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Hamed M, Brandecker S, Rana S, Potthoff AL, Eichhorn L, Bode C, Schmeel FC, Radbruch A, Schäfer N, Herrlinger U, Köksal M, Giordano FA, Vatter H, Schneider M, Banat M. Postoperative prolonged mechanical ventilation correlates to poor survival in patients with surgically treated spinal metastasis. Front Oncol 2022; 12:940790. [PMID: 36387073 PMCID: PMC9647167 DOI: 10.3389/fonc.2022.940790] [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] [Received: 05/10/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Patients with spinal metastasis (SM) are at advanced stages of systemic cancer disease. Surgical therapy for SM is a common treatment modality enabling histopathological diagnosis and the prevention of severe neurological deficits. However, surgery for SM in this vulnerable patient cohort may require prolonged postoperative intensive care treatment, which could adversely affect the anticipated benefit of the surgery. We therefore assessed postoperative prolonged mechanical ventilation (PMV) as an indicator for intensive care treatment with regard to potential correlations with early postoperative mortality and overall survival (OS). Methods Between 2015 and 2019, 198 patients were surgically treated for SM at the author´s neurosurgical department. PMV was defined as postoperative mechanical ventilation of more than 24 hours. A multivariate analysis was performed to identify pre- and perioperative collectable predictors for 30 days mortality. Results Twenty out of 198 patients (10%) with SM suffered from postoperative PMV. Patients with PMV exhibited a median OS rate of 1 month compared to 12 months for patients without PMV (p < 0.0001). The 30 days mortality was 70% and after one year 100%. The multivariate analysis identified “PMV > 24 hrs” (p < 0.001, OR 0.3, 95% CI 0.02-0.4) as the only significant and independent predictor for 30 days mortality (Nagelkerke’s R2 0.38). Conclusions Our data indicate postoperative PMV to significantly correlate to high early postoperative mortality rates as well as to poor OS in patients with surgically treated SM. These findings might encourage the initiation of further multicenter studies to comprehensively investigate PMV as a so far underestimated negative prognostic factor in the course of surgical treatment for SM.
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Affiliation(s)
- Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Simon Brandecker
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Shaleen Rana
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- *Correspondence: Mohammed Banat,
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Prolonged Mechanical Ventilation: Outcomes and Management. J Clin Med 2022; 11:jcm11092451. [PMID: 35566577 PMCID: PMC9103623 DOI: 10.3390/jcm11092451] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023] Open
Abstract
The number of patients requiring prolonged mechanical ventilation (PMV) is increasing worldwide, placing a burden on healthcare systems. Therefore, investigating the pathophysiology, risk factors, and treatment for PMV is crucial. Various underlying comorbidities have been associated with PMV. The pathophysiology of PMV includes the presence of an abnormal respiratory drive or ventilator-induced diaphragm dysfunction. Numerous studies have demonstrated that ventilator-induced diaphragm dysfunction is related to increases in in-hospital deaths, nosocomial pneumonia, oxidative stress, lung tissue hypoxia, ventilator dependence, and costs. Thus far, the pathophysiologic evidence for PMV has been derived from clinical human studies and experimental studies in animals. Moreover, recent studies have demonstrated the outcome benefits of pharmacological agents and rehabilitative programs for patients requiring PMV. However, methodological limitations affected these studies. Controlled prospective studies with an adequate number of participants are necessary to provide evidence of the mechanism, prognosis, and treatment of PMV. The great epidemiologic impact of PMV and the potential development of treatment make this a key research field.
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The Surgical Management of Brain Metastases in Non-Small Cell Lung Cancer (NSCLC): Identification of the Early Laboratory and Clinical Determinants of Survival. J Clin Med 2021; 10:jcm10174013. [PMID: 34501461 PMCID: PMC8432449 DOI: 10.3390/jcm10174013] [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: 08/07/2021] [Revised: 08/23/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Brain metastases (BM) indicate advanced states of cancer disease and cranial surgery represents a common treatment modality. In the present study, we aimed to identify the risk factors for a reduced survival in patients receiving a surgical treatment of BM derived from non-small cell lung cancer (NSCLC). Methods: A total of 154 patients with NSCLC that had been surgically treated for BM at the authors’ institution between 2013 and 2018 were included for a further analysis. A multivariate analysis was performed to identify the predictors of a poor overall survival (OS). Results: The median overall survival (mOS) was 11 months (95% CI 8.2–13.8). An age > 65 years, the infratentorial location of BM, elevated preoperative C-reactive protein levels, a perioperative red blood cell transfusion, postoperative prolonged mechanical ventilation (>48 h) and the occurrence of postoperative adverse events were identified as independent factors of a poor OS. Conclusions: The present study identified several predictors for a worsened OS in patients that underwent surgery for BM of NSCLC. These findings might guide a better risk/benefit assessment in the course of metastatic NSCLC therapy and might help to more sufficiently cope with the challenges of cancer therapy in these advanced stages of disease.
