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Zhang Z, A Celi L, Ho KM. Prediction of extended period of vasopressor infusion requiring central venous catheterisation: A burning issue in critical care. Anaesth Intensive Care 2021; 49:250-252. [PMID: 34392691 DOI: 10.1177/0310057x211030927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Hangzhou, China
- Key Laboratory of Emergency and Trauma, Hainan Medical University, Haikou, China
| | - Leo A Celi
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, USA
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Kwok M Ho
- Department of Intensive Care Medicine, 6508Royal Perth Hospital, Royal Perth Hospital, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
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2
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Mirouse A, Vigneron C, Llitjos JF, Chiche JD, Mira JP, Mokart D, Azoulay E, Pène F. Sepsis and Cancer: An Interplay of Friends and Foes. Am J Respir Crit Care Med 2020; 202:1625-1635. [PMID: 32813980 DOI: 10.1164/rccm.202004-1116tr] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sepsis and cancer share a number of pathophysiological features, and both result from the inability of the host's immune system to cope with the initial insult (tissue invasion by pathogens and malignant cell transformation, respectively). The common coexistence of both disorders and the profound related alterations in immune homeostasis raise the question of their mutual impact on each other's course. This translational review aims to discuss the interactions between cancer and sepsis supported by clinical data and the translation to experimental models. The dramatic improvement in cancer has come at a cost of increased risks of life-threatening infectious complications. Investigating the long-term outcomes of sepsis survivors has revealed an unexpected susceptibility to cancer long after discharge from the ICU. Nonetheless, it is noteworthy that an acute septic episode may harbor antitumoral properties under particular circumstances. Relevant double-hit animal models have provided clues to whether and how bacterial sepsis may impact malignant tumor growth. In sequential sepsis-then-cancer models, postseptic mice exhibited accelerated tumor growth. When using reverse cancer-then-sepsis models, bacterial sepsis applied to mice with cancer conversely resulted in inhibition or even regression of tumor growth. Experimental models thus highlight dual effects of sepsis on tumor growth, mostly depending on the sequence of insults, and allow deciphering the immune mechanisms and their relation with microorganisms.
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Affiliation(s)
- Adrien Mirouse
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, Paris, France
| | - Clara Vigneron
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
| | - Jean-François Llitjos
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
| | - Jean-Daniel Chiche
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
| | - Jean-Paul Mira
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
| | - Djamel Mokart
- Réanimation Polyvalente, Département d'Anesthésie et de Réanimation, Institut Paoli Calmettes, Marseille, France
| | - Elie Azoulay
- Université de Paris, Paris, France.,Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, Paris, France
| | - Frédéric Pène
- Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.,Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP Centre, Paris, France; and
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3
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Vasopressin Versus Norepinephrine for the Management of Septic Shock in Cancer Patients: The VANCS II Randomized Clinical Trial. Crit Care Med 2020; 47:1743-1750. [PMID: 31609774 DOI: 10.1097/ccm.0000000000004023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Previous trials suggest that vasopressin may improve outcomes in patients with vasodilatory shock. The aim of this study was to evaluate whether vasopressin could be superior to norepinephrine to improve outcomes in cancer patients with septic shock. DESIGN Single-center, randomized, double-blind clinical trial, and meta-analysis of randomized trials. SETTING ICU of a tertiary care hospital. PATIENTS Two-hundred fifty patients 18 years old or older with cancer and septic shock. INTERVENTIONS Patients were assigned to either vasopressin or norepinephrine as first-line vasopressor therapy. An updated meta-analysis was also conducted including randomized trials published until October 2018. MEASUREMENTS AND MAIN RESULTS The primary outcome was all-cause mortality at 28 days after randomization. Prespecified secondary outcomes included 90-days all-cause mortality rate; number of days alive and free of advanced organ support at day 28; and Sequential Organ Failure Assessment score 24 hours and 96 hours after randomization. We also measure the prevalence of adverse effects in 28 days. A total of 250 patients were randomized. The primary outcome was observed in 71 patients (56.8%) in the vasopressin group and 66 patients (52.8%) in the norepinephrine group (p = 0.52). There were no significant differences in 90-day mortality (90 patients [72.0%] and 94 patients [75.2%], respectively; p = 0.56), number of days alive and free of advanced organ support, adverse events, or Sequential Organ Failure Assessment score. CONCLUSIONS In cancer patients with septic shock, vasopressin as first-line vasopressor therapy was not superior to norepinephrine in reducing 28-day mortality rate.
