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Liu W, Zhou D, Zhang L, Huang M, Quan R, Xia R, Ye Y, Zhang G, Shen Z. Characteristics and outcomes of cancer patients admitted to intensive care units in cancer specialized hospitals in China. J Cancer Res Clin Oncol 2024; 150:205. [PMID: 38642154 PMCID: PMC11032264 DOI: 10.1007/s00432-024-05727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Standard intensive care unit (ICU) admission policies and treatment strategies for patients with cancer are still lacking. To depict the current status of admission, characteristics, and outcomes of patients with cancer in the ICU. METHODS A multicenter cross-sectional study was performed from May 10, 2021 to July 10, 2021, in the ICU departments of 37 cancer-specialized hospitals in China. Clinical records of all admitted patients aged ≥ 14 years and ICU duration > 24 h with complete data were included. Demographic information, clinical history, severity score at admission, ICU critical condition diagnosis and treatment, ICU and in-hospital outcomes and 90 days survival were also collected. A total of 1455 patients were admitted and stayed for longer than 24 h. The most common primary cancer diagnoses included lung, colorectal, esophageal, and gastric cancer. RESULTS Patients with lung cancer were admitted more often because of worsening complications that occurred in the clinical ward. However, other cancer patients may be more likely to be admitted to the ICU because of postoperative care. ICU-admitted patients with lung or esophageal cancer tended to have more ICU complications. Patients with lung cancer had a poor overall survival prognosis, whereas patients with colorectal cancer appeared to benefit the most according to 90 days mortality rates. CONCLUSION Patients with lung cancer require more ICU care due to critical complications and the overall survival prognosis is poor. Colorectal cancer may benefit more from ICU management. This information may be considered in ICU admission and treatment strategies.
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Affiliation(s)
- Wensheng Liu
- Department of Intensive Care Unit, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Zhejiang Cancer Hospital, No. 1 East Banshan Road, Hangzhou, 310022, China
| | - Dongmin Zhou
- Department of Intensive Care Unit, Henan Cancer Hospital, Zhengzhou, China
| | - Li Zhang
- Department of Intensive Care Unit, Hubei Cancer Hospital, Wuhan, China
| | - Mingguang Huang
- Department of Intensive Care Unit, Shanxi Province Cancer Hospital, Taiyuan, China
| | - Rongxi Quan
- Department of Intensive Care Unit, Cancer Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Rui Xia
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yong Ye
- Department of Intensive Care Unit, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Guoxing Zhang
- Department of Intensive Care Unit, Gaoxin District of Jilin Cancer Hospital, Changchun, China
| | - Zhuping Shen
- Department of Intensive Care Unit, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Zhejiang Cancer Hospital, No. 1 East Banshan Road, Hangzhou, 310022, China.
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García de Herreros M, Laguna JC, Padrosa J, Barreto TD, Chicote M, Font C, Grafiá I, Llavata L, Seguí E, Tuca A, Viladot M, Zamora-Martínez C, Fernández-Méndez S, Téllez A, Nicolás JM, Prat A, Castro-Rebollo P, Marco-Hernández J. Characterisation and Outcomes of Patients with Solid Organ Malignancies Admitted to the Intensive Care Unit: Mortality and Impact on Functional Status and Oncological Treatment. Diagnostics (Basel) 2024; 14:730. [PMID: 38611643 PMCID: PMC11011727 DOI: 10.3390/diagnostics14070730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Despite the increasing number of ICU admissions among patients with solid tumours, there is a lack of tools with which to identify patients who may benefit from critical support. We aim to characterize the clinical profile and outcomes of patients with solid malignancies admitted to the ICU. METHODS Retrospective observational study of patients with cancer non-electively admitted to the ICU of the Hospital Clinic of Barcelona (Spain) between January 2019 and December 2019. Data regarding patient and neoplasm characteristics, ICU admission features and outcomes were collected from medical records. RESULTS 97 ICU admissions of 84 patients were analysed. Lung cancer (22.6%) was the most frequent neoplasm. Most of the patients had metastatic disease (79.5%) and were receiving oncological treatment (75%). The main reason for ICU admission was respiratory failure (38%). Intra-ICU and in-hospital mortality rates were 9.4% and 24%, respectively. Mortality rates at 1, 3 and 6 months were 19.6%, 36.1% and 53.6%. Liver metastasis, gastrointestinal cancer, hypoalbuminemia, elevated basal C-reactive protein, ECOG-PS greater than 2 at ICU admission, admission from ward and an APACHE II score over 14 were related to higher mortality. Functional status was severely affected at discharge, and oncological treatment was definitively discontinued in 40% of the patients. CONCLUSION Medium-term mortality and functional deterioration of patients with solid cancers non-electively admitted to the ICU are high. Surrogate markers of cachexia, liver metastasis and poor ECOG-PS at ICU admission are risk factors for mortality.
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Affiliation(s)
- Marta García de Herreros
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Juan Carlos Laguna
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Joan Padrosa
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Tanny Daniela Barreto
- Radiation Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain;
| | - Manoli Chicote
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
| | - Carme Font
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Ignacio Grafiá
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Lucía Llavata
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
| | - Elia Seguí
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Albert Tuca
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Margarita Viladot
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Carles Zamora-Martínez
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Sara Fernández-Méndez
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Adrián Téllez
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Josep Maria Nicolás
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Aleix Prat
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Pedro Castro-Rebollo
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Javier Marco-Hernández
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
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Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, Divatia JV, Kumar A, Iyer SK, Deodhar J, Bhat RS, Salins N, Thota RS, Mathur R, Iyer RK, Gupta S, Kulkarni P, Murugan S, Nasa P, Myatra SN. Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024; 28:200-250. [PMID: 38477011 PMCID: PMC10926026 DOI: 10.5005/jp-journals-10071-24661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
End-of-life care (EOLC) exemplifies the joint mission of intensive and palliative care (PC) in their human-centeredness. The explosion of technological advances in medicine must be balanced with the culture of holistic care. Inevitably, it brings together the science and the art of medicine in their full expression. High-quality EOLC in the ICU is grounded in evidence, ethical principles, and professionalism within the framework of the Law. Expert professional statements over the last two decades in India were developed while the law was evolving. Recent landmark Supreme Court judgments have necessitated a review of the clinical pathway for EOLC outlined in the previous statements. Much empirical and interventional evidence has accumulated since the position statement in 2014. This iteration of the joint Indian Society of Critical Care Medicine-Indian Association of Palliative Care (ISCCM-IAPC) Position Statement for EOLC combines contemporary evidence, ethics, and law for decision support by the bedside in Indian ICUs. How to cite this article Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, et al. Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024;28(3):200-250.
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Affiliation(s)
- Raj K Mani
- Department of Critical Care and Pulmonology, Yashoda Super Specialty Hospital, Ghaziabad, Kaushambi, Uttar Pradesh, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Savita Butola
- Department of Palliative Care, Border Security Force Sector Hospital, Panisagar, Tripura, India
| | - Roop Gursahani
- Department of Neurology, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Dhvani Mehta
- Division of Health, Vidhi Centre for Legal Policy, New Delhi, India
| | - Srinagesh Simha
- Department of Palliative Care, Karunashraya, Bengaluru, Karnataka, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care, and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arun Kumar
- Department of Intensive Care, Medical Intensive Care Unit, Fortis Healthcare Ltd, Mohali, Punjab, India
| | - Shiva K Iyer
- Department of Critical Care, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Jayita Deodhar
- Department Palliative Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajani S Bhat
- Department of Interventional Pulmonology and Palliative Medicine, SPARSH Hospitals, Bengaluru, Karnataka, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Raghu S Thota
- Department Palliative Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Roli Mathur
- Department of Bioethics, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Rajam K Iyer
- Department of Palliative Care, Bhatia Hospital; P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Sangeetha Murugan
- Department of Education and Research, Karunashraya, Bengaluru, Karnataka, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Chaba A, Fodil S, Lemiale V, Mariotte E, Valade S, Azoulay E, Zafrani L. Clinical Warburg effect in lymphoma patients admitted to intensive care unit. Ann Intensive Care 2023; 13:97. [PMID: 37796407 PMCID: PMC10555986 DOI: 10.1186/s13613-023-01192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The Warburg effect, characterized by elevated lactate levels without tissue hypoxia or shock, has been described in patients with aggressive lymphoproliferative malignancies. However, the clinical characteristics and long-term outcomes in this population remain poorly understood. METHODS We retrospectively analyzed 135 patients with aggressive lymphoproliferative malignancies admitted to the ICU between January 2017 and December 2022. Patients were classified into three groups: Clinical Warburg Effect (CWE), No Warburg with High Lactate level (NW-HL), and No Warburg with Normal Lactate level (NW-NL). Clinical characteristics and outcomes were compared between the groups and factors associated with 1-year mortality and CWE were identified using multivariable analyses. RESULTS Of the 135 patients, 46 (34%) had a CWE. This group had a higher proportion of Burkitt and T cell lymphomas, greater tumor burden, and more frequent bone and cerebral involvement than the other groups. At 1 year, 72 patients (53%) died, with significantly higher mortality in the CWE and NW-HL groups (70% each) than in the NW-NL group (38%). Factors independently associated with 1-year mortality were age [HR = 1.02 CI 95% (1.00-1.04)], total SOFA score at admission [HR = 1.19 CI 95% (1.12-1.25)], and CWE [HR = 3.87 CI 95% (2.13-7.02)]. The main factors associated with the CWE were tumor lysis syndrome [OR = 2.84 CI 95% (1.14-7.42)], bone involvement of the underlying malignancy [OR = 3.58 CI 95% (1.02-12.91)], the total SOFA score at admission [OR = 0.81 CI 95% (0.69-0.91)] and hypoglycemia at admission [OR = 14.90 CI 95% (5.42-47.18)]. CONCLUSION CWE is associated with a higher tumor burden and increased 1-year mortality compared to patients without this condition. Our findings underscore the importance of recognizing patients with CWE as a high-risk cohort, as their outcomes closely resemble those of individuals with lymphoma and shock, despite not requiring advanced organ support. Clinicians should recognize the urgency of managing these patients and consider early intervention to improve their prognosis.
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Affiliation(s)
- Anis Chaba
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Sofiane Fodil
- Department of Hematology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
- University Paris Cité, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.
- University Paris Cité, Paris, France.
- INSERM, UMR 944, University Paris Cité, Paris, France.
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Desprez C, Kouatchet A, Marchand T, Mear JB, Tadié JM, Peterlin P, Chevalier P, Canet E, Couturier MA, Guillerm G, Bodenes L, Gyan E, Villate A, Ehrmann S, Lebreton A, Lester MA, Fronteau C, Larhantec G, André V, Riou J, Hunault-Berger M, Schmidt-Tanguy A, Orvain C. Outcome of patients with newly diagnosed AML admitted to the ICU, including preemptive admission - a multi-center study. Ann Hematol 2023; 102:1383-1393. [PMID: 37039874 DOI: 10.1007/s00277-023-05205-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
Acute myeloid leukemia (AML) can lead to life-threatening complications that may require intensive care unit (ICU) management. It has been advocated that early preemptive (ePE) ICU admission, before the onset of organ failure, could benefit some high-risk patients such as those with hyperleukocytosis. The aim of this study was to retrospectively analyze the outcome of newly diagnosed AML patients who required ICU admission in five academic centers with a special focus on patients with an ePE admission strategy, i.e., those transferred to the ICU without any organ failure (modified SOFA score ≤ 2 [omitting thrombocytopenia] and no life-sustaining intervention in the first 24 h following ICU admission) before the start of induction therapy. Between January 2017 and December 2019, 428 patients were included among which 101 were admitted to the ICU. Among patients requiring life-sustaining interventions (n = 83), 18 (22%) died while in the ICU but ICU survivors had the same survival as those not admitted to the ICU. Patients with an ePE admission (n = 18) had more comorbidities and high-risk disease features such as hyperleukocytosis but required no life-sustaining interventions while in the ICU. In a subgroup analysis of patients with hyperleukocytosis ≥ 50 G/l at diagnosis (n = 85), patients not admitted to the ICU and those admitted with an ePE strategy had similar outcomes. This study provides encouraging results about ICU outcome in AML patients during induction therapy but the potential benefit of an ePE strategy must be confirmed prospectively.