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Keng LT, Liang SK, Tseng CP, Wen YF, Tsou PH, Chang CH, Chang LY, Yu KL, Lee MR, Ko JC. Functional Status After Pulmonary Rehabilitation as a Predictor of Weaning Success and Survival in Patients Requiring Prolonged Mechanical Ventilation. Front Med (Lausanne) 2021; 8:675103. [PMID: 34150808 PMCID: PMC8206270 DOI: 10.3389/fmed.2021.675103] [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: 03/02/2021] [Accepted: 05/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Comprehensive rehabilitation programs are recommended for patients with prolonged mechanical ventilation (PMV) to facilitate functional recovery and ventilator weaning, but whether the functional status after rehabilitation influences outcome has not been clearly evaluated. This study aimed to investigate the association between post-rehabilitation functional status and weaning and survival outcome in PMV patients. Methods: We retrospectively enrolled PMV patients admitted to the respiratory care center (RCC), a post-ICU weaning facility with protocolized rehabilitation program, from January 2016 through December 2017. Functional status was measured by the de Morton Mobility Index (DEMMI), with a cut-off value set at 20 points. The primary outcomes were the weaning status at RCC discharge and hospital survival. The secondary outcomes were overall survival and survival at 3 months after RCC discharge. We followed patients until 3 months after RCC discharge or death. Logistic and Cox regressions were performed to identify significant parameters associated with weaning success and survival. Results: In total, 320 patients were enrolled. The weaning success rate was 71.6%. The survival rate at RCC discharge, hospital discharge, and 3 months after RCC discharge was 89.1, 77.5, and 66.6%, respectively. Post-rehabilitation DEMMI ≥ 20 (odds ratio [OR], 3.514; 95% confidence interval [CI], 1.436-8.598; P = 0.006) was the most significantly associated with weaning success. The weaning success and higher post-rehabilitation DEMMI were the two most significant independent factors associated with both hospital survival (weaning success, OR, 12.272; 95% CI, 5.281-28.517; P < 0.001; post-rehabilitation DEMMI ≥ 20, OR, 6.298; 95% CI, 1.302-30.477; P = 0.022) and survival at 3 months after RCC discharge (weaning success, OR, 38.788; 95% CI, 11.505-130.762; P < 0.001; post-rehabilitation DEMMI ≥ 20, OR, 4.830; 95% CI, 1.072-21.756; P = 0.040). Post-rehabilitation DEMMI ≥ 20 remained significantly association with overall survival at 3 months after RCC discharge (hazard ratio, 0.237; 95% CI, 0.072-0.785; P = 0.018). Conclusions: Post-rehabilitation functional status of PMV patients was independently associated with weaning success, as well as hospital and 3-month overall survival after RCC discharge. Post-rehabilitation, but not pre-rehabilitation, functional status was a significant parameter associated with weaning success and survival in patients requiring PMV.
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Affiliation(s)
- Li-Ta Keng
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Sheng-Kai Liang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chi-Ping Tseng
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yueh-Feng Wen
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Ping-Hsien Tsou
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chia-Hao Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Lih-Yu Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Kai-Lun Yu
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Meng-Rui Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
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Lin MY, Li CC, Lin PH, Wang JL, Chan MC, Wu CL, Chao WC. Explainable Machine Learning to Predict Successful Weaning Among Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Cohort Study in Central Taiwan. Front Med (Lausanne) 2021; 8:663739. [PMID: 33968967 PMCID: PMC8104124 DOI: 10.3389/fmed.2021.663739] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: The number of patients requiring prolonged mechanical ventilation (PMV) is increasing worldwide, but the weaning outcome prediction model in these patients is still lacking. We hence aimed to develop an explainable machine learning (ML) model to predict successful weaning in patients requiring PMV using a real-world dataset. Methods: This retrospective study used the electronic medical records of patients admitted to a 12-bed respiratory care center in central Taiwan between 2013 and 2018. We used three ML models, namely, extreme gradient boosting (XGBoost), random forest (RF), and logistic regression (LR), to establish the prediction model. We further illustrated the feature importance categorized by clinical domains and provided visualized interpretation by using SHapley Additive exPlanations (SHAP) as well as local interpretable model-agnostic explanations (LIME). Results: The dataset contained data of 963 patients requiring PMV, and 56.0% (539/963) of them were successfully weaned from mechanical ventilation. The XGBoost model (area under the curve [AUC]: 0.908; 95% confidence interval [CI] 0.864-0.943) and RF model (AUC: 0.888; 95% CI 0.844-0.934) outperformed the LR model (AUC: 0.762; 95% CI 0.687-0.830) in predicting successful weaning in patients requiring PMV. To give the physician an intuitive understanding of the model, we stratified the feature importance by clinical domains. The cumulative feature importance in the ventilation domain, fluid domain, physiology domain, and laboratory data domain was 0.310, 0.201, 0.265, and 0.182, respectively. We further used the SHAP plot and partial dependence plot to illustrate associations between features and the weaning outcome at the feature level. Moreover, we used LIME plots to illustrate the prediction model at the individual level. Additionally, we addressed the weekly performance of the three ML models and found that the accuracy of XGBoost/RF was ~0.7 between weeks 4 and week 7 and slightly declined to 0.6 on weeks 8 and 9. Conclusion: We used an ML approach, mainly XGBoost, SHAP plot, and LIME plot to establish an explainable weaning prediction ML model in patients requiring PMV. We believe these approaches should largely mitigate the concern of the black-box issue of artificial intelligence, and future studies are warranted for the landing of the proposed model.
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Affiliation(s)
- Ming-Yen Lin
- Department of Information Engineering and Computer Science, Feng Chia University, Taichung, Taiwan
| | - Chi-Chun Li
- Department of Information Engineering and Computer Science, Feng Chia University, Taichung, Taiwan
| | - Pin-Hsiu Lin
- Department of Information Engineering and Computer Science, Feng Chia University, Taichung, Taiwan
| | - Jiun-Long Wang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan
| | - Ming-Cheng Chan
- Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Central Taiwan University of Science and Technology, Taichung, Taiwan
- The College of Science, Tunghai University, Taichung, Taiwan
| | - Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Computer Science, Tunghai University, Taichung, Taiwan
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
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Schuss P, Schäfer N, Bode C, Borger V, Eichhorn L, Giordano FA, Güresir E, Heimann M, Ko YD, Landsberg J, Lehmann F, Potthoff AL, Radbruch A, Schaub C, Schwab KS, Weller J, Vatter H, Herrlinger U, Schneider M. The Impact of Prolonged Mechanical Ventilation on Overall Survival in Patients With Surgically Treated Brain Metastases. Front Oncol 2021; 11:658949. [PMID: 33816316 PMCID: PMC8013703 DOI: 10.3389/fonc.2021.658949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Surgical resection represents a common treatment modality in patients with brain metastasis (BM). Postoperative prolonged mechanical ventilation (PMV) might have an enormous impact on the overall survival (OS) of these patients suffering from advanced cancer disease. We therefore have analyzed our institutional database with regard to a potential impact of PMV on OS of patients who had undergone surgery for brain metastases. Methods 360 patients with surgically treated brain metastases were included. The definition of PMV consisted of postoperative mechanical ventilation lasting for more than 48 hours. Analysis of survival incorporating established prognostic factors such as age, location of BM, and preoperative physical status was performed. Results 14 of 360 patients with BM (4%) suffered from postoperative PMV after surgical treatment of BM. Patients with PMV presented in a significantly more impaired neurological condition preoperatively than patients without (p<0.0001). Multivariate analysis determined PMV to be a significant prognostic factor for OS after surgical treatment in patients with BM, independent of other predictive factors (p<0.0001). Conclusions The present study demonstrates postoperative PMV as significantly related to poor OS in patients with surgically treated BM. Postoperative PMV is a so far underestimated prognostic predictor, but might be utilized for optimized patient management early in the postoperative phase. For this purpose, the results of the present study should encourage the initiation of further scientific efforts.