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4
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Kochanek M, Schalk E, von Bergwelt-Baildon M, Beutel G, Buchheidt D, Hentrich M, Henze L, Kiehl M, Liebregts T, von Lilienfeld-Toal M, Classen A, Mellinghoff S, Penack O, Piepel C, Böll B. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2019; 98:1051-1069. [PMID: 30796468 PMCID: PMC6469653 DOI: 10.1007/s00277-019-03622-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
Sepsis and septic shock are major causes of mortality during chemotherapy-induced neutropenia for malignancies requiring urgent treatment. Thus, awareness of the presenting characteristics and prompt management is most important. Improved management of sepsis during neutropenia may reduce the mortality of cancer therapies. However, optimal management may differ between neutropenic and non-neutropenic patients. The aim of the current guideline is to give evidence-based recommendations for hematologists, oncologists, and intensive care physicians on how to manage adult patients with neutropenia and sepsis.
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Affiliation(s)
- Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany.
| | - E Schalk
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - M von Bergwelt-Baildon
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Medical Department III, University Medical Center & Comprehensive Cancer Center Munich, Munich, Germany
| | - G Beutel
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation Hannover Medical School, Hannover, Germany
| | - D Buchheidt
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Hematology and Oncology, Mannheim University Hospital, Mannheim, Germany
| | - M Hentrich
- Department of Medicine III - Hematology and Oncology, Red Cross Hospital, Munich, Germany
| | - L Henze
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - M Kiehl
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Internal Medicine I, Clinic Frankfurt (Oder), Frankfurt, Germany
| | - T Liebregts
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - M von Lilienfeld-Toal
- Department for Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | - A Classen
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Mellinghoff
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - O Penack
- Department for Hematology, Oncology and Tumorimmunology, Campus Virchow Clinic, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C Piepel
- Department of Hematology, Oncology and Infectious Diseases, Klinikum Bremen-Mitte, Bremen, Germany
| | - B Böll
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
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5
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Mokart D, Saillard C, Zemmour C, Bisbal M, Sannini A, Chow-Chine L, Brun JP, Faucher M, Boher JM, Toiron Y, Chabannon C, Borg JP, Gonçalves A, Camoin L. Early prognostic factors in septic shock cancer patients: a prospective study with a proteomic approach. Acta Anaesthesiol Scand 2018; 62:493-503. [PMID: 29315472 DOI: 10.1111/aas.13060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Organ failures are the main prognostic factors in septic shock. The aim was to assess classical clinico-biological parameters evaluating organ dysfunctions at intensive care unit admission, combined with proteomics, on day-30 mortality in critically ill onco-hematology patients admitted to the intensive care unit for septic shock. METHODS This was a prospective monocenter cohort study. Clinico-biological parameters were collected at admission. Plasma proteomics analyses were performed, including protein profiling using isobaric Tag for Relative and Absolute Quantification (iTRAQ) and subsequent validation by ELISA. RESULTS Sixty consecutive patients were included. Day-30 mortality was 47%. All required vasopressors, 32% mechanical ventilation, 33% non-invasive ventilation and 13% renal-replacement therapy. iTRAQ-based proteomics identified von Willebrand factor as a protein of interest. Multivariate analysis identified four factors independently associated with day-30 mortality: positive fluid balance in the first 24 h (odds ratio = 1.06, 95% CI = 1.01-1.12, P = 0.02), severe acute respiratory failure (odds ratio = 6.14, 95% CI = 1.04-36.15, P = 0.04), von Willebrand factor plasma level > 439 ng/ml (odds ratio = 9.7, 95% CI = 1.52-61.98, P = 0.02), and bacteremia (odds ratio = 6.98, 95% CI = 1.17-41.6, P = 0.03). CONCLUSION Endothelial dysfunction, revealed by proteomics, appears as an independent prognostic factor on day-30 mortality, as well as hydric balance, acute respiratory failure and bacteremia, in critically ill cancer patients admitted to the intensive care unit. Endothelial failure is underestimated in clinical practice and represents an innovative therapeutic target.