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Affiliation(s)
- Christophe Desprez
- Service des maladies du sang, CHU d'Angers, 4 rue LarreyAngers Cedex 9, F-49933, Angers, France
- Service de médecine intensive et réanimation et de médecine hyperbare, CHU d'Angers, Angers, France
| | - Achille Kouatchet
- Service de médecine intensive et réanimation et de médecine hyperbare, CHU d'Angers, Angers, France
| | - Tony Marchand
- Service d'hématologie clinique, CHU de Rennes, Rennes, France
- INSERM U1236, Université Rennes 1, Rennes, France
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
| | | | - Jean Marc Tadié
- Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France
| | - Pierre Peterlin
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'hématologie clinique, CHU de Nantes, Nantes, France
| | - Patrice Chevalier
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'hématologie clinique, CHU de Nantes, Nantes, France
| | | | - Marie-Anne Couturier
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Gaelle Guillerm
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Laetitia Bodenes
- Médecine Intensive et Réanimation, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France
| | - Emmanuel Gyan
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'Hématologie et Thérapie Cellulaire, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - Alban Villate
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'Hématologie et Thérapie Cellulaire, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - Stephan Ehrmann
- Service de Médecine Intensive et Réanimation, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | | | | | | | - Gaelle Larhantec
- Pharmacie Oncologique, CHU de Brest, Hôpital Morvan, Brest, France
| | | | - Jérémie Riou
- Inserm, CNRS, MINT, SFR ICAT, Univ Angers, CHU Angers, Angers, France
| | - Mathilde Hunault-Berger
- Service des maladies du sang, CHU d'Angers, 4 rue LarreyAngers Cedex 9, F-49933, Angers, France
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Université d'Angers, F-49000, Angers, France
| | - Aline Schmidt-Tanguy
- Service des maladies du sang, CHU d'Angers, 4 rue LarreyAngers Cedex 9, F-49933, Angers, France
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Université d'Angers, F-49000, Angers, France
| | - Corentin Orvain
- Service des maladies du sang, CHU d'Angers, 4 rue LarreyAngers Cedex 9, F-49933, Angers, France.
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France.
- Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Université d'Angers, F-49000, Angers, France.
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Bıkmaz ŞGA, Gökçe O, Haşimoğlu MM, Boyacı N, Türkoğlu M, Yeğin ZA, Özkurt ZN, Yağcı AM. Risk factors for ICU mortality in patients with hematological malignancies: a singlecenter, retrospective cohort study from Turkey. Turk J Med Sci 2023; 53:340-351. [PMID: 36945922 PMCID: PMC10387870 DOI: 10.55730/1300-0144.5590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/01/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Patients with hematological malignancies (HM) often require admission to the intensive care unit (ICU) due to organ failure, disease progression or treatment-related complications, and they generally have a poor prognosis. Therefore, understanding the factors affecting ICU mortality in HM patients is important. In this study, we aimed to identify the risk factors for ICU mortality in our critically ill HM patients. METHODS We retrospectively reviewed the medical records of HM patients who were hospitalized in our medical ICU between January 1, 2010 and December 31, 2018. We recorded some parameters of these patients and compared these parameters by statistically between survivors and nonsurvivors to determine the risk factors for ICU mortality. RESULTS The study included 368 critically ill HM patients who were admitted to our medical ICU during a 9-year period. The median age was 58 (49-67) years and 63.3% of the patients were male. Most of the patients (43.2%) had acute leukemia. Hematopoietic stem cell transplantation (HSCT) was performed in 153 (41.6%) patients. The ICU mortality rate was 51.4%. According to univariable analyses, a lot of parameters (e.g., admission APACHE II and SOFA scores, length of ICU stay, some laboratory parameters at the ICU admission, the reason for ICU admission, comorbidities, type of HM, type of HSCT, infections on ICU admission and during ICU stay, etc.) were significantly different between survivors and nonsurvivors. However, only high SOFA scores at ICU admission (OR:1.281, p = 0.004), presence of septic shock (OR:17.123, p = 0.0001), acute kidney injury (OR:48.284, p = 0.0001), and requirement of invasive mechanical ventilation support during ICU stay (OR:23.118, p = 0.0001) were independent risk factors for ICU mortality. DISCUSSION In our cohort, critically ill HM patients had high ICU mortality. We found four independent predictors for ICU mortality. Yet, there is still a need for further research to better understand poor outcome predictors in critically ill HM patients.
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Affiliation(s)
| | - Onur Gökçe
- Division of Intensive Care Medicine, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Meryem Merve Haşimoğlu
- Division of Intensive Care Medicine, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nazlıhan Boyacı
- Division of Intensive Care Medicine, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Melda Türkoğlu
- Division of Intensive Care Medicine, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Zeynep Arzu Yeğin
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Zübeyde Nur Özkurt
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Abdullah Münci Yağcı
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
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7
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Toffart AC, M'Sallaoui W, Jerusalem S, Godon A, Bettega F, Roth G, Pavillet J, Girard E, Galerneau LM, Piot J, Schwebel C, Payen JF. Quality of life of patients with solid malignancies at 3 months after unplanned admission in the intensive care unit: A prospective case-control study. PLoS One 2023; 18:e0280027. [PMID: 36603018 DOI: 10.1371/journal.pone.0280027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although short- and long-term survival in critically ill patients with cancer has been described, data on their quality of life (QoL) after an intensive care unit (ICU) stay are scarce. This study aimed to determine the impact of an ICU stay on QoL assessed at 3 months in patients with solid malignancies. METHODS A prospective case-control study was conducted in three French ICUs between February 2020 and February 2021. Adult patients with lung, colorectal, or head and neck cancer who were admitted in the ICU were matched in a 1:2 ratio with patients who were not admitted in the ICU regarding their type of cancer, curative or palliative anticancer treatment, and treatment line. The primary endpoint was the QoL assessed at 3 months from inclusion using the mental and physical components of the Short Form 36 (SF-36) Health Survey. The use of anticancer therapies at 3 months was also evaluated. RESULTS In total, 23 surviving ICU cancer patients were matched with 46 non-ICU cancer patients. Four patients in the ICU group did not respond to the questionnaire. The mental component score of the SF-36 was higher in ICU patients than in non-ICU patients: median of 54 (interquartile range: 42-57) vs. 47 (37-52), respectively (p = 0.01). The physical component score of the SF-36 did not differ between groups: 35 (31-47) vs. 42 (34-47) (p = 0.24). In multivariate analysis, no association was found between patient QoL and an ICU stay. A good performance status and a non-metastatic cancer at baseline were independently associated with a higher physical component score. The use of anticancer therapies at 3 months was comparable between the two groups. CONCLUSION In patients with solid malignancies, an ICU stay had no negative impact on QoL at 3 months after discharge when compared with matched non-ICU patients.
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Affiliation(s)
- Anne-Claire Toffart
- Institute for Advanced Biosciences INSERM U1209 CNRS UMR5309, Grenoble Alpes University, Grenoble, France
- Department of Pneumology and Physiology, Grenoble Alpes University, Grenoble, France
| | - Wassila M'Sallaoui
- Department of Pneumology and Physiology, Grenoble Alpes University, Grenoble, France
| | - Sophie Jerusalem
- Department of Anesthesia and Intensive Care, Grenoble Alpes University, Grenoble, France
| | - Alexandre Godon
- Department of Anesthesia and Intensive Care, Grenoble Alpes University, Grenoble, France
| | - Francois Bettega
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Gael Roth
- Institute for Advanced Biosciences, CNRS UMR 5309/INSERM U1209, Grenoble Alpes University, Grenoble, France
| | - Julien Pavillet
- Department of Oncology, Grenoble Alpes University, Grenoble, France
| | - Edouard Girard
- Department of Digestive and Emergency Surgery, Grenoble Alpes University, TIMC laboratory, CNRS, CHU Grenoble Alpes, Grenoble, France
| | | | - Juliette Piot
- Department of Anesthesia and Intensive Care, Grenoble Alpes University, Grenoble, France
| | - Carole Schwebel
- Department of Medical ICU, Grenoble Alpes University, Grenoble, France
| | - Jean Francois Payen
- Department of Anesthesia and Intensive Care, Grenoble Alpes University, Grenoble, France
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8
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Lucet A, Franchitti J, Legay L, Milacic H, Fontaine JP, Ellouze S, Peyrony O. Effect of a delayed admission to the intensive care unit on survival after emergency department visit in patients with cancer: a retrospective observational study. Eur J Emerg Med 2022; 29:221-226. [PMID: 35297386 DOI: 10.1097/mej.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND IMPORTANCE Delayed admission to the ICU is reported to be associated with worse outcomes in cancer patients. OBJECTIVE The main objective of this study was to compare the 180-day survival of cancer patients whether they were directly admitted to the ICU from the emergency department (ED) or secondarily from the wards after the ED visit. DESIGN, SETTINGS AND PARTICIPANTS This was a retrospective observational study including all adult cancer patients that visited the ED in 2018 and that were admitted to the ICU at some point within 7 days from the ED visit. EXPOSURE Delayed ICU admission. OUTCOME MEASURE AND ANALYSIS Survival at day 180 was plotted using Kaplan-Meier curves, and hazard ratio (HR) from Cox proportional-hazard models was used to quantify the association between admission modality (directly from the ED or later from wards) and survival at day 180, after adjustment to baseline characteristics. RESULTS During the study period, 4560 patients were admitted to the hospital following an ED visit, among whom 136 (3%) patients had cancer and were admitted to the ICU, either directly from the ED in 101 (74%) cases or secondarily from the wards in 35 (26%) cases. Patients admitted to the ICU from the ED had a better 180-day survival than those admitted secondarily from wards (log-rank P = 0.006). After adjustment to disease status (remission or uncontrolled malignancy), survival at day 180 was significantly improved in the case of admission to the ICU directly from the ED with an adjusted HR of 0.50 (95% confidence interval, 0.26-0.95), P = 0.03. CONCLUSION In ED patients with cancer, a direct admission to the ICU was associated with better 180-day survival compared with patients with a delayed ICU admission secondary from the wards. However, several confounders were not taken into account, which limits the validity of this result.
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Affiliation(s)
- Aude Lucet
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
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9
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Predictors associated with planned and unplanned admission to intensive care units after colorectal cancer surgery: a retrospective study. Support Care Cancer 2022; 30:5099-5105. [DOI: 10.1007/s00520-022-06939-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/24/2022] [Indexed: 12/19/2022]
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10
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Abdel-Nabey M, Chaba A, Serre J, Lengliné E, Azoulay E, Darmon M, Zafrani L. Tumor lysis syndrome, acute kidney injury and disease-free survival in critically ill patients requiring urgent chemotherapy. Ann Intensive Care 2022; 12:15. [PMID: 35166948 PMCID: PMC8847484 DOI: 10.1186/s13613-022-00990-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/04/2022] [Indexed: 12/12/2022] Open
Abstract
Background Tumor lysis syndrome (TLS) is a life-threatening complication during the treatment of malignant neoplasia. We sought to describe characteristics and predictors of acute kidney injury (AKI), remission and mortality in high-risk TLS patients. In this retrospective monocentric study, we included all patients with the diagnosis of biological and/or clinical TLS from 2012 to 2018. The primary outcome was the prevalence of AKI during the acute phase of TLS. Secondary outcomes were overall mortality and remission of the underlying malignancy at 1 year. Results Among 153 patients with TLS, 123 (80.4%) patients experienced AKI and 83 (54.2%) required renal replacement therapy. mSOFA score (OR = 1.15, IC 95% [1.02–1.34]), age (OR = 1.05, IC 95% [1.02–1.08]) and male gender (OR = 6.79, IC 95% [2.59–19.44]) were associated with AKI. Rasburicase use (HR = 2.45, IC 95% [1.17–5.15]) was associated with remission of the underlying malignancy at 1 year. Parameters associated with mortality at 1 year were mechanical ventilation (HR = 1.96, IC 95% [1.02–3.78]), vasopressors (HR = 3.13, IC 95% [1.59–6.15]), age (HR = 1.02, IC 95% [1–1.03]), spontaneous TLS (HR = 1.65, IC 95% [1.01–2.69]) and delay of chemotherapy administration (HR = 1.01, IC 95% [1–1.03]). Conclusions AKI is highly prevalent in TLS patients. Rasburicase is associated with better outcomes regarding remission of the underlying malignancy. As rasburicase may be an indirect marker of a high degree of tumor lysis and chemosensitivity, more studies are warranted to confirm the protective role of urate oxidase. Delaying chemotherapy may be deleterious in terms of long-term outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00990-1.
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Affiliation(s)
- Moustafa Abdel-Nabey
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Anis Chaba
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Justine Serre
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Etienne Lengliné
- University of Paris, Paris, France.,Hematology Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.,University of Paris, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.,University of Paris, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France. .,University of Paris, Paris, France. .,INSERM UMR 976, University of Paris, Paris, France.
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11
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Hong Y, Kim WJ, Hong JY, Jeong YJ, Park J. A comprehensive analysis of 5-year outcomes in patients with cancer admitted to intensive care units. Tuberc Respir Dis (Seoul) 2022; 85:195-201. [PMID: 35045687 PMCID: PMC8987664 DOI: 10.4046/trd.2021.0106] [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: 07/07/2021] [Accepted: 01/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to evaluate the long-term (5-year) clinical outcomes of patients who received intensive care unit (ICU) treatment using Korean nationwide data. Methods All patients aged >18 years with ICU admission according to Korean claims data from January 2008 to December 2010 were enrolled. These enrolled patients were followed up until December 2015. The primary outcome was ICU mortality. Results Among all critically ill patients admitted to the ICU (n=323,765), patients with cancer showed higher ICU mortality (18.6%) than those without cancer (13.2%, p<0.001). However, there was no significant difference in ICU mortality at day 28 among patients without cancer (14.5%) and those with cancer (lung cancer or hematologic malignancies) (14.3%). Compared to patients without cancer, hazard ratios of those with cancer for ICU mortality at 5 years were: 1.90 (1.87–1.94) for lung cancer; 1.44 (1.43–1.46) for other solid cancers; and 3.05 (2.95–3.16) for hematologic malignancies. Conclusion This study showed that the long-term survival rate of patients with cancer was significantly worse than that of general critically ill patients. However, short term outcomes of critically ill patients with cancer were not significantly different from those of general patients, except for those with lung cancer or hematologic malignancies.