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Affiliation(s)
- Patrick Schuss
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neuro-Oncology, Department of Neurology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Muriel Heimann
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Yon-Dschun Ko
- Department of Oncology and Hematology, Center of Integrated Oncology (CIO) Bonn, Johanniter Hospital Bonn, Bonn, Germany
| | - Jennifer Landsberg
- Department of Dermatology and Allergy, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Felix Lehmann
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Anna-Laura Potthoff
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neuro-Oncology, Department of Neurology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Katjana S Schwab
- Department of Internal Medicine III, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neuro-Oncology, Department of Neurology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Matthias Schneider
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
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Huang HY, Lee CS, Chiu TH, Chen HH, Chan LY, Chang CJ, Chang SC, Hu HC, Kao KC, Chen NH, Lin SM, Li LF. Clinical outcomes and prognostic factors for prolonged mechanical ventilation in patients with acute stroke and brain trauma. J Formos Med Assoc 2021; 121:162-169. [PMID: 33750622 DOI: 10.1016/j.jfma.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/28/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND/PURPOSE Neurological dysfunction is a common condition necessitating prolonged mechanical ventilation (PMV). We investigated the clinical features and outcomes of patients with acute neurological diseases requiring PMV. METHODS This retrospective observational study was conducted at the Respiratory Care Center (RCC) of Chang Gung Memorial Hospital, Taiwan, between January 2011 and January 2014. The main outcome was weaning success, defined as successful withdrawal from mechanical ventilator support for more than 5 days. RESULTS The study included 103 patients with acute stroke and brain trauma receiving PMV. Weaning success was reported in 63 (61%) patients and weaning failure was reported in 40 (39%) patients. Patients in the weaning failure group were older and had a lower RCC Glasgow Coma Scale (GCS) score (6.0 vs 7.9, p = 0.005), lower albumin level (2.8 vs 3.1, p = 0.015), longer RCC stay (28.7 vs 21.3 days, p = 0.017), and higher in-hospital mortality rate (47% vs 9%, p < 0.01). Multivariate analysis revealed that reduced RCC GCS score is an independent prognostic factor for weaning failure (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.05-1.46, p = 0.016) and that per unit increase of RCC GCS score is associated with a lower risk of in-hospital mortality (OR = 0.83, 95% CI = 0.70-0.96, p = 0.019). CONCLUSION Reduced RCC GCS score is an independent prognostic factor for weaning failure, and is associated with increased in-hospital mortality rates in patients with acute stroke and brain trauma requiring PMV.
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Affiliation(s)
- Hung-Yu Huang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Chung-Shu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Hsuan Chiu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Hsiang Hsuan Chen
- School of Medicine, College of Medicine, Chang Gung University, Kaohsiung, Taiwan; Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Yi Chan
- School of Medicine, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chee-Jen Chang
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Chen Chang
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Han-Chung Hu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ning-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Shu-Min Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Li-Fu Li
- Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
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Xiong S, Liu S, Qiao Y, He D, Ke C, Shen Y. Estimation of losses of quality-adjusted life expectancy attributed to the combination of cognitive impairment and multimorbidity among Chinese adults aged 45 years and older. BMC Public Health 2021; 21:24. [PMID: 33402151 PMCID: PMC7786915 DOI: 10.1186/s12889-020-10069-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES This study aims to estimate the losses of quality-adjusted life expectancy (QALE) due to the joint effects of cognitive impairment and multimorbidity, and to further confirm additional losses attributable to this interaction among middle-aged and elderly Chinese people. METHODS The National Cause of Death Monitoring Data were linked with the China Health and Retirement Longitudinal Study (CHARLS). A mapping and assignment method was used to estimate health utility values, which were further used to calculate QALE. Losses of QALE were measured by comparing the differences between subgroups. All the losses of QALE were displayed at two levels: the individual and population levels. RESULTS At age 45, the individual-level and population-level losses of QALE attributed to the combination of cognitive impairment and multimorbidity were 7.61 (95% CI: 5.68, 9.57) years and 4.30 (95% CI: 3.43, 5.20) years, respectively. The losses for cognitive impairment alone were 3.10 (95% CI: 2.29, 3.95) years and 1.71 (95% CI: 1.32, 2.13) years at the two levels. Similarly, the losses for multimorbidity alone were 3.53 (95% CI: 2.53, 4.56) years and 1.91 (95% CI: 1.24, 2.63) years at the two levels. Additional losses due to the interaction of cognitive impairment and multimorbidity were indicated by the 0.98 years of the individual-level gap and 0.67 years of the population-level gap. CONCLUSION Among middle-aged and elderly Chinese people, cognitive impairment and multimorbidity resulted in substantial losses of QALE, and additional QALE losses were seen due to their interaction at both individual and population levels.
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Affiliation(s)
- Suting Xiong
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Siyuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Yanan Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Dingliu He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China.