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Affiliation(s)
- D. Mokart
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
- Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (GRRROH); Paris France
| | - C. Saillard
- Hematology Department; Institut Paoli Calmettes; Marseille France
| | - C. Zemmour
- Departement of Clinical Research and Innovation; Institut Paoli-Calmettes; Marseille France
| | - M. Bisbal
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
- Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (GRRROH); Paris France
| | - A. Sannini
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
| | - L. Chow-Chine
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
| | - J.-P. Brun
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
| | - M. Faucher
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
| | - J.-M. Boher
- Departement of Clinical Research and Innovation; Institut Paoli-Calmettes; Marseille France
| | - Y. Toiron
- Inserm, U1068; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
| | - C. Chabannon
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- CNRS, UMR7258; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Aix-Marseille Medical University; Marseille France
- Cell Therapy Department; Institut Paoli Calmettes; Marseille France
| | - J.-P. Borg
- Inserm, U1068; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- CNRS, UMR7258; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- UM105; Aix-Marseille Université; Marseille France
| | - A. Gonçalves
- Inserm, U1068; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- CNRS, UMR7258; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Aix-Marseille Medical University; Marseille France
- Department of Medical Oncology; Institut Paoli Calmettes; Marseille France
| | - L. Camoin
- Inserm, U1068; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
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6
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Mirouse A, Resche-Rigon M, Lemiale V, Mokart D, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Lebert C, Perez P, Renault A, Meert AP, Benoit D, Hamidfar R, Jourdain M, Darmon M, Azoulay E, Pène F. Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies. Ann Intensive Care 2017; 7:62. [PMID: 28608137 PMCID: PMC5468360 DOI: 10.1186/s13613-017-0292-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/02/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Indications for red blood cell (RBC) transfusion in septic acute circulatory failure remain unclear. We addressed the practices and the prognostic impact of RBC transfusion in the early resuscitation of severe sepsis and septic shock in patients with hematological malignancies. METHODS We performed a retrospective analysis of a prospectively collected database of patients with hematological malignancies who required intensive care unit (ICU) admission in 2010-2011. Patients with a main admission diagnosis of severe sepsis or septic shock were included in the present study. We assessed RBC transfusion during the first two days as part of initial resuscitation. RESULTS Among the 1011 patients of the primary cohort, 631 (62.4%) were admitted to the ICU for severe sepsis (55%) or septic shock (45%). Among them, 210 (33.3%) patients received a median of 2 [interquartile 1-3] packed red cells during the first 48 h. Hemoglobin levels were lower in transfused patients at days 1 and 2 and became similar to those of non-transfused patients at day 3. Early RBC transfusion was more likely in patients with myeloid neoplasms and neutropenia. Transfused patients displayed more severe presentations as assessed by higher admission SOFA scores and blood lactate levels and the further requirements for organ failure supports. RBC transfusion within the first two days was associated with higher day 7 (20.5 vs. 13.3%, p = 0.02), in-ICU (39 vs. 25.2%, p < 0.001) and in-hospital (51 vs. 36.6%, p < 0.001) mortality rates. RBC transfusion remained independently associated with increased in-hospital mortality in multivariate logistic regression (OR 1.52 [1.03-2.26], p = 0.03) and propensity score-adjusted (OR 1.64 [1.05-2.57], p = 0.03) analysis. CONCLUSIONS RBC transfusion is commonly used in the early resuscitation of septic patients with hematological malignancies. Although it was preferentially provided to the most severe patients, we found it possibly associated with an increased risk of death.