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Affiliation(s)
- Yoonki Hong
- Department of Internal Medicine, School of Medicine, Kangwon National University, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine, School of Medicine, Kangwon National University, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Ji Young Hong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon 24253, Republic of Korea
| | - Yun-Jeong Jeong
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
| | - Jinkyeong Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
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12
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Lemiale V, Yvin E, Kouatchet A, Mokart D, Demoule A, Dumas G. Oxygenation strategy during acute respiratory failure in immunocompromised patients. JOURNAL OF INTENSIVE MEDICINE 2021; 1:81-89. [PMID: 36788802 PMCID: PMC9923978 DOI: 10.1016/j.jointm.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/02/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022]
Abstract
Acute respiratory failure (ARF) in immunocompromised patients remains challenging to treat. A large number of case require admission to intensive care unit (ICU) where mortality remains high. Oxygenation without intubation is important in this setting. This review summarizes recent studies assessing oxygenation devices for immunocompromised patients. Previous studies showed that non-invasive ventilation (NIV) has been associated with lower intubation and mortality rates. Indeed, in recent years, the outcomes of immunocompromised patients admitted to the ICU have improved. In the most recent randomized controlled trials, including immunocompromised patients admitted to the ICU with ARF, neither NIV nor high-flow nasal oxygen (HFNO) could reduce the mortality rate. In this setting, other strategies need to be tested to decrease the mortality rate. Early admission strategy and avoiding late failure of oxygenation strategy have been assessed in retrospective studies. However, objective criteria are still lacking to clearly discriminate time to admission or time to intubation. Also, diagnosis strategy may have an impact on intubation or mortality rates. On the other hand, lack of diagnosis has been associated with a higher mortality rate. In conclusion, improving outcomes in immunocompromised patients with ARF may include strategies other than the oxygenation strategy alone. This review discusses other unresolved questions to decrease mortality after ICU admission in such patients.
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Affiliation(s)
- Virginie Lemiale
- Service de Médecine Intensive et Réanimation, APHP Hopital Saint Louis, 1 Avenue Claude Vellefaux, Paris 75010, France,Corresponding author: Virginie Lemiale, Service de Médecine Intensive et Réanimation, APHP Hopital Saint Louis, 1 Avenue Claude Vellefaux, Paris 75010, France.
| | - Elise Yvin
- Service de Médecine Intensive et Réanimation, APHP Hopital Saint Louis, 1 Avenue Claude Vellefaux, Paris 75010, France
| | - Achille Kouatchet
- Service de Réanimation Médicale et Médecine Hyperbare, Angers 49100, France
| | - Djamel Mokart
- Institut Paoli-Calmettes, Réanimation Medico-Chirurgicale, Marseille 13009, France
| | - Alexandre Demoule
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris 75013, France
| | - Guillaume Dumas
- Service de Médecine Intensive et Réanimation, APHP Hopital Saint Louis, 1 Avenue Claude Vellefaux, Paris 75010, France
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13
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Kang JH, Swisher CB, Buckley ED, Herndon JE, Lipp ES, Kirkpatrick JP, Desjardins A, Friedman HS, Johnson MO, Randazzo DM, Ashley DM, Peters KB. Primary brain tumor patients admitted to a US intensive care unit: a descriptive analysis. CNS Oncol 2021; 10:CNS77. [PMID: 34545753 PMCID: PMC8461751 DOI: 10.2217/cns-2021-0009] [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] [Indexed: 11/21/2022] Open
Abstract
Purpose: To describe our population of primary brain tumor (PBT) patients, a subgroup of cancer patients whose intensive care unit (ICU) outcomes are understudied. Methods: Retrospective analysis of PBT patients admitted to an ICU between 2013 to 2018 for an unplanned need. Using descriptive analyses, we characterized our population and their outcomes. Results: Fifty-nine PBT patients were analyzed. ICU mortality was 19% (11/59). The most common indication for admission was seizures (n = 16, 27%). Conclusion: Our ICU mortality of PBT patients was comparable to other solid tumor patients and the general ICU population and better than patients with hematological malignancies. Further study of a larger population would inform guidelines for triaging PBT patients who would most benefit from ICU-level care. Purpose: Data are lacking regarding outcomes of patients with primary brain tumors (PBTs) admitted to an intensive care unit (ICU), which may it difficult for ICU providers to know who of these patients will best benefit from ICU-level care. We aimed to describe our patient population to contribute to the limited data. Methods: We performed a retrospective analysis of critically ill PBT patients in our ICU. Results: Of 59 patients analyzed, ICU mortality was 19% (11/59), and the most common indication for admission was seizures (n = 16, 27%). Conclusion: Our ICU mortality of PBT patients was comparable to other solid tumor patients and the general ICU population and better than patients with hematological malignancies.
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Affiliation(s)
- Jennifer H Kang
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Evan D Buckley
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA
| | - James E Herndon
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA
| | - Eric S Lipp
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - John P Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | - Annick Desjardins
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Henry S Friedman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Margaret O Johnson
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Dina M Randazzo
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - David M Ashley
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.,Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
| | - Katherine B Peters
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
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14
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van der Zee EN, Benoit DD, Hazenbroek M, Bakker J, Kompanje EJO, Kusadasi N, Epker JL. Outcome of cancer patients considered for intensive care unit admission in two university hospitals in the Netherlands: the danger of delayed ICU admissions and off-hour triage decisions. Ann Intensive Care 2021; 11:125. [PMID: 34379217 PMCID: PMC8357904 DOI: 10.1186/s13613-021-00898-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background Very few studies assessed the association between Intensive Care Unit (ICU) triage decisions and mortality. The aim of this study was to assess whether an association could be found between 30-day mortality, and ICU admission consultation conditions and triage decisions. Methods We conducted a retrospective cohort study in two large referral university hospitals in the Netherlands. We identified all adult cancer patients for whom ICU admission was requested from 2016 to 2019. Via a multivariable logistic regression analysis, we assessed the association between 30-day mortality, and ICU admission consultation conditions and triage decisions. Results Of the 780 cancer patients for whom ICU admission was requested, 332 patients (42.6%) were considered ‘too well to benefit’ from ICU admission, 382 (49%) patients were immediately admitted to the ICU and 66 patients (8.4%) were considered ‘too sick to benefit’ according to the consulting intensivist(s). The 30-day mortality in these subgroups was 30.1%, 36.9% and 81.8%, respectively. In the patient group considered ‘too well to benefit’, 258 patients were never admitted to the ICU and 74 patients (9.5% of the overall study population, 22.3% of the patients ‘too well to benefit’) were admitted to the ICU after a second ICU admission request (delayed ICU admission). Thirty-day mortality in these groups was 25.6% and 45.9%. After adjustment for confounders, ICU consultations during off-hours (OR 1.61, 95% CI 1.09–2.38, p-value 0.02) and delayed ICU admission (OR 1.83, 95% CI 1.00–3.33, p-value 0.048 compared to “ICU admission”) were independently associated with 30-day mortality. Conclusion The ICU denial rate in our study was high (51%). Sixty percent of the ICU triage decisions in cancer patients were made during off-hours, and 22.3% of the patients initially considered “too well to benefit” from ICU admission were subsequently admitted to the ICU. Both decisions during off-hours and a delayed ICU admission were associated with an increased risk of death at 30 days. Our study suggests that in cancer patients, ICU triage decisions should be discussed during on-hours, and ICU admission policy should be broadened, with a lower admission threshold for critically ill cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00898-2.
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Affiliation(s)
- Esther N van der Zee
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | | | - Marinus Hazenbroek
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Jan Bakker
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Pulmonology and Critical Care, New York University, New York, USA.,Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA.,Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erwin J O Kompanje
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Nuray Kusadasi
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelle L Epker
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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15
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Díaz-Lagares C, Fox L, García-Roche A, Santafe M, Romera I, Barba P, Pacheco A, Roldán E, Plata-Menchaca E, Roca O, Pérez M, Valcarcel D, Ferrer R. Sequential Organ Failure Assessment Score and the Need for Organ Support Predict Mortality in Allogeneic Stem Cell Transplant Patients Admitted to the Intensive Care Unit. Transplant Cell Ther 2021; 27:865.e1-865.e7. [PMID: 34217846 DOI: 10.1016/j.jtct.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/12/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective therapy resulting in increased definitive cure rates or extended disease-free survival in various malignant and nonmalignant hematologic diseases. However, because of the high risk of severe complications of this therapy, up to 50% of patients may require being admitted to the intensive care unit (ICU) to manage life-threatening conditions. We aimed to evaluate the in-hospital mortality of allo-HSCT recipients admitted to the ICU and to identify those variables associated with in-hospital mortality. A 10-year (January 2010 to December 2019), single-center, retrospective study was conducted in Vall d´Hebron University Hospital, Barcelona. We included all consecutive allo-HSCT patients who required admission to the ICU. Baseline and disease-related characteristics were registered. Severity scores and the need for organ support were also assessed on days 1, 3, and 5 of ICU admission. In-hospital mortality-associated independent variables were identified using the Cox proportional hazards regression model. Three hundred twenty-three patients underwent allo-HSCT during the study period, of whom 82 (25%) were admitted to the ICU; 53 (65%) male, with a median age of 51 (38-59) years. Most patients received allo-HSCT for the treatment of lymphoma (20 patients [24%]) or acute leukemia (44 patients [54%]). The median Acute Physiology And Chronic Health Evaluation II score was 23 (17-28), and the median Sequential Organ Failure Assessment (SOFA) score on admission was 9 (7-11). Forty-nine (60%) patients died in the ICU, and 11 (13%) died in the hospital after being discharged from the ICU. Disease-related characteristics were not associated with mortality. Yet, SOFA score on day 1 (hazard ratio [HR]: 1.11 [95% confidence interval {CI}: 1.04-1.02]; P = .002), the need for vasopressors on day 3 (HR: 2.35 [95% CI: 1.27-4.36]; P = .007), and a nondecreasing SOFA score on day 5 (HR: 2.13 [95% CI: 1.03-4.39]; P = .04), were independently associated with in-hospital mortality. Mortality in allo-HSCT patients who require ICU admission remains high. In the present study, SOFA score, the need for vasopressors on day 3, and a nondecreasing SOFA score on day 5 predicted in-hospital mortality.
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Affiliation(s)
- Cándido Díaz-Lagares
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Laura Fox
- Hematology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, Barcelona, Spain
| | - Alejandra García-Roche
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Manel Santafe
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Irene Romera
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Pere Barba
- Hematology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, Barcelona, Spain
| | - Andrés Pacheco
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Elisa Roldán
- Hematology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, Barcelona, Spain
| | - Erika Plata-Menchaca
- SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Oriol Roca
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Marcos Pérez
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - David Valcarcel
- Hematology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
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16
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van der Zee EN, Noordhuis LM, Epker JL, van Leeuwen N, Wijnhoven BPL, Benoit DD, Bakker J, Kompanje EJO. Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study. PLoS One 2021; 16:e0252771. [PMID: 34115771 PMCID: PMC8195393 DOI: 10.1371/journal.pone.0252771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Given clinicians' frequent concerns about unfavourable outcomes, Intensive Care Unit (ICU) triage decisions in acutely ill cancer patients can be difficult, as clinicians may have doubts about the appropriateness of an ICU admission. To aid to this decision making, we studied the survival and performance status of cancer patients 2 years following an unplanned ICU admission. MATERIALS AND METHODS This was a retrospective cohort study in a large tertiary referral university hospital in the Netherlands. We categorized all adult patients with an unplanned ICU admission in 2017 into two groups: patients with or without an active malignancy. Descriptive statistics, Pearson's Chi-square tests and the Mann-Whitney U tests were used to evaluate the primary objective 2-year mortality and performance status. A good performance status was defined as ECOG performance status 0 (fully active) or 1 (restricted in physically strenuous activity but ambulatory and able to carry out light work). A multivariable binary logistic regression analysis was used to identify factors associated with 2-year mortality within cancer patients. RESULTS Of the 1046 unplanned ICU admissions, 125 (12%) patients had cancer. The 2-year mortality in patients with cancer was significantly higher than in patients without cancer (72% and 42.5%, P <0.001). The median performance status at 2 years in cancer patients was 1 (IQR 0-2). Only an ECOG performance status of 2 (OR 8.94; 95% CI 1.21-65.89) was independently associated with 2-year mortality. CONCLUSIONS In our study, the majority of the survivors have a good performance status 2 years after ICU admission. However, at that point, three-quarter of these cancer patients had died, and mortality in cancer patients was significantly higher than in patients without cancer. ICU admission decisions in acutely ill cancer patients should be based on performance status, severity of illness and long-term prognosis, and this should be communicated in the shared decision making. An ICU admission decision should not solely be based on the presence of a malignancy.