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Schuss P, Lehmann F, Schäfer N, Bode C, Scharnböck E, Schaub C, Heimann M, Potthoff AL, Weller J, Güresir E, Putensen C, Vatter H, Herrlinger U, Schneider M. Postoperative Prolonged Mechanical Ventilation in Patients With Newly Diagnosed Glioblastoma-An Unrecognized Prognostic Factor. Front Oncol 2020; 10:607557. [PMID: 33392096 PMCID: PMC7775591 DOI: 10.3389/fonc.2020.607557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022] Open
Abstract
Objective Although the treatment of glioblastoma patients is well established in neuro-oncological surgery, precious scarce data is available on patients with glioblastoma requiring postoperative prolonged mechanical ventilation (PMV). Therefore, the aim of the present study was to determine the influence of PMV on overall survival (OS) in patients with glioblastoma. Methods Patients with newly diagnosed glioblastoma who had undergone surgical therapy and complete subsequent neuro-oncological treatment at the authors’ neuro-oncological center from January 2013 to December 2018 were selected and included in the further analysis. PMV was defined as mechanical ventilation for more than 24 h after surgery. Survival analyses were performed, including established prognostic factors such as age, Karnofsky performance score, MGMT-promoter methylation status and extent of resection. Results A total of 240 patients with newly diagnosed glioblastoma and subsequent surgical treatment were identified. 13 patients (5%) suffered from PMV during the treatment course of glioblastoma. All but one patient were successfully weaned from mechanical ventilation. Patients suffering from PMV achieved significantly less often favorable functional outcome after 3, 6, 9, and 12 months compared to patients without PMV. Multivariate analysis revealed PMV to constitute a significant prognostic factor for OS, independent of other prognostic factors (p<0.0001, OR 6.7, 95% CI 3.2–13.8). Conclusions The present study identifies PMV as significantly associated with impaired functional outcome and poor OS in patients suffering from newly diagnosed glioblastoma. These findings encourage further efforts to investigate/assess this prognostic factor in future studies.
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Affiliation(s)
- Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Felix Lehmann
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Elisa Scharnböck
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Muriel Heimann
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Johannes Weller
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Christian Putensen
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
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10
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Hong Y, Woo S, Kim Y, Lee JJ, Hong JY. Plasma concentrations of NOX4 are predictive of successful liberation from mechanical ventilation and 28-day mortality in intubated patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1376. [PMID: 33313121 PMCID: PMC7723573 DOI: 10.21037/atm-20-4252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) enzymes play important roles in generating reactive oxygen species (ROS); in particular, NOX4 plays a distinct role in regulating lung inflammation and apoptosis. Methods We determined whether plasma NOX4 level can be used as a prognostic biomarker to guide weaning from mechanical ventilation and to predict mortality in intubated patients. Plasma levels of NOX4 were measured at days 1 (NOX4 D1) and 7 (NOX4 D7) after initiation of mechanical ventilation in 184 patients. Results With increase in day 7 NOX4 quartile, the success of weaning tended to decrease and 28-day mortality tended to increase. On multivariate logistic regression, Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) [odds ratio (OR): 1.10; 95% CI, 1.02–1.18], duration of mechanical ventilation (OR: 1.12; 95% CI: 1.06–1.18), and NOX4 D7 levels >18.2 ng/mL (OR: 4.40; 95% CI: 1.91–10.06) were independently associated with weaning failure. Also, Cox-hazard proportional model showed that NOX4 D7 level >18.2 ng/mL (hazard ratio [HR], 2.29; 95% CI, 1.26–4.16), APACHE II (HR: 1.07; 95% CI: 1.02–1.14), Sequential Organ Failure Assessment (SOFA) (HR: 1.10; 95% CI: 1.01–1.20) and coexisting cancer (HR: 1.99; 95% CI, 1.01–3.94), were independently associated with 28-day mortality. The longitudinal trend of NOX4 level varied according to the clinical outcomes. Conclusions An increased plasma NOX4 D7 level was associated with weaning failure and 28-day mortality in patients with mechanical ventilation. Our results suggest that NOX4-directed management may lead to improved outcomes in patients with mechanical ventilation.
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Affiliation(s)
- Yoonki Hong
- Department of Internal Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Seongji Woo
- Institute of New frontier Research, Hallym University College of Medicine, Republic of Korea
| | - Youngmi Kim
- Institute of New frontier Research, Hallym University College of Medicine, Republic of Korea
| | - Jae Jun Lee
- Institute of New frontier Research, Hallym University College of Medicine, Republic of Korea
| | - Ji Young Hong
- Institute of New frontier Research, Hallym University College of Medicine, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon, Gangwon-do, Republic of Korea.,Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea
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11
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Decavèle M, Gatulle N, Weiss N, Rivals I, Idbaih A, Demeret S, Mayaux J, Dres M, Morawiec E, Hoang-Xuan K, Similowski T, Demoule A. One-year survival of patients with high-grade glioma discharged alive from the intensive care unit. J Neurol 2020; 268:516-525. [PMID: 32860544 PMCID: PMC7456207 DOI: 10.1007/s00415-020-10191-0] [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: 07/12/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/04/2022]
Abstract
Introduction Only limited data are available regarding the long-term prognosis of patients with high-grade glioma discharged alive from the intensive care unit. We sought to quantify 1-year mortality and evaluate the association between mortality and (1) functional status, and (2) management of anticancer therapy in patients with high-grade glioma discharged alive from the intensive care unit.
Patients and methods Retrospective observational cohort study of patients with high-grade glioma admitted to two intensive care units between January 2009 and June 2018. Functional status was assessed by the Karnofsky Performance Status. Anticancer therapy after discharge was classified as (1) continued (unchanged), (2) modified (changed or stopped), or (3) initiated (for newly diagnosed disease).
Results Ninety-one high-grade glioma patients (73% of whom had glioblastoma) were included and 78 (86%) of these patients were discharged alive from the intensive care unit. Anticancer therapy was continued, modified, and initiated in 41%, 42%, and 17% of patients, respectively. Corticosteroid therapy at the time of ICU admission [odds ratio (OR) 0.07] and cancer progression (OR 0.09) was independently associated with continuation of anticancer therapy. The mortality rate 1 year after ICU admission was 73%. On multivariate analysis, continuation of anticancer therapy (OR 0.18) and Karnofsky performance status on admission (OR 0.90) were independently associated with lower 1-year mortality.