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Affiliation(s)
- Adrien Mirouse
- Réanimation médicale, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Matthieu Resche-Rigon
- Département de biostatistiques, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
| | - Virginie Lemiale
- Réanimation médicale, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
| | - Djamel Mokart
- Département d’anesthésie-réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Achille Kouatchet
- Réanimation médicale et médecine hyperbare, CHU d’Angers, Angers, France
| | - Julien Mayaux
- Réanimation médicale, Hôpital de la Pitié-Salpêtrière, AP-HP and Université Pierre et Marie Curie, Paris, France
| | - François Vincent
- Réanimation polyvalente, Centre Hospitalier Intercommunal, Montfermeil, France
| | | | - Fabrice Bruneel
- Réanimation polyvalente, Hôpital André Mignot, Le Chesnay, France
| | - Antoine Rabbat
- Unité de soins intensifs respiratoires, Hôpital Cochin, AP-HP and Université Paris Descartes, Paris, France
| | - Christine Lebert
- Réanimation polyvalente, Centre Hospitalier Départemental, La Roche-sur-Yon, France
| | - Pierre Perez
- Réanimation médicale, Hôpital Brabois, Nancy, France
| | - Anne Renault
- Réanimation médicale, Centre Hospitalier de Brest, Brest, France
| | - Anne-Pascale Meert
- Service des soins intensifs et urgences oncologiques, Institut Jules Bordet, Brussels, Belgium
| | | | | | - Mercé Jourdain
- Université de Lille and Réanimation Polyvalente, CHU de Lille, Lille, France
| | - Michaël Darmon
- Réanimation médicale, Centre Hospitalier de Saint-Etienne, Saint-Etienne, France
| | - Elie Azoulay
- Réanimation médicale, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
| | - Frédéric Pène
- Réanimation médicale, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - on behalf of the Groupe de Recherche sur la Réanimation Respiratoire en Onco-Hématologie (Grrr-OH)
- Réanimation médicale, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
- Département de biostatistiques, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
- Réanimation médicale, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
- Département d’anesthésie-réanimation, Institut Paoli-Calmettes, Marseille, France
- Réanimation médicale et médecine hyperbare, CHU d’Angers, Angers, France
- Réanimation médicale, Hôpital de la Pitié-Salpêtrière, AP-HP and Université Pierre et Marie Curie, Paris, France
- Réanimation polyvalente, Centre Hospitalier Intercommunal, Montfermeil, France
- Centre Hospitalier de Roubaix, Roubaix, France
- Réanimation polyvalente, Hôpital André Mignot, Le Chesnay, France
- Unité de soins intensifs respiratoires, Hôpital Cochin, AP-HP and Université Paris Descartes, Paris, France
- Réanimation polyvalente, Centre Hospitalier Départemental, La Roche-sur-Yon, France
- Réanimation médicale, Hôpital Brabois, Nancy, France
- Réanimation médicale, Centre Hospitalier de Brest, Brest, France
- Service des soins intensifs et urgences oncologiques, Institut Jules Bordet, Brussels, Belgium
- Ghent University Hospital, Ghent, Belgium
- Réanimation médicale, CHU Grenoble-Alpes, Grenoble, France
- Université de Lille and Réanimation Polyvalente, CHU de Lille, Lille, France
- Réanimation médicale, Centre Hospitalier de Saint-Etienne, Saint-Etienne, France
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7
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Azoulay E, Schellongowski P, Darmon M, Bauer PR, Benoit D, Depuydt P, Divatia JV, Lemiale V, van Vliet M, Meert AP, Mokart D, Pastores SM, Perner A, Pène F, Pickkers P, Puxty KA, Vincent F, Salluh J, Soubani AO, Antonelli M, Staudinger T, von Bergwelt-Baildon M, Soares M. The Intensive Care Medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med 2017; 43:1366-1382. [PMID: 28725926 DOI: 10.1007/s00134-017-4884-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
Abstract
Over the coming years, accelerating progress against cancer will be associated with an increased number of patients who require life-sustaining therapies for infectious or toxic chemotherapy-related events. Major changes include increased number of cancer patients admitted to the ICU with full-code status or for time-limited trials, increased survival and quality of life in ICU survivors, changing prognostic factors, early ICU admission for optimal monitoring, and use of noninvasive diagnostic and therapeutic strategies. In this review, experts in the management of critically ill cancer patients highlight recent changes in the use and the results of intensive care in patients with malignancies. They seek to put forward a standard of care for the management of these patients and highlight important updates that are required to care for them. The research agenda they suggest includes important studies to be conducted in the next few years to increase our understanding of organ dysfunction in this population and to improve our ability to appropriately use life-saving therapies or select new therapeutic approaches that are likely to improve outcomes. This review aims to provide more guidance for the daily management of patients with cancer, in whom outcomes are constantly improving, as is our global ability to fight against what is becoming the leading cause of mortality in industrialized and non-industrialized countries.