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Affiliation(s)
- Esther N. van der Zee
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Lianne M. Noordhuis
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jelle L. Epker
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Center for Medical Decision Making, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bas P. L. Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jan Bakker
- Department of Pulmonology and Critical Care, New York University NYU Langone Medical Center, New York, NY, United States of America
- Department of Pulmonology and Critical Care Columbia University Irvine Medical Center, New York, NY, United States of America
- Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erwin J. O. Kompanje
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
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17
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Dumas G, Lemiale V, Rathi N, Cortegiani A, Pène F, Bonny V, Salluh J, Albaiceta GM, Soares M, Soubani AO, Canet E, Hanane T, Kouatchet A, Mokart D, Lebiedz P, Türkoğlu M, Coudroy R, Jeon K, Demoule A, Mehta S, Caruso P, Frat JP, Yang KY, Roca O, Laffey J, Timsit JF, Azoulay E, Darmon M. Survival in Immunocompromised Patients Ultimately Requiring Invasive Mechanical Ventilation: A Pooled Individual Patient Data Analysis. Am J Respir Crit Care Med 2021; 204:187-196. [PMID: 33751920 DOI: 10.1164/rccm.202009-3575oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Acute respiratory failure (ARF) is associated with high mortality in immunocompromised patients, particularly when invasive mechanical ventilation is needed. Therefore, noninvasive oxygenation/ventilation strategies have been developed to avoid intubation, with uncertain impact on mortality, especially when intubation is delayed. Objectives: We sought to report trends of survival over time in immunocompromised patients receiving invasive mechanical ventilation. The impact of delayed intubation after failure of noninvasive strategies was also assessed. Methods: Systematic review and meta-analysis using individual patient data of studies that focused on immunocompromised adult patients with ARF requiring invasive mechanical ventilation. Studies published in English were identified through PubMed, Web of Science, and Cochrane Central (2008-2018). Individual patient data were requested from corresponding authors for all identified studies. We used mixed-effect models to estimate the effect of delayed intubation on hospital mortality and described mortality rates over time. Measurements and Main Results: A total of 11,087 patients were included (24 studies, three controlled trials, and 21 cohorts), of whom 7,736 (74%) were intubated within 24 hours of ICU admission (early intubation). The crude mortality rate was 53.2%. Adjusted survivals improved over time (from 1995 to 2017, odds ratio [OR] for hospital mortality per year, 0.96 [0.95-0.97]). For each elapsed day between ICU admission and intubation, mortality was higher (OR, 1.38 [1.26-1.52]; P < 0.001). Early intubation was significantly associated with lower mortality (OR, 0.83 [0.72-0.96]), regardless of initial oxygenation strategy. These results persisted after propensity score analysis (matched OR associated with delayed intubation, 1.56 [1.44-1.70]). Conclusions: In immunocompromised intubated patients, survival has improved over time. Time between ICU admission and intubation is a strong predictor of mortality, suggesting a detrimental effect of late initial oxygenation failure.
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Affiliation(s)
- Guillaume Dumas
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Virginie Lemiale
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Nisha Rathi
- Department of Critical Care, MD Anderson Cancer Center, Houston, Texas
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Frédéric Pène
- Medical ICU, Cochin Teaching Hospital, Paris, France
| | - Vincent Bonny
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Jorge Salluh
- The Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Guillermo M Albaiceta
- Instituto de Investigación Sanitaria del Principado de Asturias, Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.,CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Marcio Soares
- The Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Tarik Hanane
- Department of Critical Care, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Pia Lebiedz
- ICU, Evangelisches Krankenhaus, Oldenburg, Germany
| | - Melda Türkoğlu
- Medical ICU, Gazi University School of Medicine, Ankara, Turkey
| | - Rémi Coudroy
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.,INSERM CIC1402, groupe ALIVE, Université de Poitiers, Poitiers, France
| | - Kyeongman Jeon
- Department of Critical Care Medicine and.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro, Gangnam-gu, Seoul, Korea
| | - Alexandre Demoule
- APHP Sorbonne Université site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S) and INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Sangeeta Mehta
- Medical Surgical ICU, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Pedro Caruso
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - Jean-Pierre Frat
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.,INSERM CIC1402, groupe ALIVE, Université de Poitiers, Poitiers, France
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Oriol Roca
- CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Servei de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - John Laffey
- Department of Anesthesia and.,Department of Intensive Care Medicine, NUI Galway, Ireland; and
| | - Jean-François Timsit
- Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, UMR 1137 Inserm, Université de Paris, IAME, Paris, France
| | - Elie Azoulay
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Michael Darmon
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
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18
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Peyrony O, Fontaine JP, Trabattoni E, Nakad L, Charreyre S, Picaud A, Bosc J, Viglino D, Jacquin L, Laribi S, Pereira L, Thiriez S, Paquet AL, Tanneau A, Azoulay E, Chevret S. Cancer Patients' Prehospital Emergency Care: Post Hoc Analysis from the French Prospective Multicenter Study EPICANCER. J Clin Med 2021; 10:jcm10051145. [PMID: 33803366 PMCID: PMC7967166 DOI: 10.3390/jcm10051145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Very little data are available concerning the prehospital emergency care of cancer patients. The objective of this study is to report the trajectories and outcomes of cancer patients attended by prehospital emergency services. Methods: This was an ancillary study from a three-day cross-sectional prospective multicenter study in France. Adult patients with cancer were included if they called the emergency medical dispatch center Service d’Aide Médicale Urgente (SAMU). The study was registered on ClinicalTrials.gov (NCT03393260, accessed on 8th January 2018). Results: During the study period, 1081 cancer patients called the SAMU. The three most frequent reasons were dyspnea (20.2%), neurological disorder (15.4%), and fatigue (13.1%). Among those patients, 949 (87.8%) were directed to the hospital, among which 802 (90.8%) were directed to an emergency department (ED) and 44 (5%) were transported directly to an intensive care unit (ICU). A mobile intensive care unit (MICU) was dispatched 213 (31.6%) times. The decision to dispatch an MICU seemed generally based on the patient’s reason for seeking emergency care and the presence of severity signs rather than on the malignancy or the patient general health status. Among the patients who were directed to the ED, 98 (16.1%) were deceased on day 30. Mortality was 15.4% for those patients directed to the ED but who were not admitted to the ICU in the next 7 days, 28.2% for those who were admitted to ICU in the next 7 days, and 56.1% for those patients transported by the MICU directly to the ICU. Conclusion: Cancer patients attending prehospital emergency care were most often directed to EDs. Patients who were directly transported to the ICU had a high mortality rate, raising the question of improving triage policies.
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Affiliation(s)
- Olivier Peyrony
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Correspondence: ; Tel.: +33-1-4249-8404
| | - Jean-Paul Fontaine
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
| | | | - Lionel Nakad
- Emergency Department, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France;
| | - Sylvain Charreyre
- Emergency Department, SAMU de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
- University Claude Bernard Lyon 1, 69007 Lyon, France
| | - Adrien Picaud
- Emergency Department, SAMU, SMUR. Le Mans Hospital, 72181 Le Mans, France;
| | - Juliane Bosc
- Emergency Department, SMUR. Libourne and Sainte Foy la Grande Hospital, 33243 Libourne, France;
| | - Damien Viglino
- Emergency Department, Grenoble-Alpes University Hospital, 38043 Grenoble, France;
- HP2 INSERM U 1042 University Grenoble-Alpes, 38043 Grenoble, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civils de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
| | - Saïd Laribi
- Emergency Department, Tours University Hospital, 37000 Tours, France;
| | - Laurent Pereira
- Emergency Department, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France;
| | - Sylvain Thiriez
- Emergency Department, SMUR, Victor Provo Hospital, Roubaix Hospital, 59100 Roubaix, France;
| | - Anne-Laure Paquet
- Emergency Department, la Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
- Sorbonne-UPMC-Paris VI University, 75005 Paris, France
| | - Alexandre Tanneau
- Emergency Department, SMUR of Lorient and Quimperlé, Bretagne Sud Hospital Group, 56322 Lorient, France;
| | - Elie Azoulay
- Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
| | - Sylvie Chevret
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
- Department of Biostatistics and Medical Information, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
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19
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Neves MT, Eiriz I, Tomás TC, Gama F, Almeida G, Monteiro FB, Lamas T, Simões I, Gaspar I, Carmo E. The Reality of Critical Cancer Patients in a Polyvalent Intensive Care Unit. Cureus 2021; 13:e13581. [PMID: 33796424 PMCID: PMC8005787 DOI: 10.7759/cureus.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective With the increasing incidence of cancer and the rise in the survival rates of cancer patients, more and more oncological candidates are being considered for admission to intensive care units (ICU). Several studies have demonstrated no difference in the outcomes of cancer patients compared to non-cancer patients. Our study aimed to describe and analyze the outcomes related to cancer patients in a polyvalent ICU. Methods We conducted a retrospective study of consecutive oncological patients admitted to a polyvalent ICU (2013-2017). Cox model and receiver operating characteristic (ROC) curve analysis were performed to analyze the results. Results A total of 236 patients were included in the study; the mean age of the patients was 53.5 ± 15.3 years, and 65% of them were male. The main cancer types were those related to the central nervous system (CNS; 31%), as well as gastrointestinal (18%), genitourinary (17%), and hematological (15%). Curative/diagnostic surgeries (49%) and sepsis/septic shock (17%) were the main reasons for admission. The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores in hematological patients vs. solid tumors were as follows: 30 vs. 20 and 63 vs. 38, respectively (p<0.005). Vasopressors, invasive mechanical ventilation (IMV), and renal replacement therapy (RRT) were used more widely in hematological patients compared to solid-tumor patients. Length of stay was longer in hematological patients vs. solid-tumor patients (12.8 vs. 7 days, p=0.002). The median overall survival in hematological patients was one month and that in solid-tumor patients was 5.8 months (p<0.005). The survival rate at six months was better than described in the existing literature (48 vs. 32.4%). Conclusion Both SAPS II and APACHE II scores were reasonably accurate in predicting mortality, demonstrating their value in cancer patients.
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Affiliation(s)
- Maria Teresa Neves
- Oncology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Inês Eiriz
- Medical Oncology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, PRT
| | - Tiago C Tomás
- Medical Oncology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, PRT
| | - Francisco Gama
- Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Gabriela Almeida
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Filipa B Monteiro
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Tomás Lamas
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Isabel Simões
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Isabel Gaspar
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Eduarda Carmo
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
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20
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[Bone marrow transplantation patients in the intensive care unit]. Med Klin Intensivmed Notfmed 2021; 116:111-120. [PMID: 33564899 PMCID: PMC7871956 DOI: 10.1007/s00063-021-00782-8] [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: 10/26/2020] [Revised: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 10/31/2022]
Abstract
Allogeneic hematopoetic stem cell transplantation yields improved long-term survival for patients with high-risk malignant and non-malignant hematologic disease. However, it is associated with high morbidity and mortality. A proportion of patients need intensive care due to infectious, immunological and/or toxic complications. The utility of intensive care unit (ICU) treatments as mechanical ventilation and renal replacement therapy for these patients is uncertain since mortality is high. We describe the most frequent complications and the treatment options concerning the ICU in recipients of allogeneic hematopoetic stem cells.
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21
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Kim YJ, Kang J, Kim MJ, Ryoo SM, Kang GH, Shin TG, Park YS, Choi SH, Kwon WY, Chung SP, Kim WY. Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study. BMC Med 2020; 18:390. [PMID: 33308206 PMCID: PMC7733739 DOI: 10.1186/s12916-020-01875-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Clinical decision-making of invasive high-intensity care for critically ill stage IV cancer patients in the emergency department (ED) is challenging. A reliable and clinically available prognostic score for advanced cancer patients with septic shock presented at ED is essential to improve the quality of intensive care unit care. This study aimed to develop a new prognostic score for advanced solid cancer patients with septic shock available early in the ED and to compare the performance to the previous severity scores. METHODS This multi-center, prospective cohort study included consecutive adult septic shock patients with stage IV solid cancer. A new scoring system for 28-day mortality was developed and validated using the data of development (January 2016 to December 2017; n = 469) and validation sets (January 2018 to June 2019; n = 428). The developed score's performance was compared to that of the previous severity scores. RESULTS New scoring system for 28-day mortality was based on six variables (score range, 0-8): vital signs at ED presentation (respiratory rate, body temperature, and altered mentation), lung cancer type, and two laboratory values (lactate and albumin) in septic shock (VitaL CLASS). The C-statistic of the VitaL CLASS score was 0.808 in the development set and 0.736 in the validation set, that is superior to that of the Sequential Organ Failure Assessment score (0.656, p = 0.01) and similar to that of the Acute Physiology and Chronic Health Evaluation II score (0.682, p = 0.08). This score could identify 41% of patients with a low-risk group (observed 28-day mortality, 10.3%) and 7% of patients with a high-risk group (observed 28-day mortality, 73.3%). CONCLUSIONS The VitaL CLASS score could be used for both risk stratification and as part of a shared clinical decision-making strategy for stage IV solid cancer patients with septic shock admitting at ED within several hours.