Conclusion The presence of high-grade glioma is not sufficient to justify refusal of intensive care unit admission. Performance status and continuation of anticancer therapy are associated with higher survival after intensive care unit discharge.
Previous presentation Preliminary results were presented at the most recent congress of the French Intensive Care Society, Paris, 2019. Electronic supplementary material The online version of this article (10.1007/s00415-020-10191-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maxens Decavèle
- Médecine Intensive Et Réanimation (Département R3S), Service de Pneumologie, AP-HP, Site Pitié-Salpêtrière, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service de Neurologie 2-Mazarin, 75013, Paris, France. .,UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, INSERM, Sorbonne Université, 75005, Paris, France.
| | - Nicolas Gatulle
- Médecine Intensive Et Réanimation (Département R3S), Service de Pneumologie, AP-HP, Site Pitié-Salpêtrière, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service de Neurologie 2-Mazarin, 75013, Paris, France
| | - Nicolas Weiss
- Unité de Médecine Intensive Réanimation Neurologique, Département de Neurologie, DMU Neurosciences Et Institut de Neurosciences Translationnelles, AP-HP.Sorbonne IHU-A-ICM, Hôpital de La Pitié-Salpêtrière, Université Paris, Paris, France.,Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de Recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN),, Sorbonne Université, Paris, France
| | - Isabelle Rivals
- UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, INSERM, Sorbonne Université, 75005, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
| | - Ahmed Idbaih
- Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, 75013, Paris, France
| | - Sophie Demeret
- Unité de Médecine Intensive Réanimation Neurologique, Département de Neurologie, DMU Neurosciences Et Institut de Neurosciences Translationnelles, AP-HP.Sorbonne IHU-A-ICM, Hôpital de La Pitié-Salpêtrière, Université Paris, Paris, France
| | - Julien Mayaux
- UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, INSERM, Sorbonne Université, 75005, Paris, France
| | - Martin Dres
- Médecine Intensive Et Réanimation (Département R3S), Service de Pneumologie, AP-HP, Site Pitié-Salpêtrière, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service de Neurologie 2-Mazarin, 75013, Paris, France.,UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, INSERM, Sorbonne Université, 75005, Paris, France
| | - Elise Morawiec
- UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, INSERM, Sorbonne Université, 75005, Paris, France
| | - Khe Hoang-Xuan
- Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, 75013, Paris, France
| | - Thomas Similowski
- Médecine Intensive Et Réanimation (Département R3S), Service de Pneumologie, AP-HP, Site Pitié-Salpêtrière, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service de Neurologie 2-Mazarin, 75013, Paris, France.,UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, INSERM, Sorbonne Université, 75005, Paris, France
| | - Alexandre Demoule
- Médecine Intensive Et Réanimation (Département R3S), Service de Pneumologie, AP-HP, Site Pitié-Salpêtrière, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service de Neurologie 2-Mazarin, 75013, Paris, France.,UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, INSERM, Sorbonne Université, 75005, Paris, France
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12
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Assessing delivery of mechanical ventilation: risks and benefits of large databases. Intensive Care Med 2020; 46:2297-2300. [PMID: 32845351 PMCID: PMC7447597 DOI: 10.1007/s00134-020-06214-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/08/2020] [Indexed: 12/03/2022]
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13
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Haviland K, Tan KS, Schwenk N, Pillai MV, Stover DE, Downey RJ. Outcomes after long-term mechanical ventilation of cancer patients. BMC Palliat Care 2020; 19:42. [PMID: 32228554 PMCID: PMC7106688 DOI: 10.1186/s12904-020-00544-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background The probability of weaning and of long-term survival of chronically mechanically ventilated cancer patients is unknown, with incomplete information available to guide therapeutic decisions. We sought to determine the probability of weaning and overall survival of cancer patients requiring long-term mechanical ventilation in a specialized weaning unit. Methods A single-institution retrospective review of patients requiring mechanical ventilation outside of a critical care setting from 2008 to 2012 and from January 1 to December 31, 2018, was performed. Demographic and clinical data were recorded, including cancer specifics, comorbidities, treatments, and outcomes. Overall survival was determined using the Kaplan-Meier approach. Time to weaning was analyzed using the cumulative incidence function, with death considered a competing risk. Prognostic factors were evaluated for use in prospective evaluations of weaning protocols. Results Between 2008 and 2012, 122 patients required mechanical ventilation outside of a critical care setting with weaning as a goal of care. The cumulative incidence of weaning after discharge from the intensive care unit was 42% at 21 days, 49% at 30 days, 58% at 60 days, 61% at 90 days, and 61% at 120 days. The median survival was 0.16 years (95% CI, 0.12 to 0.33) for those not weaned and 1.05 years (95% CI, 0.60 to 1.34) for those weaned. Overall survival at 1 year and 2 years was 52 and 32% among those weaned and 16 and 9% among those not weaned. During 2018, 36 patients at our institution required mechanical ventilation outside of a critical care setting, with weaning as a goal of care. Overall, with a median follow-up of 140 days (range, 0–425 days; average, 141 days), 25% of patients requiring long-term mechanical ventilation (9 of 36) are alive. Conclusions Cancer patients can be weaned from long-term mechanical ventilation, even after prolonged periods of support. Implementation of a resource-intensive weaning program did not improve rates of successful weaning. No clear time on mechanical ventilation could be identified beyond which weaning was unprecedented. Short-term overall survival for these patients is poor.