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Affiliation(s)
- Elie Azoulay
- ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France. .,Medical Intensive Care Unit, Hôpital Saint-Louis, Paris, France.
| | | | - Michael Darmon
- Saint-Etienne University Hospital, Saint-Etienne, France
| | | | | | | | | | | | | | | | | | | | | | | | - Peter Pickkers
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Jorge Salluh
- Instituto de Ensino e Perquisa da Santa Casa de Belo Horizonte, Rio de Janeiro, Brazil
| | | | | | | | | | - Marcio Soares
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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8
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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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Zafrani L, Azoulay E. How to treat severe infections in critically ill neutropenic patients? BMC Infect Dis 2014; 14:512. [PMID: 25431154 PMCID: PMC4289060 DOI: 10.1186/1471-2334-14-512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/09/2014] [Indexed: 12/30/2022] Open
Abstract
Severe infections in neutropenic patient often progress rapidly leading to life-threatening organ dysfunction requiring admission to the Intensive Care Unit. Management strategies include early adequate appropriate empirical antimicrobial, early admission to ICU to avoid any delay in the diagnostic and therapeutic management of organ dysfunction. This review discusses the main clinical situations encountered in critically ill neutropenic patients. Specific diagnostic and therapeutic approaches have been proposed for acute respiratory failure, shock, neutropenic enterocolitis, catheter-related infections, cellulitis and primary bacteriemia. Non anti-infectious agents and recent advances will also be discussed. At present, most of large-scale studies and recommendations in neutropenic patients stem from hematological patients and will need further validation in ICU patients.
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Affiliation(s)
| | - Elie Azoulay
- AP-HP, Hôpital Saint-Louis, Medical ICU, Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique (Grrr-OH), Paris, France.
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Abstract
OBJECTIVE The objective of this study was to compare vasopressor requirements between African American (AA) patients and white patients in septic shock. METHODS This was a retrospective cohort review conducted over a 2-year period measuring total and mean dosage of various vasopressors used between two racial groups during the treatment of patients admitted with septic shock. The study included patients admitted to the intensive care unit with septic shock at an 805-bed tertiary, academic center. All septic shock patients were managed with vasopressors. Vasopressor selection, dosage, and duration were at the discretion of the treating physician. Total, mean, and duration of vasopressor dosing requirements were obtained for study participants. Comorbidities, prehospitalization antihypertensive medication requirements, intravenous fluids given during the septic shock phase, and source of infection were analyzed. RESULTS One hundred fifty-nine patients with septic shock were analyzed, of which 96 (60.4%) were AAs (P < 0.059). African Americans had higher rates of end-stage renal disease and hypertension compared with whites, 85.7% vs. 14.3% (P < 0.011; odds ratio [OR], 15.684) and 68.3% vs. 31.7% (P < 0.007; OR, 3.357), respectively. Norepinephrine (NE) was administered to 150 patients, 57.2% of which were AAs (P < 0.509). Thirteen patients received dopamine (5% AAs, P < 0.588), 40 patients received phenylephrine (15.7% AAs, P < 0.451), and five patients received epinephrine (1.9% AAs, P < 0.660). Comparing vasopressors between races, only NE showed statistical significance via logistic regression modeling for the AA race in terms of total dosage (AAs 736.8 [SD, 897.3] μg vs. whites 370 [SD, 554.2] μg, P < 0.003), duration of vasopressor used (AAs 38.38 [SD, 34.75] h vs. whites 29.09 [SD, 27.11] h, P < 0.037), and mean dosage (AAs 21.08 [SD, 22.23] μg/h vs. whites 12.37 [SD, 13.86] μg/h, P < 0.01). Mortality between groups was not significant. Logistic regression identified discrepancy of the mean dose NE in AAs compared with whites, with OR of 1.043 (P = 0.01). CONCLUSIONS African American patients with septic shock were treated with higher doses of NE and required longer duration of NE administration compared with white patients.
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