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Affiliation(s)
- Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jihoon Kang
- Department of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Gu Hyun Kang
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, South Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, Guro Hospital, Korea University Medical Center, Seoul, South Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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22
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Reddy DRS, Botz GH. Triage and Prognostication of Cancer Patients Admitted to the Intensive Care Unit. Crit Care Clin 2020; 37:1-18. [PMID: 33190763 DOI: 10.1016/j.ccc.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cancer remains a leading cause of morbidity and mortality. Advances in cancer screening, early detection, targeted therapies, and supportive care have led to improvements in outcomes and quality of life. The rapid increase in novel cancer therapies can cause life-threatening adverse events. The need for intensive care unit (ICU) care is projected to increase. Until 2 decades ago, cancer diagnosis often precluded ICU admission. Recently, substantial cancer survival has been achieved; therefore, ICU denial is not recommended. ICU resources are limited and expensive; hence, appropriate utilization is needed. This review focuses on triage and prognosis in critically ill cancer patients requiring ICU admission.
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Affiliation(s)
- Dereddi Raja Shekar Reddy
- Department of Critical Care and Respiratory Care, Division of Anesthesiology, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 112, Houston, TX 77030, USA
| | - Gregory H Botz
- Department of Critical Care and Respiratory Care, Division of Anesthesiology, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 112, Houston, TX 77030, USA.
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23
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Abstract
End-of-life care of critically ill adult patients with advanced or incurable cancers is imbued with major ethical challenges. Oncologists, hospitalists, and intensivists can inadvertently subjugate themselves to the perceived powers of autonomous patients. Therapeutic illusion and poor insight by surrogates in physicians' ability to offer accurate prognosis, missed opportunities and miscommunication by clinicians, and lack of systematic or protocolized approach represent important barriers to high-quality palliative care. Enhanced collaboration, models that allow clinicians and surrogates to share the burdens of decision, and institutional support for early integration of palliative care can foster an ethical climate.
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Affiliation(s)
- Jamie C Riches
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Louis P Voigt
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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24
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Hourmant Y, Mailloux A, Valade S, Lemiale V, Azoulay E, Darmon M. Impact of early ICU admission on outcome of critically ill and critically ill cancer patients: A systematic review and meta-analysis. J Crit Care 2020; 61:82-88. [PMID: 33157309 DOI: 10.1016/j.jcrc.2020.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Prognostic impact of early ICU admission remains controversial. The aim of this review was to investigate the impact of early ICU admission in the general ICU population and in critically ill cancer patients and to report level of evidences of this later. METHODS Systematic review and meta-analysis performed on articles published between 1970 and 2017. Two authors extracted data. Influence of early ICU admission on mortality is reported as Risk Ratio (95%CI) using both fixed and random-effects model. DATA SYNTHESIS For general ICU population, 31 studies reporting on 73,213 patients were included (including 66,797 patients with early ICU admission) and for critically ill cancer patients 14 studies reporting on 2414 patients (including 1272 with early ICU admission) were included. Early ICU admission was associated with decreased mortality using a random effect model (RR 0.65; 95% confidence interval 0.58-0.73; I2 = 66%) in overall ICU population as in critically ill cancer patients (RR 0.69; 95% confidence interval 0.52-0.90; I2 = 85%). To explore heterogeneity, a meta-regression was performed. Characteristics of the trials (prospective vs. retrospective, monocenter vs. multicenter) had no impact on findings. Publication after 2010 (median publication period) was associated with a lower effect of early ICU admission (estimate 0.37; 95%CI 0.14-0.60; P = 0.002) in the general ICU population. A significant publication bias was observed. CONCLUSION Theses results suggest that early ICU admission is associated with decreased mortality in the general ICU population and in CICP. These results were however obtained from high risk of bias studies and a high heterogeneity was noted. Systematic review registration: PROSPERO 2018 CRD42018094828.
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Affiliation(s)
- Yannick Hourmant
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Arnaud Mailloux
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Sandrine Valade
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Virginie Lemiale
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Elie Azoulay
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France; ECSTRA team, Biostatistics and clinical epidemiology, UMR 1153 (center of epidemiology and biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris, France
| | - Michael Darmon
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France; ECSTRA team, Biostatistics and clinical epidemiology, UMR 1153 (center of epidemiology and biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris, France.
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25
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Al Qahtani S, Alaklabi A, El-Saed A. Impact of critical care response team implementation on oncology patient outcomes: A retrospective cohort study. Int J Crit Illn Inj Sci 2020; 10:33-38. [PMID: 33376688 PMCID: PMC7759073 DOI: 10.4103/ijciis.ijciis_13_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 01/15/2020] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: The main goal of a critical care response team (CCRT) is to quickly assess and transfer, if required, rapidly deteriorating patients to an intensive care unit (ICU) to prevent cardiopulmonary arrest, stabilize patients' condition, and help in optimizing the care provided by the primary team. The objective of this study was to investigate the correlation between early intervention by CCRT and the outcome of oncology patients. Materials and Methods: This is a retrospective cohort study conducted at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. KAMC is a tertiary care facility with 1200-bed capacity. The study compared oncology patients to nononcology patients. Results: Over 4 years, a total number of 4941 patients were reviewed, of which 172 were oncology patients. The average age of patients in the oncology group was 48.8 ± 20.7, while the average age for nononcology was 52.8 ± 21.2 (P = 0.016). The average Acute Physiology and Chronic Health Evaluation II score on admission for oncology patients was higher than that for the nononcology group (27.8 ± 8.9 vs. 23.6 ± 9.3, respectively). Lower ICU mortality was seen after CCRT implementation (38.8% vs. 62.7%). The average duration of hospital stay and ICU stay increased after CCRT implementation (37.34 vs. 29.31 and 11.93 vs. 8.9, respectively). Conclusion: In this study, we identified that early intervention by implementing CCRT had a significant impact in reducing ICU mortality for oncology and nononcology patients.
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Affiliation(s)
- Saad Al Qahtani
- Department of Critical Care Medicine, College of Medicine, King Saud Bin AbdulAziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Intensive Care, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Saudi Arabia
| | - Ali Alaklabi
- Department of Internal Medicine and Thrombosis, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Saudi Arabia
| | - Aiman El-Saed
- Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Saudi Arabia.,Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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26
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van der Zee EN, Epker JL, Bakker J, Benoit DD, Kompanje EJO. Treatment Limitation Decisions in Critically Ill Patients With a Malignancy on the Intensive Care Unit. J Intensive Care Med 2020; 36:42-50. [PMID: 32787659 PMCID: PMC7705645 DOI: 10.1177/0885066620948453] [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] [Indexed: 12/04/2022]
Abstract
Background: Treatment limitation decisions (TLDs) on the ICU can be challenging, especially in patients with a malignancy. Up-to-date literature regarding TLDs in critically ill patients with a malignancy admitted to the ICU is scarce. The aim was to compare the incidence of written TLDs between patients with an active malignancy, patients with a malignancy in their medical history (complete remission, CR) and patients without a malignancy admitted unplanned to the ICU. Methods: We conducted a retrospective cohort study in a large university hospital in the Netherlands. We identified all unplanned admissions to the ICU in 2017 and categorized the patients in 3 groups: patients with an active malignancy (study population), with CR and without a malignancy. A TLD was defined as a written instruction not to perform life-saving treatments, such as CPR in case of cardiac arrest. A multivariate binary logistic regression analysis was used to identify whether having a malignancy was associated with TLDs. Results: Of the 1046 unplanned admissions, 125 patients (12%) had an active malignancy and 76 (7.3%) patients had CR. The incidence of written TLDs in these subgroups were 37 (29.6%) and 20 (26.3%). Age (OR 1.03; 95% CI 1.01 -1.04), SOFA score at ICU admission (OR 1.11; 95% CI 1.05 -1.18) and having an active malignancy (OR 1.75; 95% CI 1.04-2.96) compared to no malignancy were independently associated with written TLDs. SOFA scores on the day of the TLD were not significantly different in patients with and without a malignancy. Conclusions: This study shows that the presence of an underlying malignancy is independently associated with written TLDs during ICU stay. Patients with CR were not at risk of more written TLDs. Whether this higher incidence of TLDs in patients with a malignancy is justified, is at least questionable and should be evaluated in future research.
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Affiliation(s)
- Esther N van der Zee
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands
| | - Jelle L Epker
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands
| | - Jan Bakker
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands.,Department of Pulmonology and Critical Care, New York University NYU Langone Medical Center, New York, NY, USA.,Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, NY, USA.,Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dominique D Benoit
- Department of Intensive Care, 60200Ghent University Hospital, Ghent, Belgium
| | - Erwin J O Kompanje
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands
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27
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Cardona M, Anstey M, Lewis ET, Shanmugam S, Hillman K, Psirides A. Appropriateness of intensive care treatments near the end of life during the COVID-19 pandemic. Breathe (Sheff) 2020; 16:200062. [PMID: 33304408 PMCID: PMC7714540 DOI: 10.1183/20734735.0062-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022] Open
Abstract
The patient and family perspective on the appropriateness of intensive care unit (ICU) treatments involves preferences, values and social constructs beyond medical criteria. The clinician's perception of inappropriateness is more reliant on clinical judgment. Earlier consultation with families before ICU admission and patient education on the outcomes of life-sustaining therapies may help reconcile these provider-patient disagreements. However, global emergencies like COVID-19 change the usual paradigm of end-of-life care, as it is a new disease with only scarce predictive information about it. Pandemics can also bring about the burdensome predicament of doctors having to make unwanted choices of rationing access to the ICU when demand for otherwise life-saving resources exceeds supply. Evidence-based prognostic checklists may guide treatment triage but the principles of shared decision-making are unchanged. Yet, they need to be altered with respect to COVID-19, defining likely outcomes and likelihood of benefit for the patient, and clarifying their willingness to take on the risks inherent to being in an ICU for 2 weeks for those eligible. For patients who are admitted during the prodrome of COVID-19 disease, or those who deteriorate in the second week, clinicians have some lead time in hospital to have appropriate discussions about ceilings of treatments offered based on severity. KEY POINTS The patient and family perspective on inappropriateness of intensive care at the end of life often differs from the clinician's opinion due to the nonmedical frame of mind.To improve satisfaction with communication on treatment goals, consultation on patient values and inclusion of social constructs in addition to clinical prediction is a good start to reconcile differences between physician and health service users' viewpoints.During pandemics, where health systems may collapse, different admission criteria driven by the need to ration services may be warranted. EDUCATIONAL AIMS To explore the extent to which older patients and their families are involved in decisions about appropriateness of intensive care admission or treatmentsTo understand how patients or their families define inappropriate intensive care admission or treatmentsTo reflect on the implications of decision to admit or not to admit to the intensive care unit in the face of acute resource shortages during a pandemic.
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Affiliation(s)
- Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
- Gold Coast Hospital and Health Service, Southport, Australia
| | - Matthew Anstey
- Intensive Care Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Ebony T. Lewis
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Australia
| | | | - Ken Hillman
- Intensive Care Unit, Liverpool Hospital, Liverpool, Australia
| | - Alex Psirides
- Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
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28
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Segelov E, Underhill C, Prenen H, Karapetis C, Jackson C, Nott L, Clay T, Pavlakis N, Sabesan S, Heywood E, Steer C, Lethborg C, Gan HK, Yip D, Karanth N, Karikios D, MacIntyre CR. Practical Considerations for Treating Patients With Cancer in the COVID-19 Pandemic. JCO Oncol Pract 2020; 16:467-482. [PMID: 32401686 DOI: 10.1200/op.20.00229] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cancer has become a prevalent disease, affecting millions of new patients globally each year. The COVID-19 pandemic is having far-reaching impacts around the world, causing substantial disruptions to health and health care systems that are likely to last for a prolonged period. Early data have suggested that having cancer is a significant risk factor for mortality from severe COVID-19. A diverse group of medical oncologists met to formulate detailed practical advice on systemic anticancer treatments during this crisis. In the context of broad principles, issues including risks of treatment, principles of prioritizing resources, treatment of elderly patients, and psychosocial impact are discussed. Detailed treatment advice and options are given at a tumor stream level. We must maintain care for patients with cancer as best we can and recognize that COVID-19 poses a significant competing risk for death that changes conventional treatment paradigms.