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Affiliation(s)
- Kelly Haviland
- Department of Nursing, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadja Schwenk
- Department of Nursing, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Manju V Pillai
- Pulmonary Service, Department of Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diane E Stover
- Pulmonary Service, Department of Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Hospital, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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14
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Sun Y, Li S, Wang S, Li C, Li G, Xu J, Wang H, Liu F, Yao G, Chang Z, Liu Y, Shang M, Wang D. Predictors of 1-year mortality in patients on prolonged mechanical ventilation after surgery in intensive care unit: a multicenter, retrospective cohort study. BMC Anesthesiol 2020; 20:44. [PMID: 32085744 PMCID: PMC7033944 DOI: 10.1186/s12871-020-0942-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care demand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed the prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This study analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after surgery. Methods In this multicenter, respective cohort study, 124 patients who required PMV after surgery in the ICUs of five tertiary hospitals in Beijing between January 2007 and June 2016 were enrolled. The primary outcome was the duration of survival within 1 year. Predictors of 1-year mortality were identified with a multivariable Cox proportional hazard model. The predictive effect of the ProVent score was also validated. Results Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From the multivariable Cox proportional hazard analysis, cancer diagnosis (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.37–3.35; P < 0.01), no tracheostomy (HR 2.01, 95% CI 1.22–3.30; P < 0.01), enteral nutrition intolerance (HR 1.88, 95% CI 1.19–2.97; P = 0.01), blood platelet count ≤150 × 109/L (HR 1.77, 95% CI 1.14–2.75; P = 0.01), requirement of vasopressors (HR 1.78, 95% CI 1.13–2.80; P = 0.02), and renal replacement therapy (HR 1.71, 95% CI 1.01–2.91; P = 0.047) on the 21st day of mechanical ventilation (MV) were associated with shortened 1-year survival. Conclusions For patients who required PMV after surgery, cancer diagnosis, no tracheostomy, enteral nutrition intolerance, blood platelet count ≤150 × 109/L, vasopressor requirement, and renal replacement therapy on the 21st day of MV were associated with shortened 1-year survival. The prognosis in PMV patients in ICUs can facilitate the decision-making process of physicians and patients’ family members on treatment schedule.
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Affiliation(s)
- Yueming Sun
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China
| | - Shuangling Li
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China.
| | - Shupeng Wang
- Department of Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Chen Li
- Department of Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Gang Li
- Department of Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jiaxuan Xu
- Department of Critical Care Medicine, Beijing Cancer Hospital, Beijing, 100142, China
| | - Hongzhi Wang
- Department of Critical Care Medicine, Beijing Cancer Hospital, Beijing, 100142, China
| | - Fei Liu
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Gaiqi Yao
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Zhigang Chang
- Department of Critical Care Medicine, National Center of Gerontology, Beijing Hospital, Beijing, 100730, China
| | - Yalin Liu
- Department of Critical Care Medicine, National Center of Gerontology, Beijing Hospital, Beijing, 100730, China
| | - Meixia Shang
- Department of Biostatistics, Peking University First Hospital, Beijing, 100034, China
| | - Dongxin Wang
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China
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15
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Hsiue EHC, Lee PL, Chen YH, Wu TH, Cheng CF, Cheng KM, Yang PC, Chen HW, Lin PY, Chiang DL, Wu HD, Yang JCH, Yu CJ. Weaning outcome of solid cancer patients requiring mechanical ventilation in the intensive care unit. J Formos Med Assoc 2019; 118:995-1004. [PMID: 30857753 DOI: 10.1016/j.jfma.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/22/2019] [Accepted: 02/20/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Whether the weaning outcome of solid cancer patients receiving mechanical ventilation (MV) in the intensive care unit (ICU) is comparable to that in non-cancer patients is unknown. The aim of this study was to compare the weaning outcomes between non-cancer patients and patients with different types of cancer. METHODS We studied patients requiring MV during ICU stay for medical reasons between 2012 and 2014. Cancer patients were grouped into those with lung cancer (LC), head and neck cancer (HNC), hepatocellular carcinoma (HCC), and other cancers (OC). The primary endpoint was successful weaning at day 90 after the initiation of MV, and the main secondary endpoints were 28-day and 90-day mortality after ICU admission. RESULTS Five hundred and eighteen patients with solid cancers and 1362 non-cancer patients were recruited. The rate of successful weaning at day 90 was 57.9% in cancer patients, which was lower than 68.9% in non-cancer patients (p < 0.001). Compared to non-cancer patients, LC was associated with a lower probability of weaning at day 90 (hazard ratio 0.565, 95% CI 0.446 to 0.715), while HNC, HCC, and OC had similar probabilities. The 28-day and 90-day mortality rates were higher in cancer patients than in non-cancer patients (45.2% vs. 29.4%, and 65.6% vs. 37.7%, respectively, both p < 0.001). CONCLUSION Among mechanically ventilated patients in the ICU, those with LC were associated with a lower probability of weaning at day 90 compared to non-cancer patients.
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Affiliation(s)
- Emily Han-Chung Hsiue
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Cellular and Molecular Medicine Program, Johns Hopkins School of Medicine, Suite 2-103, 1830 East Monument St, Baltimore, MD, 21205, USA
| | - Pei-Lin Lee
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Center for Electronics Technology Integration, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Yung-Hsuan Chen
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Ting-Hui Wu
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Chiao-Feng Cheng
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Keng-Man Cheng
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Po-Chun Yang
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Hsing-Wu Chen
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Pei-Yu Lin
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Dai-Lung Chiang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, No.1, Sec.4, Roosevelt Road, Taipei, Taiwan
| | - Huey-Dong Wu
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren-Ai Rd, 100, Taipei, Taiwan; National Taiwan University Cancer Center, No. 1, Sec. 1, Ren-Ai Rd, Taipei, 100, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
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16
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Martos-Benítez FD, Cordero-Escobar I, Soto-García A, Betancourt-Plaza I, González-Martínez I. APACHE II score for critically ill patients with a solid tumor: A reclassification study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:447-455. [PMID: 29779786 DOI: 10.1016/j.redar.2018.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To improve the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) II model for predicting hospital mortality in critically ill cancer patients. MATERIALS AND METHODS This was a prospective cohort study of 522 patients admitted to ICU with a solid tumor. We developed the "APACHE II score for critically ill patients with a solid tumor" (APACHE IICCP score), in which typical variables of critically ill cancer patients were added to general APACHE II score. Calibration and discrimination were evaluated by Hosmer-Lemeshow test (H-L) and area under receiver operating characteristic curve (AROC), respectively. The improvement in predicting hospital mortality with the new model was assessed using a reclassification analysis by integrated discrimination improvement (IDI), net reclassification improvement (NRI; cut-off point of 20% in risk of death) and quantitative NRI (qNRI). RESULTS The hospital mortality rate was 13%. Discrimination was superior for APACHE IICCP score (AROC=0.91 [95% CI 0.87-0.94; P<.0001]) compared to general APACHE II score (AROC=0.62 [95% CI 0.54-0.70; P=.002]). Calibration was better using APACHE IICCP score (H-L; P=.267 vs. P=.001). In reclassification analysis, an improved mortality prediction was observed with APACHE IICCP score (IDI=0.2994 [P<.0001]; total qNRI=134.3% [95% CI 108.8-159.8%; P<.0001]; total NRI=41.5% [95% CI 23.7-59.3%; P<.0001]). CONCLUSIONS The performance of APACHE IICCP score was superior to that observed for general APACHE II score in predicting mortality in critically ill patients with a solid tumor. Other studies validating this new predictive model are required.
