tended to be male with poorer functional ability at intensive care unit discharge. Caregivers' responses during intensive care unit admission did not differ in regard to number of days patients were on mechanical ventilation before enrollment. CONCLUSION Findings suggest two patterns of depressive symptom response in caregivers of critically ill adults on mechanical ventilation from intensive care unit admission to 2 months postintensive care unit discharge. Future studies are necessary to confirm these findings and implications for providing caregiver support.
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Meenaghan T, Dowling M, Kelly M. Acute leukaemia: making sense of a complex blood cancer. ACTA ACUST UNITED AC 2012; 21:76, 78-83. [PMID: 22306635 DOI: 10.12968/bjon.2012.21.2.76] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute leukaemia represents a diverse group of blood cancers that affect both children and adults. Treatment schedules for these haematology cancers are often prolonged, with many associated side effects and complications. Nurses caring for patients with acute leukaemia require an anticipatory approach, where care is aimed at minimizing the side effects of treatment and being constantly vigilant for any impending adverse effects. Moreover, patients require support for the psychosocial issues that can arise for patients during their illness. This article provides an overview of acute lymphoblastic leukaemia and acute myeloid leukaemia. Nursing considerations in the care of patients being treated for acute leukaemia are also explored.
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Affiliation(s)
- Teresa Meenaghan
- Haematology Department, Galway University Hospital, and School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Abstract
OBJECTIVE To review the current knowledge of common comorbidities in the intensive care unit, including diabetes mellitus, chronic obstructive pulmonary disease, cancer, end-stage renal disease, end-stage liver disease, HIV infection, and obesity, with specific attention to epidemiology, contribution to diseases and outcomes, and the impact on treatments in these patients. DATA SOURCE Review of the relevant medical literature for specific common comorbidities in the critically ill. RESULTS Critically ill patients are admitted to the intensive care unit for various reasons, and often the admission diagnosis is accompanied by a chronic comorbidity. Chronic comorbid conditions commonly seen in critically ill patients may influence the decision to provide intensive care unit care, decisions regarding types and intensity of intensive care unit treatment options, and outcomes. The presence of comorbid conditions may predispose patients to specific complications or forms of organ dysfunction. The impact of specific comorbidities varies among critically ill medical, surgical, and other populations, and outcomes associated with certain comorbidities have changed over time. Specifically, outcomes for patients with cancer and HIV have improved, likely related to advances in therapy. Overall, the negative impact of chronic comorbidity on survival in critical illness may be primarily influenced by the degree of organ dysfunction or the cumulative severity of multiple comorbidities. CONCLUSION Chronic comorbid conditions are common in critically ill patients. Both the acute illness and the chronic conditions influence prognosis and optimal care delivery for these patients, particularly for adverse outcomes and complications influenced by comorbidities. Further work is needed to fully determine the individual and combined impact of chronic comorbidities on intensive care unit outcomes.
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Horster S, Stemmler HJ, Mandel PC, Mück A, Tischer J, Hausmann A, Parhofer KG, Geiger S. Mortality of Patients with Hematological Malignancy after Admission to the Intensive Care Unit. ACTA ACUST UNITED AC 2012; 35:556-61. [DOI: 10.1159/000342672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Patients with a variety of haematological conditions are at risk of infection and its most serious complication: septic shock. Mortality for septic shock remains high and especially so in patients with haematological malignancy and following bone marrow transplantation. However, advances in the treatment of severe sepsis have improved mortality rates even though evidence for the management of severe sepsis in haematology patients is limited. Wherever possible this review will concentrate on evidence directly applicable to haematology patients but inevitably will have to extrapolate evidence from other patient groups. The Surviving Sepsis Guidelines 2008 provide information on best practice in the management of patients with severe sepsis and septic shock and are broadly applicable though not specific to haematology patients. This review summarizes a practical approach to the management of severe sepsis in haematology patients and highlights areas of research which may bring new treatments in the future. The review is limited to the management and initial resuscitation of septic shock in adult haematology patients and will not address the detailed intensive care management of these patients or the management of severe sepsis in children.
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Affiliation(s)
- Jon Cohen
- Department of Infectious Diseases, Brighton and Sussex Medical School, Brighton Consultant in Intensive Care, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton, UK.
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