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Affiliation(s)
- Eva Segelov
- Department of Oncology, Monash University and Monash Health, Melbourne, Victoria, Australia
| | - Craig Underhill
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, and University of NSW Rural Clinical School, Albury Campus, Albury, New South Wales, Australia
| | - Hans Prenen
- Department of Oncology, University Hospital Antwerp, Edegem, Belgium
| | - Christos Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | | | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Tim Clay
- Department of Oncology, St John of God Subiaco Hospital and School of Medicine and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sabe Sabesan
- Department of Medical Oncology, Townsville Cancer Centre, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Ellen Heywood
- Cancer Services, Monash Health, Melbourne, Victoria, Australia
| | - Christopher Steer
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, and University of NSW Rural Clinical School, Albury Campus, Albury, New South Wales, Australia
| | - Carrie Lethborg
- Inclusive Health Research, St Vincent's Health Australia, Melbourne, Victoria, Australia
| | - Hui K Gan
- Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia.,La Trobe University School of Cancer Medicine, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital and ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Narayan Karanth
- Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Deme Karikios
- Department of Medical Oncology, Nepean Hospital and Nepean Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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29
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Baylot C, Francopoulo A, Gross-Goupil M, Quivy A, Guisset O, Hilbert G, Frison E, Ravaud A, Daste A. Prognostic factors for cancer patient admitted to a medical intensive care unit. Acta Oncol 2020; 59:458-461. [PMID: 31948319 DOI: 10.1080/0284186x.2019.1711171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Camille Baylot
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | | | - Marine Gross-Goupil
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | - Amandine Quivy
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | - Olivier Guisset
- Department of Medical Intensive Care Unit, Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | - Gilles Hilbert
- Department of Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
- Bordeaux University, CHU Bordeaux, Bordeaux, France
| | - Eric Frison
- Medical Information Department, CHU Bordeaux, Bordeaux, France
| | - Alain Ravaud
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
- Bordeaux University, CHU Bordeaux, Bordeaux, France
| | - Amaury Daste
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
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30
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Borcoman E, Dupont A, Mariotte E, Doucet L, Joseph A, Chermak A, Valade S, Resche-Rigon M, Azoulay E, Lemiale V. One-year survival in patients with solid tumours discharged alive from the intensive care unit after unplanned admission: A retrospective study. J Crit Care 2020; 57:36-41. [PMID: 32032902 DOI: 10.1016/j.jcrc.2020.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE Outcomes in cancer patients after unplanned ICU admission was reassessed. METHODS retrospective cohort of patients with solid tumours admitted to ICU over a 10 years period. RESULTS 622 patients (age 62 [53-70]) were analysed. The most common primary sites of cancer were lung (n = 133; 21.4%) and digestive tract (n = 126; 20.2%) The ICU mortality rate was 22.2% (n = 138). Among 470 ICU survivors, the 1-year mortality was 41.3% (95% CI, 36-45.9) (n = 167). Factors independently associated with 1-year mortality were ICU admission after 2010 (HR 0.53 (0.37-0.76), p < .001), disease status (respectively, HR = 1.88 (1.0.2-3.45), p = .002) for locally advanced cancer and HR = 2.23 (1.35-3.67), p = .003) for metastatic cancer), poor performance status (HR = 1.58 (1.08-2.31), p = .019), newly diagnosed cancer at ICU admission (HR = 2.02 (1.28-3.20), p = .003), inability to receive oncologic treatment after ICU discharge (HR = 5.34 (3.49-8.18), p < .001) and decision to withhold life-sustaining treatment during ICU stay (HR = 2.34 (1.50-3.65), p < .001). CONCLUSIONS Among the factors associated with one-year mortality after ICU discharge, the possibility of receiving oncologic treatment after ICU discharge seems crucial.
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Affiliation(s)
- Edith Borcoman
- Medical ICU, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Axelle Dupont
- Biostatistic department, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Eric Mariotte
- Medical ICU, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Ludovic Doucet
- Oncologic department, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Adrien Joseph
- Medical ICU, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Akli Chermak
- Medical ICU, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Sandrine Valade
- Medical ICU, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Matthieu Resche-Rigon
- Biostatistic department, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Elie Azoulay
- Medical ICU, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France; Biostatistic department, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Virginie Lemiale
- Medical ICU, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France.
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31
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Corrêa LC, Teles D, Silva OBD, Trindade-Filho GH, Loureiro P, Cavalcati MDSM. Predictors of mortality among patients with acute leukemias admitted to an intensive care unit specialized in patients with hematological disease at a Brazilian hospital. Hematol Transfus Cell Ther 2020; 42:33-39. [PMID: 31103671 PMCID: PMC7031107 DOI: 10.1016/j.htct.2019.01.004] [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: 02/19/2018] [Revised: 11/29/2018] [Accepted: 01/07/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Hematologists deal every day with high mortality rates of acute leukemia patients. Many times these patients need Intensive Care Unit (ICU) support and some general ICU teams believe that these patients have a much greater chance of dying than patients with other pathologies. In Brazil, data related to mortality rates and ICUs for acute leukemia patients are scarce. METHODS Therefore, to assess mortality predictors in patients with acute leukemia admitted to a specialized hematological ICU, we evaluated demographics, supportive care, hospitalization time, disease status, admitting diagnosis, neutropenia, number of transfusions and Acute Physiology and Chronic Health Evaluation (APACHE)/Sepsis Related Organ Failure Assessment (SOFA) scores as possible factors associated with mortality. Data were extracted from the first admission records of 110 patients with acute leukemia admitted to the Hemocentro de Pernambuco (Hemope) ICU between 2006 and 2009. RESULTS In this retrospective cohort study, 72/110 of the patients were men, and 64/110 were from the metropolitan area of Recife. The patients' age median was 43.5 years (±17.9); 67.3% had acute myeloid leukemia (AML) and 32.7% had acute lymphoid leukemia. The main admitting diagnosis in the ICU was sepsis (66.7%). The mean APACHE II score was 18.3. Of the total, 65 (59%) died, and the mortality rate was independently related to longer hospitalization (p<0.001), the increase in the APACHE II score (p<0.038) and having received hemodialysis (p<0.006). Neutropenia, receiving multiple transfusions and using any kind of mechanical ventilation or vasoactive drug on admission were not relevant to mortality. Factors associated with higher mortality rates were: longer hospitalization, increase in the APACHE II score, and use of hemodialysis. CONCLUSION With these data, to prevent organ lesions before admission to the ICU, a better strategy might be to reduce mortality for leukemia patients.
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Affiliation(s)
| | - Dahra Teles
- Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope), Recife, PE, Brazil
| | | | - Gustavo Henriques Trindade-Filho
- Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope), Recife, PE, Brazil
| | - Paula Loureiro
- Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope), Recife, PE, Brazil
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32
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Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care. Crit Care Med 2019; 47:e120-e128. [PMID: 30335623 PMCID: PMC6336487 DOI: 10.1097/ccm.0000000000003526] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: Historically, patients with a hematologic malignancy have one of the highest mortality rates among cancer patients admitted to the ICU. Therefore, physicians are often reluctant to admit these patients to the ICU. The aim of our study was to examine the survival of patients who have a hematologic malignancy and multiple organ failure admitted to the ICU. Design: This retrospective cohort study, part of the HEMA-ICU study group, was designed to study the survival of patients with a hematologic malignancy and organ failure after admission to the ICU. Patients were followed for at least 1 year. Setting: Five university hospitals in the Netherlands. Patients: One-thousand ninety-seven patients with a hematologic malignancy who were admitted at the ICU. Interventions: None. Measurements and Main Results: Primary outcome was 1-year survival. Organ failure was categorized as acute kidney injury, respiratory failure, hepatic failure, and hemodynamic failure; multiple organ failure was defined as failure of two or more organs. The World Health Organization performance score measured 3 months after discharge from the ICU was used as a measure of functional outcome. The 1-year survival rate among these patients was 38%. Multiple organ failure was inversely associated with long-term survival, and an absence of respiratory failure was the strongest predictor of 1-year survival. The survival rate among patients with 2, 3, and 4 failing organs was 27%, 22%, and 8%, respectively. Among all surviving patients for which World Health Organization scores were available, 39% had a World Health Organization performance score of 0–1 3 months after ICU discharge. Functional outcome was not associated with the number of failing organs. Conclusions: Our results suggest that multiple organ failure should not be used as a criterion for excluding a patient with a hematologic malignancy from admission to the ICU.
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33
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Escudero-Acha P, Peñasco Y, Rodriguez-Borregan JC, Cuenca Fito E, Ferreira Freire L, González-Castro A. [Concordance between the oncologist and the intensivist in the decisions of aggressive measures in cancer patients]. Med Intensiva 2019; 45:246-247. [PMID: 31630915 DOI: 10.1016/j.medin.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 11/26/2022]
Affiliation(s)
- P Escudero-Acha
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Y Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Servicio de Oncología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - J C Rodriguez-Borregan
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Servicio de Oncología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - E Cuenca Fito
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - L Ferreira Freire
- Servicio de Oncología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - A González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
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Kemlin D, Biard L, Kerhuel L, Zafrani L, Venot M, Teixeira L, Schlemmer B, Azoulay E, Canet E. Acute kidney injury in critically ill patients with solid tumours. Nephrol Dial Transplant 2019; 33:1997-2005. [PMID: 29579262 DOI: 10.1093/ndt/gfy051] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/07/2018] [Indexed: 12/29/2022] Open
Abstract
Background Patients with solid tumours are at risk for acute kidney injury (AKI), however, epidemiological data are limited. Methods We conducted a study that included patients with solid tumours admitted to a single-centre intensive care unit (ICU) from January 2011 to December 2015. We analysed factors associated with the occurence of AKI, ICU and Day-90 mortality. Results Two-hundred and four patients were included. The incidence of AKI was 59%, chiefly related to sepsis (80%), hypovolaemia (40%) and outflow tract obstruction (17%). Renal replacement therapy was implemented in 12% of the patients, with a hospital mortality of 39%. Independent predictors of AKI were: Simplified Acute Physiological Score II (SAPS II) [odds ratio (OR) 1.05; 95% confidence interval (95% CI) 1.02-1.07; P < 0.001], abdominal or pelvic cancer (OR 2.84; 95% CI 1.35-5.97; P = 0.006), nephrotoxic chemotherapy within the previous 3 months (OR 3.84; 95% CI 1.67-8.84; P = 0.002) and sepsis (OR 2.74; 95% CI 1.30-5.77; P = 0.008). Renal recovery at Day 90 was inversely related to AKI severity. ICU, hospital and Day-90 mortality were 15, 29 and 37%, respectively. Factors independently associated with ICU mortality were: total serum protein (OR per 10 g/L, 0.44; 95% CI 0.23-0.86; P = 0.02) and SAPS II (OR 1.04; 95% CI 1.01-1.07; P = 0.02), while Day-90 mortality was associated with performance status 3-4 (OR 6.59; 95% CI 2.42-18; P < 0.001) and total serum protein (OR 0.60; 95% CI 0.38-0.94; P = 0.02). Conclusions AKI in patients with solid tumours was frequent and renal recovery gradually decreased in proportion to AKI severity. However, AKI was not independently associated with a higher short-term mortality.
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Affiliation(s)
- Delphine Kemlin
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Lucie Biard
- Biostatistics Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Lionel Kerhuel
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Marion Venot
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Luis Teixeira
- Radiation-Oncology Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Benoit Schlemmer
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France
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Peyrony O, Chevret S, Meert AP, Perez P, Kouatchet A, Pène F, Mokart D, Lemiale V, Demoule A, Nyunga M, Bruneel F, Lebert C, Benoit D, Mirouse A, Azoulay E. Direct admission to the intensive care unit from the emergency department and mortality in critically ill hematology patients. Ann Intensive Care 2019; 9:110. [PMID: 31578641 PMCID: PMC6775178 DOI: 10.1186/s13613-019-0587-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/21/2019] [Indexed: 01/06/2023] Open
Abstract
Background The aim of this study was to assess the benefit of direct ICU admission from the emergency department (ED) compared to admission from wards, in patients with hematological malignancies requiring critical care. Methods Post hoc analysis derived from a prospective, multicenter cohort study of 1011 critically ill adult patients with hematologic malignancies admitted to 17 ICU in Belgium and France from January 2010 to May 2011. The variable of interest was a direct ICU admission from the ED and the outcome was in-hospital mortality. The association between the variable of interest and the outcome was assessed by multivariable logistic regression after multiple imputation of missing data. Several sensitivity analyses were performed: complete case analysis, propensity score matching and multivariable Cox proportional-hazards analysis of 90-day survival. Results Direct ICU admission from the ED occurred in 266 (26.4%) cases, 84 of whom (31.6%) died in the hospital versus 311/742 (41.9%) in those who did not. After adjustment, direct ICU admission from the ED was associated with a decreased in-hospital mortality (adjusted OR: 0.63; 95% CI 0.45–0.88). This was confirmed in the complete cases analysis (adjusted OR: 0.64; 95% CI 0.45–0.92) as well as in terms of hazard of death within the 90 days after admission (adjusted HR: 0.77; 95% CI 0.60–0.99). By contrast, in the propensity score-matched sample of 402 patients, direct admission was not associated with in-hospital mortality (adjusted OR: 0.92; 95% CI 0.84–1.01). Conclusions In this study, patients with hematological malignancies admitted to the ICU were more likely to be alive at hospital discharge if they were directly admitted from the ED rather than from the wards. Assessment of early predictors of poor outcome in cancer patients admitted to the ED is crucial so as to allow early referral to the ICU and avoid delays in treatment initiation and mis-orientation.