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Affiliation(s)
- F D Martos-Benítez
- Unidad de Cuidados Intensivos 8B, Hospital "Hermanos Ameijeiras", La Habana, Cuba.
| | - I Cordero-Escobar
- Departamento de Anestesiología, Hospital "Hermanos Ameijeiras", La Habana, Cuba
| | - A Soto-García
- Unidad de Cuidados Intensivos Oncológicos, Instituto de Oncología y Radiobiología, La Habana, Cuba
| | - I Betancourt-Plaza
- Unidad de Cuidados Intensivos, Hospital Docente "Dr. Miguel Enríquez", La Habana, Cuba
| | - I González-Martínez
- Unidad de Cuidados Intensivos, Hospital Docente "Dr. Miguel Enríquez", La Habana, Cuba
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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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18
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Martos-Benítez FD, Gutiérrez-Noyola A, Badal M, Dietrich NA. Risk factors and outcomes of severe acute respiratory failure requiring invasive mechanical ventilation in cancer patients: A retrospective cohort study. Med Intensiva 2017; 42:354-362. [PMID: 28966007 DOI: 10.1016/j.medin.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the risk factors for severe acute respiratory failure requiring invasive mechanical ventilation (SARF-MV) and its effect upon clinical outcomes in critically ill cancer patients. DESIGN A retrospective cohort study was carried out. SETTING A 12-bed oncological intensive care unit (ICU) from January 2014 to December 2015. PATIENTS A total of 878 consecutive cancer patients were included. Patients with an ICU stay of ≤1 day were excluded. The final sample size was 691 patients. INTERVENTIONS None. VARIABLES Clinical variables at ICU admission were extracted from the medical records. The primary outcome was SARF-MV. We also measured ICU and hospital mortality, as well as length of stay. RESULTS The SARF-MV rate was 15.8%. The multivariate analysis identified brain tumour (OR 14.54; 95%CI 3.86-54.77; p<0.0001), stage IV cancer (OR 3.47; 95%CI 1.26-9.54; p=0.016), sepsis upon admission (OR 2.28; 95%CI 1.14-4.56; p=0.020) and an APACHE II score≥20 points (OR 5.38; 95%CI 1.92-15.05; p=0.001) as being independently associated to SARF-MV. Compared with the patients without SARF-MV, those with SARF-MV had a prolonged length of ICU stay (p<0.0001), a lower ICU survival rate (p<0.0001) and a lower hospital survival rate (p<0.0001). CONCLUSIONS A number of clinical factors are related to SARF-MV. In this regard, SARF-MV is a powerful factor independently correlated to poor outcomes. Future studies should investigate means for preventing SARF-MV in critically ill cancer patients, which may have an impact upon outcomes.
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Affiliation(s)
- F D Martos-Benítez
- Department of Intensive Care, Institute of Oncology and Radiobiology, 29 Street, Vedado, Havana, Cuba.
| | - A Gutiérrez-Noyola
- Department of Intensive Care, Institute of Oncology and Radiobiology, 29 Street, Vedado, Havana, Cuba
| | - M Badal
- Department of Intensive Care, Institute of Oncology and Radiobiology, 29 Street, Vedado, Havana, Cuba
| | - N A Dietrich
- Department of Intensive Care, Institute of Oncology and Radiobiology, 29 Street, Vedado, Havana, Cuba
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Long-Term Survival, Quality of Life, and Quality-Adjusted Survival in Critically Ill Patients With Cancer. Crit Care Med 2017; 44:1327-37. [PMID: 26998653 DOI: 10.1097/ccm.0000000000001648] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the long-term survival, health-related quality of life, and quality-adjusted life years of cancer patients admitted to ICUs. DESIGN Prospective cohort. SETTING Two cancer specialized ICUs in Brazil. PATIENTS A total of 792 participants. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The health-related quality of life before ICU admission; at 15 days; and at 3, 6, 12, and 18 months was assessed with the EQ-5D-3L. In addition, the vital status was assessed at 24 months. The mean age of the subjects was 61.6 ± 14.3 years, 42.5% were female subjects and half were admitted after elective surgery. The mean Simplified Acute Physiology Score 3 was 47.4 ± 15.6. Survival at 12 and 18 months was 42.4% and 38.1%, respectively. The mean EQ-5D-3L utility measure before admission to the ICU was 0.47 ± 0.43, at 15 days it was 0.41 ± 0.44, at 90 days 0.56 ± 0.42, at 6 months 0.60 ± 0.41, at 12 months 0.67 ± 0.35, and at 18 months 0.67 ± 0.35. The probabilities for attaining 12 and 18 months of quality-adjusted survival were 30.1% and 19.1%, respectively. There were statistically significant differences in survival time and quality-adjusted life years according to all assessed baseline characteristics (ICU admission after elective surgery, emergency surgery, or medical admission; Simplified Acute Physiology Score 3; cancer extension; cancer status; previous surgery; previous chemotherapy; previous radiotherapy; performance status; and previous health-related quality of life). Only the previous health-related quality of life and performance status were associated with the health-related quality of life during the 18-month follow-up. CONCLUSIONS Long-term survival, health-related quality of life, and quality-adjusted life year expectancy of cancer patients admitted to the ICU are limited. Nevertheless, these clinical outcomes exhibit wide variability among patients and are associated with simple characteristics present at the time of ICU admission, which may help healthcare professionals estimate patients' prognoses.