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Affiliation(s)
- Olivier Peyrony
- Emergency Department, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
| | - Sylvie Chevret
- Biostatistics and Medical Information Department, Hôpital Saint-Louis, Paris, France.,Centre de Recherche en Épidémiologie et Statistiques - Université de Paris (CRESS-INSERM-UMR1153), Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, Paris, France.,Université de Paris, Paris, France
| | - Anne-Pascale Meert
- Intensive Care Unit, Institut Jules Bordet, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre Perez
- Intensive Care Unit, Hôpital Brabois, Vandoeuvre Les Nancy, France
| | - Achille Kouatchet
- Intensive Care Unit, Centre hospitalier régional universitaire, Angers, France
| | - Frédéric Pène
- Université de Paris, Paris, France.,Intensive Care Unit, Hôpital Cochin, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France
| | - Djamel Mokart
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | | | - Alexandre Demoule
- Intensive Care Unit, Hôpital Pitié-Salpêtrière, Paris, France.,INSERM, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.,Université Paris Sorbonne, Paris, France
| | - Martine Nyunga
- Intensive Care Unit, Hôpital Victor Provo, Roubaix, France
| | - Fabrice Bruneel
- Intensive Care Unit, Hôpital André Mignot, Versailles, France
| | - Christine Lebert
- Intensive Care Unit, Centre hospitalier départemental Vendee, La Roche Sur Yon, France
| | - Dominique Benoit
- Intensive Care Unit, Hôpital universitaire de Ghent, Ghent, Belgium
| | | | - Elie Azoulay
- Centre de Recherche en Épidémiologie et Statistiques - Université de Paris (CRESS-INSERM-UMR1153), Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, Paris, France.,Université de Paris, Paris, France.,Intensive Care Unit, Hôpital Saint-Louis, Paris, France
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36
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Lyons PG, Klaus J, McEvoy CA, Westervelt P, Gage BF, Kollef MH. Factors Associated With Clinical Deterioration Among Patients Hospitalized on the Wards at a Tertiary Cancer Hospital. J Oncol Pract 2019; 15:e652-e665. [PMID: 31306039 PMCID: PMC6694031 DOI: 10.1200/jop.18.00765] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Patients hospitalized outside the intensive care unit (ICU) frequently experience clinical deterioration. Little has been done to describe the landscape of clinical deterioration among inpatients with cancer. We aimed to describe the frequency of clinical deterioration among patients with cancer hospitalized on the wards at a major academic hospital and to identify independent risk factors for clinical deterioration among these patients. METHODS This was a retrospective cohort study at a 1,300-bed urban academic hospital with a 138-bed inpatient cancer center. We included consecutive admissions to the oncology wards between January 1, 2014, and June 30, 2017. We defined clinical deterioration as the composite of ward death and transfer to the ICU. RESULTS We evaluated 21,219 admissions from 9,058 patients. The composite outcome occurred during 1,945 admissions (9.2%): 1,365 (6.4%) had at least one ICU transfer, and 580 (2.7%) involved ward death. Logistic regression identified several independent risk factors for clinical deterioration, including the following: age (odds ratio [OR], 1.33 per decade; 95% CI, 1.07 to 1.67), male sex (OR, 1.15; 95% CI, 1.05 to 1.33), comorbidities, illness severity (OR, 1.11; 95% CI, 1.10 to 1.13), emergency admission (OR, 1.45; 95% CI, 1.26 to 1.67), hospitalization on particular wards (OR, 1.525; 95% CI, 1.326 to 1.67), bacteremia (OR, 1.24; 95% CI, 1.01 to 1.52), fungemia (OR, 3.76; 95% CI, 1.90 to 7.41), tumor lysis syndrome (OR, 3.01; 95% CI, 2.41 to 3.76), and receipt of antimicrobials (OR, 2.04; 95% CI, 1.72 to 2.42) and transfusions (OR, 1.65; 95% CI, 1.42 to 1.92). CONCLUSION Clinical deterioration was common; it occurred in more than 9% of admissions. Factors independently associated with deterioration included comorbidities, admission source, infections, and blood product transfusion.
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Affiliation(s)
| | | | | | - Peter Westervelt
- Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, St Louis, MO
| | - Brian F. Gage
- Washington University School of Medicine, St Louis, MO
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37
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Tan AC, Jacques SK, Oatley M, Guminski AD. Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit. Intern Med J 2019; 49:734-739. [DOI: 10.1111/imj.14160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Aaron C. Tan
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
| | - Sarah K. Jacques
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
| | - Meredith Oatley
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
| | - Alexander D. Guminski
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
- Melanoma Institute Australia Sydney New South Wales Australia
- Northern Clinical School, University of Sydney Sydney New South Wales Australia
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38
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Taheri L, Anandanadesan R, de Lavallade H, Pagkalidou E, Pagliuca A, Mufti G, Auzinger G, Metaxa V. The role of a critical care outreach service in the management of patients with haematological malignancy. J Intensive Care Soc 2019; 20:327-334. [PMID: 31695737 DOI: 10.1177/1751143719855201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Although improvement in survival from haematological malignancies has been reported, a substantial number of these patients develop life threatening complications. Critical care outreach services (CCOS) aim to avert inappropriate ICU admissions, while ensuring timely patient review. Methods We retrospectively analysed patients with haematological malignancy reviewed by an outreach service between January 2014 and December 2015 at a single institution. The aim of our study was to describe the patient population assessed by a well-established outreach team, identify predictors of ICU admission, as well as ICU and hospital mortality. Results Sixty of 126 patients reviewed (47.6%) were admitted to ICU. ICU and hospital mortality were 25.3% and 45.2%, respectively. The odds of being admitted to ICU was 13 times higher (p = 0.013) if the patient was referred for hypoxia, 20 times higher (p = 0.006) if they were referred for sepsis or 14 times higher (p = 0.027) if they were referred to CCOS for hypotension, compared to when the team was automatically alerted. The odds of not surviving hospital admission increased 1.27 times for every extra day of CCOS review (p = 0.02). When a patient was referred having a refractory or progressive haematological condition, the odds of not surviving to hospital discharge increased by four or 12 times, respectively, compared to when the referred patient was in remission. Receiving high flow nasal cannula oxygen (HFNCO) was associated with a reduction in ICU admission (p = 0.03), irrespective of the underlying diagnosis, performance status or location of delivery. The CCOS participated in end-of-life discussions in 29% patients. Conclusions ICU and hospital mortality of patients with haemato-oncological malignancy continue to improve. CCOS are heavily involved in the recognition and management of these patients, as well as in the facilitation of end-of-life discussions. Sepsis was associated with increased risk of ICU admission and mortality. Initiation of HFNCO outside ICU appears to be feasible and safe and was not associated with increasing risk in this single centre study.
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Affiliation(s)
- Leila Taheri
- South Thames Training Scheme, London Deanery, London, UK
| | - Rathai Anandanadesan
- South Thames/South East School of Anaesthesia (SESA), London LETB, London Deanery, London, UK
| | - Hugues de Lavallade
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Eirini Pagkalidou
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Ghulam Mufti
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Georg Auzinger
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
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39
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Rathi NK, Haque SA, Morales F, Kaul B, Ramirez R, Ovu S, Feng L, Dong W, Price KJ, Ugarte S, Raimondi N, Quintero A, Cardenas YR, Nates JL. Variability in triage practices for critically ill cancer patients: A randomized controlled trial. J Crit Care 2019; 53:18-24. [PMID: 31174172 DOI: 10.1016/j.jcrc.2019.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Intensive care triage practices and end-user interpretation of triage guidelines have rarely been assessed. We evaluated agreement between providers on the prioritization of patients for ICU admission using different triage guidelines. MATERIALS AND METHODS A multi-centered randomized study on providers from 18 different countries was conducted using clinical vignettes of oncological patients. The level of agreement between providers was measured using two different guidelines, with one being cancer specific. RESULTS Amongst 257 providers, 52.5% randomly received the Society of Critical Care Prioritization Model, and 47.5% received a cancer specific flowchart as a guide. In the Prioritization Model arm the average entropy was 1.193, versus 1.153 in the flowchart arm (P = .095) indicating similarly poor agreement. The Fleiss' kappa coefficients were estimated to be 0.2136 for the SCCMPM arm and 0.2457 for the flowchart arm, also similarly implying poor agreement. CONCLUSIONS The low agreement amongst practitioners on the prioritization of cancer patient cases for ICU admission existed using both general triage guidelines and guidelines tailored only to cancer patients. The lack of consensus on intensive care unit triage practices in the oncological population exposes a potential barrier to appropriate resource allocation that needs to be addressed.
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Affiliation(s)
- Nisha K Rathi
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 112, Houston, TX 77030, United States of America.
| | - Sajid A Haque
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 112, Houston, TX 77030, United States of America.
| | - Freddy Morales
- Hospital Oncológico "Dr. Julio Villacreses Colmont" SOLCA Manabí, Núcleo de Portoviejo, Autopista del Valle Manabí Guillen en Portoviejo, Manibi, Ecuador
| | - Bhavika Kaul
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 112, Houston, TX 77030, United States of America.
| | - Rafael Ramirez
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 112, Houston, TX 77030, United States of America.
| | - Steven Ovu
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 112, Houston, TX 77030, United States of America.
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Wenli Dong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Kristen J Price
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 112, Houston, TX 77030, United States of America.
| | - Sebastian Ugarte
- INDISA Clinic, Salvador's Hospital, Avenida Santa Maria 1810, Providencia Region Metropolitana, Santiago, Chile
| | - Nestor Raimondi
- Juan A. Fernandez Hospital, Cervino 3356, C1425AGP CABA, Buenos Aires, Argentina
| | | | - Yenny R Cardenas
- Critical Care Department, Universidad del Rosario, Hospital Universitario Fundacion Santa Fe de Bogota, Carrera 7 No. 117 - 15, Bogota DC, Colombia
| | - Joseph L Nates
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 112, Houston, TX 77030, United States of America.
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Fassbind P, Jeker B, Mueller BU, Bacher U, Zimmerli S, Endrich O, Gahl B, Novak U, Pabst T. Improved survival rates of AML patients following admission to the intensive care unit. Leuk Lymphoma 2019; 60:2423-2431. [PMID: 30943056 DOI: 10.1080/10428194.2019.1594213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Induction chemotherapy in AML patients may have life-threatening side effects requiring intensive care unit (ICU) treatment. We analyzed all AML patients receiving intensive chemotherapy at a single academic center between 01/2006-12/2016. At least one ICU admission was observed in 32% (76/240) patients, and 33% of those died following ICU admission. Whereas the ICU admission proportion remained stable, mortality after ICU admission decreased from 14% (2006-2008) to 3% (2014-2016; p = .056). The number of failing organ systems inversely correlated with surviving ICU admission (p < .001). Sepsis and renal, cardiac and pulmonary failure were each associated with higher mortality. With increasing ICU duration, survival probability decreased (p < .001), but remained >50% even after 14 days of ICU treatment. Progression-free and overall survival were comparable between ICU surviving patients and patients never needing ICU support. In conclusion, outcome after ICU admission of AML patients has substantially improved in recent years.