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Significant Clinical Factors Associated with Long-term Mortality in Critical Cancer Patients Requiring Prolonged Mechanical Ventilation. Sci Rep 2017; 7:2148. [PMID: 28526862 PMCID: PMC5438375 DOI: 10.1038/s41598-017-02418-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/11/2017] [Indexed: 02/08/2023] Open
Abstract
Studies about prognostic assessment in cancer patients requiring prolonged mechanical ventilation (PMV) for post-intensive care are scarce. We retrospectively enrolled 112 cancer patients requiring PMV support who were admitted to the respiratory care center (RCC), a specialized post-intensive care weaning facility, from November 2009 through September 2013. The weaning success rate was 44.6%, and mortality rates at hospital discharge and after 1 year were 43.8% and 76.9%, respectively. Multivariate logistic regression showed that weaning failure, in addition to underlying cancer status, was significantly associated with an increased 1-year mortality (odds ratio, 6.269; 95% confidence interval, 1.800–21.834; P = 0.004). Patients who had controlled non-hematologic cancers and successful weaning had the longest median survival, while those with other cancers who failed weaning had the worst. Patients with low maximal inspiratory pressure, anemia, and poor oxygenation at RCC admission had an increased risk of weaning failure. In conclusion, cancer status and weaning outcome were the most important determinants associated with long-term mortality in cancer patients requiring PMV. We suggest palliative care for those patients with clinical features associated with worse outcomes. It is unknown whether survival in this specific patient population could be improved by modifying the risk of weaning failure.
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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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22
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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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Scheiermann J, Klinman DM. Suppressive oligonucleotides inhibit inflammation in a murine model of mechanical ventilator induced lung injury. J Thorac Dis 2016; 8:2434-2443. [PMID: 27746995 DOI: 10.21037/jtd.2016.08.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mechanical ventilation (MV) is commonly used to improve blood oxygenation in critically ill patients and for general anesthesia. Yet the cyclic mechanical stress induced at even moderate ventilation volume settings [tidal volume (Vt) <10 mL/kg] can injure the lungs and induce an inflammatory response. This work explores the effect of treatment with suppressive oligonucleotides (Sup ODN) in a mouse model of ventilator-induced lung injury (VILI). METHODS Balb/cJ mice were mechanically ventilated for 4 h using clinically relevant Vt and a positive end-expiratory pressure of 3 cmH2O under 2-3% isoflurane anesthesia. Lung tissue and bronchoalveolar lavage fluid were collected to assess lung inflammation and lung function was monitored using a FlexiVent®. RESULTS MV induced significant pulmonary inflammation characterized by the influx and activation of CD11c+/F4/80+ macrophages and CD11b+/Ly6G+ polymorphonuclear cells into the lung and bronchoalveolar lavage fluid. The concurrent administration of Sup ODN attenuated pulmonary inflammation as evidenced by reduced cellular influx and production of inflammatory cytokines. Oligonucleotide treatment did not worsen lung function as measured by static compliance or resistance. CONCLUSIONS Treatment with Sup ODN reduces the lung injury induced by MV in mice.
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Affiliation(s)
- Julia Scheiermann
- Cancer and Inflammation Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Dennis M Klinman
- Cancer and Inflammation Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
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Liao KM, Lin WC, Lin TC, Li CY, Yang YHK. Disease severity at the first hospitalization as a predictor for mechanical ventilation dependency in elderly patients with chronic obstructive pulmonary disease. TOHOKU J EXP MED 2015; 234:263-9. [PMID: 25447276 DOI: 10.1620/tjem.234.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are predisposed to respiratory failure with ventilator dependency. This study aims to determine the risk of prolonged mechanical ventilation (PMV), defined as 22 days or more of mechanical ventilation dependency after the first day of hospital admission (index date) in patients diagnosed with COPD. A retrospective cohort was conducted using medical claim data of Taiwan's National Health Insurance Research Database. Eligible study subjects were those who had a diagnosis of COPD made between January 1, 2005 and December 31, 2009. Patients were then followed until being registered as a PMV case, death, or the end of the study. The comorbidities were measured from January 1, 1997 to the index date by the ICD-9 code. The study sample consisted of 6,341 patients with COPD with a mean age of 73.89 (± 12.01) years. Over a maximum of 6 years of follow-up, 654 patients developed PMV dependency, with an incidence density of 41.56 per 1,000 person-years. Patients aged 70 years and older were at significantly increased risk for PMV dependency, compared to those aged 40-49 years after adjusting for confounders. Expenses per visit and hospital visits per year, representing the severity of the COPD, were also associated with an elevated risk of PMV. Most patients developed PMV dependency within the first two years after the index date. Physicians should be aware that elderly patients with COPD have a high risk of PMV after first hospitalization, and these patients need to be closely monitored.
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Toffart AC, Timsit JF. Is prolonged mechanical ventilation of cancer patients futile? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:189. [PMID: 24053905 PMCID: PMC4056103 DOI: 10.1186/cc13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The issue of limiting life-sustaining treatments for intensive care unit (ICU)
patients is complex. The ethical principles applied by ICU staff when making
treatment-limitation decisions must comply with the law of their country. Until
2011, the law in Taiwan prohibited the withdrawal of mechanical ventilation.
Consequently, patients with severe underlying diseases could receive prolonged
mechanical ventilation. In a study conducted by Shih and colleagues in patients
with cancer in Taiwan, continuous mechanical ventilation for more than 21 days
was associated with poor outcomes, particularly in the subgroups of patients
with metastases, lung cancer, or liver cancer. These results highlight the need
for appropriate legislation regarding the withdrawal of life-sustaining
treatments in patients, especially those for whom no effective cancer treatments
are available.
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