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Affiliation(s)
- Priska Fassbind
- Department of Medical Oncology, University Hospital Bern, Inselspital, University of Bern , Bern , Switzerland
| | - Barbara Jeker
- Department of Medical Oncology, University Hospital Bern, Inselspital, University of Bern , Bern , Switzerland
| | - Beatrice U Mueller
- Department of Biomedical Research, University Hospital Bern, Inselspital, University of Bern , Bern , Switzerland
| | - Ulrike Bacher
- Department of Hematology, University Hospital Bern, Inselspital, University of Bern , Bern , Switzerland
| | - Stefan Zimmerli
- Department of Infectious Diseases, University Hospital Bern, Inselspital, University of Bern , Bern , Switzerland
| | - Olga Endrich
- Department of Medicine, University Hospital Bern, Inselspital, University of Bern , Bern , Switzerland
| | - Brigitta Gahl
- Clinical Trial Unit Bern, University Hospital Bern, Inselspital, University of Bern , Bern , Switzerland
| | - Urban Novak
- Department of Medical Oncology, University Hospital Bern, Inselspital, University of Bern , Bern , Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, University Hospital Bern, Inselspital, University of Bern , Bern , Switzerland
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Kondakci M, Reinbach MC, Germing U, Kobbe G, Fenk R, Schroeder T, Quader J, Zeus T, Rassaf T, Haas R. Interaction of increasing ICU survival and admittance policies in patients with hematologic neoplasms: A single center experience with 304 patients. Eur J Haematol 2019; 102:265-274. [DOI: 10.1111/ejh.13206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Mustafa Kondakci
- Department of Haematology, Oncology and Clinical Immunology, Medical Faculty University Hospital Duesseldorf Duesseldorf Germany
| | - Marc C. Reinbach
- Department of Haematology, Oncology and Clinical Immunology, Medical Faculty University Hospital Duesseldorf Duesseldorf Germany
| | - Ulrich Germing
- Department of Haematology, Oncology and Clinical Immunology, Medical Faculty University Hospital Duesseldorf Duesseldorf Germany
| | - Guido Kobbe
- Department of Haematology, Oncology and Clinical Immunology, Medical Faculty University Hospital Duesseldorf Duesseldorf Germany
| | - Roland Fenk
- Department of Haematology, Oncology and Clinical Immunology, Medical Faculty University Hospital Duesseldorf Duesseldorf Germany
| | - Thomas Schroeder
- Department of Haematology, Oncology and Clinical Immunology, Medical Faculty University Hospital Duesseldorf Duesseldorf Germany
| | - Jasmin Quader
- Department of Haematology, Oncology and Clinical Immunology, Medical Faculty University Hospital Duesseldorf Duesseldorf Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty University Hospital Duesseldorf Duesseldorf Germany
| | - Tienush Rassaf
- Department of Cardiology, Medical Faculty University Hospital Essen Essen Germany
| | - Rainer Haas
- Department of Haematology, Oncology and Clinical Immunology, Medical Faculty University Hospital Duesseldorf Duesseldorf Germany
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42
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Darvall JN, Byrne T, Douglas N, Anstey JR. Intensive Care Practice in the Cancer Patient Population:
Special Considerations and Challenges. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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43
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Outcomes for Critically Ill Cancer Patients in the ICU: Current Trends and Prediction. Int Anesthesiol Clin 2018; 54:e62-75. [PMID: 27623129 DOI: 10.1097/aia.0000000000000121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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44
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The 10 signs telling me that my cancer patient in the emergency department is at high risk of becoming critically ill. Intensive Care Med 2018; 44:2315-2318. [PMID: 30421252 DOI: 10.1007/s00134-018-5449-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 02/06/2023]
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45
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Dumas G, Biard L, Givel C, Amorim S, Zafrani L, Lemiale V, Mariotte E, Azoulay E, Thiéblemont C, Canet E. Intensive care unit admission in patients with T cell lymphomas: clinical features and outcome. Ann Hematol 2018; 98:195-203. [PMID: 30218163 DOI: 10.1007/s00277-018-3496-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/06/2018] [Indexed: 01/31/2023]
Abstract
T cell non-Hodgkin lymphomas (T-NHLs) are aggressive malignancies which have a high risk of life-threatening complications. However, their prognosis in the intensive care unit (ICU) setting has not yet been assessed. We conducted a study including 87 ICU patients either with newly diagnosed T-NHLs or those undergoing first-line therapy admitted between January 1, 2000, and December 31, 2014. The primary subtypes were peripheral T cell lymphoma (PTCL) (n = 41, 47%), anaplastic large-cell lymphoma (ALCL) (n = 13, 15%), and adult T-leukaemia/lymphoma (ATLL) (n = 11, 13%). Six in every ten patients had malignancy-related complications (haemophagocytic syndrome 37%, tumour lysis syndrome 18% and hypercalcaemia 9%), while infections accounted for one quarter of ICU admissions. Nine fungal infections were documented, including six invasive aspergillosis. Urgent chemotherapy was started in the ICU in 59% of the patients, and urgent surgery was required in 13%. ICU and day-90 mortality were 22% and 41%, respectively. Multivariate analysis showed that SOFA score at day 1, age, sepsis and haemophagocytic syndrome were independent predictors of day-90 mortality. Compared to 66 ICU-matched controls with non-Hodgkin B cell lymphomas, patients with T-NHLs had a similar ICU survival. Overall survival rates of patients with T cell NHLs and B cell NHLs were 20% and 46%, respectively (hazard ratio for death associated with T cell NHLs 2.00 [1.12-3.58]). Patients with T cell NHLs had a very poor long-term outcome. Although the high rate of short-term survival suggests that an ICU trial is a reasonable option for patients newly diagnosed for the malignancy, extended stay in the ICU or further readmission should be considered only for highly selected patients who respond to the haematological treatment.
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Affiliation(s)
- Guillaume Dumas
- Medical Intensive Care Unit, AP-HP, Saint-Louis University Hospital, 1 avenue Claude Vellefaux, 75010, Paris, France.
| | - Lucie Biard
- Biostatistics Department, AP-HP, Saint-Louis University Hospital, Paris, France
| | - Claire Givel
- Medical Intensive Care Unit, AP-HP, Saint-Louis University Hospital, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Sandy Amorim
- Hemato-Oncology Department, Saint-Louis University Hospital, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, AP-HP, Saint-Louis University Hospital, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, AP-HP, Saint-Louis University Hospital, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, AP-HP, Saint-Louis University Hospital, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, AP-HP, Saint-Louis University Hospital, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Catherine Thiéblemont
- Hemato-Oncology Department, Saint-Louis University Hospital, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, AP-HP, Saint-Louis University Hospital, 1 avenue Claude Vellefaux, 75010, Paris, France
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46
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Oxygenation/non-invasive ventilation strategy and risk for intubation in immunocompromised patients with hypoxemic acute respiratory failure. Oncotarget 2018; 9:33682-33693. [PMID: 30263094 PMCID: PMC6154743 DOI: 10.18632/oncotarget.26069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/21/2018] [Indexed: 02/01/2023] Open
Abstract
We investigated how the initial ventilation/oxygenation management may influence the need for intubation on the coming day in a cohort of immunocompromised patients with acute hypoxemic respiratory failure (ARF). Data from 847 immunocompromised patients with ARF were used to estimate the probability of intubation at day+1 within the first 3 days of ICU admission, according to oxygenation management. First, noninvasive ventilation (NIV) was compared to oxygen therapy whatever the administration device; then standard oxygen was compared to High Flow Nasal Cannula therapy alone (HFNC), NIV alone or NIV+HFNC. To take into account the oxygenation regimens over time and to handle confounders, propensity score weighting models were used. In the original sample, the probability of intubation at day+1 was higher in the NIV group vs oxygenation therapy (OR = 1.64, 95CI, 1.09–2.48) or vs the standard oxygen group (OR = 2.05, 95CI: 1.29–3.29); it was also increased in the HFNC group compared to standard oxygen (OR = 2.85, 95CI: 1.37–5.67). However, all these differences disappeared by handling confounding-by-indication in the weighted samples, as well as in the pooled model. Note that adjusted OR for day-28 mortality increased with the day of intubation. In this large cohort of immunocompromised patients, ventilation/oxygenation management had no impact on the probability of intubation on the coming day.
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De Jong A, Calvet L, Lemiale V, Demoule A, Mokart D, Darmon M, Jaber S, Azoulay E. The challenge of avoiding intubation in immunocompromised patients with acute respiratory failure. Expert Rev Respir Med 2018; 12:867-880. [PMID: 30101630 DOI: 10.1080/17476348.2018.1511430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION A growing number of immunocompromised (IC) patients with acute hypoxemic respiratory failure (ARF) is admitted to the intensive care unit (ICU) worldwide. Areas covered: This review provides an overview of the current knowledge of the ways to prevent intubation in IC patients with ARF. Expert commentary: Striking differences oppose ARF incidence, characteristics, etiologies and management between IC and non-IC patients. Survival benefits have been reported with early admission to ICU in IC patients. Then, while managing hypoxemia and associated organ dysfunction, the identification of the cause of ARF will be guided by a rigorous clinical assessment at the bedside, further assisted by an invasive or noninvasive diagnostic strategy based on clinical probability for each etiology. Finally, the initial respiratory support aims to avoid mechanical ventilation for the many yet recognizing those patients for whom delaying intubation expose them to suboptimal management. We advocate for not using noninvasive ventilation (NIV) in this setting. A proper evaluation of High-flow nasal cannula oxygen (HFNC) is required in IC patients as to demonstrate its superiority compared to standard oxygen therapy. Day-to-day decisions must strive to avoid delayed intubation, and make every effort to identify ARF etiology.
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Affiliation(s)
- Audrey De Jong
- a Medical Intensive Care Unit , University of Paris-Diderot, Saint Louis Hospital , Paris , France.,b Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B , Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier , Montpellier , France
| | - Laure Calvet
- a Medical Intensive Care Unit , University of Paris-Diderot, Saint Louis Hospital , Paris , France
| | - Virginie Lemiale
- a Medical Intensive Care Unit , University of Paris-Diderot, Saint Louis Hospital , Paris , France
| | - Alexandre Demoule
- c Service de Pneumologie et Réanimation Médicale , Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, INSERM et Université Pierre et Marie Curie , Paris , France
| | - Djamel Mokart
- d Réanimation Polyvalente et Département d'Anesthésie et de Réanimation , Institut Paoli-Calmettes , Marseille , France
| | - Michael Darmon
- a Medical Intensive Care Unit , University of Paris-Diderot, Saint Louis Hospital , Paris , France.,e ECSTRA Team, and Clinical Epidemiology , UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University , Paris , France
| | - Samir Jaber
- b Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B , Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier , Montpellier , France
| | - Elie Azoulay
- a Medical Intensive Care Unit , University of Paris-Diderot, Saint Louis Hospital , Paris , France.,e ECSTRA Team, and Clinical Epidemiology , UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University , Paris , France
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48
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Allogeneic stem cell transplantation recipients requiring intensive care: time is of the essence. Ann Hematol 2018; 97:1601-1609. [DOI: 10.1007/s00277-018-3320-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/25/2018] [Indexed: 01/13/2023]
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49
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Kiehl MG, Beutel G, Böll B, Buchheidt D, Forkert R, Fuhrmann V, Knöbl P, Kochanek M, Kroschinsky F, La Rosée P, Liebregts T, Lück C, Olgemoeller U, Schalk E, Shimabukuro-Vornhagen A, Sperr WR, Staudinger T, von Bergwelt Baildon M, Wohlfarth P, Zeremski V, Schellongowski P. Consensus statement for cancer patients requiring intensive care support. Ann Hematol 2018; 97:1271-1282. [PMID: 29704018 PMCID: PMC5973964 DOI: 10.1007/s00277-018-3312-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/19/2018] [Indexed: 02/06/2023]
Abstract
This consensus statement is directed to intensivists, hematologists, and oncologists caring for critically ill cancer patients and focuses on the management of these patients.
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Affiliation(s)
- M G Kiehl
- Department of Internal Medicine I, Clinic Frankfurt/Oder GmbH, Müllroser Chaussee 7, 15236, Frankfurt (Oder), Germany.
| | - G Beutel
- Hannover Medical School (MHH) Clinic for Hematology, Coagulation, Oncology and Stem Cell Transplantation, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - B Böll
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - D Buchheidt
- III. Medical Clinic, Medical Faculty Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - R Forkert
- Johanniter-Hospital, Johanniterstr. 3-5, 53113, Bonn, Germany
| | - V Fuhrmann
- Clinic for Intensive Care Medicine, University Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - P Knöbl
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Kochanek
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - F Kroschinsky
- Department of Internal Medicine I, University Hospital, Fetschertstr. 74, 01307, Dresden, Germany
| | - P La Rosée
- Department of Internal Medicine III, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen-Schwenningen, Germany
| | - T Liebregts
- Clinic for Stem Cell Transplantation, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - C Lück
- Hannover Medical School (MHH) Clinic for Hematology, Coagulation, Oncology and Stem Cell Transplantation, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - U Olgemoeller
- Department of Cardiology and Pulmonary Medicine, University Hospital, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - E Schalk
- Department of Hematology and Oncology, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - A Shimabukuro-Vornhagen
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - W R Sperr
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - T Staudinger
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M von Bergwelt Baildon
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - P Wohlfarth
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - V Zeremski
- Department of Hematology and Oncology, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - P Schellongowski
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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50
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Carmona-Bayonas A, Gordo F, Beato C, Castaño Pérez J, Jiménez-Fonseca P, Virizuela Echaburu J, Garnacho-Montero J. Intensive care in cancer patients in the age of immunotherapy and molecular therapies: Commitment of the SEOM-SEMICYUC. Med Intensiva 2018. [PMID: 29519710 DOI: 10.1016/j.medin.2018.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cancer patients are a vulnerable group exposed to numerous and serious risks beyond cancer itself. In recent years, the prognosis of these individuals has improved substantially thanks to several advances such as immunotherapy, targeted molecular therapies, surgical techniques, or developments in support treatment. This coincides with the prolonged survival of oncological patients admitted to the ICU due to critical complications, and under the supervision of intensivists. The time has therefore come to revisit the intensive care support of these patients, which poses new professional as well as organizational challenges. An agreement was signed in 2017 between the SEOM and SEMICYUC with the aim of improving the quality of care of cancer patients with critical complications. The initiative seeks to aid in decision-making, standardize criteria, decrease subjectivity, generate channels of communication, and delve deeper into the ethical and scientific aspects of these situations. This document sets forth the most important reasons that have led us to undertake this initiative.
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Affiliation(s)
- A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), UMU, Murcia, Spain
| | - F Gordo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares (Coslada-Madrid), Grupo de investigación en patología crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - C Beato
- Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - J Castaño Pérez
- Intensive Care Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Virizuela Echaburu
- Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - J Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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