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Silva CMDD, Besen BAMP, Nassar AP. Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study. J Crit Care 2024; 79:154468. [PMID: 37995613 DOI: 10.1016/j.jcrc.2023.154468] [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: 09/14/2023] [Revised: 10/26/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE Although admitting cancer patients to the ICU is no longer an issue, it may be valuable to identify patients perceived least likely to benefit from admission. Our objective was to investigate factors associated with potentially inappropriate ICU admission. METHODS Retrospective cohort study of patients with cancer with unplanned ICU admission. We classified admissions as appropriate or potentially inappropriate according to Society of Critical Care Medicine guidelines. We used logistic regression model to assess factors associated with inappropriateness for ICU admission. RESULTS From 3384 patients, 663 (19.6%) were classified as potentially inappropriate. They received more invasive mechanical ventilation (25.3% vs 12.5%, P < 0.001) and vasopressors (34.4% vs 30.1%, P = 0.034), had higher ICU [3 (2,6) vs 2 (1,4), P < 0.001] length-of-stay, higher ICU (32.7% vs 8.4%, P < 0.001), hospital (71.9% vs 21.3%, P < 0.001), and one-year mortality (97.6% vs 54.7%, P < 0.001) compared with those considered appropriate. Performance status impairment, more severe organ dysfunctions at admission, metastatic disease, and source of ICU admission were the characteristics associated with intensivist's perception of inappropriateness of ICU admission. CONCLUSIONS These findings may help guide ICU admission policies and triage criteria for end-of-life discussions among hospitalized patients with cancer.
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Affiliation(s)
- Carla Marchini Dias da Silva
- Intensive Care Unit, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Intensive Care Unit, Hospital Vila Nova Star, São Paulo, SP, Brazil.
| | - Bruno Adler Maccagnan Pinheiro Besen
- Intensive Care Unit, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Medical Intensive Care Unit, Internal Medicine Department, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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2
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Imran S, Chen LL, Rausen M, Morris LGT, Patel S, Halpern NA. A Case Series of Patients With Complex Airway Disease and Large Thyroid Tumors Anterior to the Trachea Precluding Tracheostomy. Crit Care Explor 2024; 6:e1047. [PMID: 38343442 PMCID: PMC10857691 DOI: 10.1097/cce.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND This case series explores the management of respiratory failure in patients with large anterior tracheal thyroid tumors where tracheostomy is not an option. To our knowledge, this study is the first to address the challenges associated with caring for such patients. CASE SUMMARY We present the clinical courses of four intubated adults with advanced thyroid cancer and complex airway issues that preclude surgical tracheostomy. Interventions included custom airway stents, long-term intubation, and oncological therapies. Ethical quandaries around patient autonomy and capacity emerged, exacerbated by the absence of viable exit strategies for prolonged intubation, notably the performance of a tracheostomy, causing emotional distress in patients, families, and staff. CONCLUSIONS This study showcases the multifaceted challenges in medical, ethical, and emotional domains associated with managing intubated patients with complex disease precluding tracheotomies. We advocate for a nuanced, multidisciplinary, and personalized approach to confront unique issues in airway management, ethical considerations, and disposition.
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Affiliation(s)
- Saira Imran
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leon L Chen
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Rausen
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Snehal Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil A Halpern
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Toffart AC, Gonzalez F, Hamidfar-Roy R, Darrason M. [ICU admission for cancer patients with respiratory failure: An ethical dilemma]. Rev Mal Respir 2023; 40:692-699. [PMID: 37659881 DOI: 10.1016/j.rmr.2023.07.003] [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: 03/09/2023] [Accepted: 07/06/2023] [Indexed: 09/04/2023]
Abstract
In medicine, each decision is the result of a trade-off between medical scientific data, the rights of individuals (protection of persons, information, consent), individual desires, collective values and norms, and the economic constraints that guide our society. Whether or not to admit a cancer patient to an intensive care unit is very often an ethical dilemma. It is necessary to distinguish patients who would benefit from admission to an intensive care unit (ICU) from those for whom it would be futile. In this review, we will discuss the appropriateness of ICU admission and the concept of unreasonable admission, along with the different levels of intensity of ICU care and the alternatives to intensive care. We will then consider how and when to initiate reflection leading to a reasonable decision for the patient.
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Affiliation(s)
- A-C Toffart
- Service hospitalo-universitaire de pneumologie et physiologie, pôle thorax et vaisseaux, centre hospitalier universitaire Grenoble Alpes, 38043 Grenoble cedex 9, France; Université Grenoble 1 U 823, institut pour l'avancée des biosciences, université Grenoble Alpes, Grenoble, France.
| | - F Gonzalez
- Unité de réanimation, département anesthésie-réanimation, institut Paoli-Calmettes, Marseille, France
| | - R Hamidfar-Roy
- Service hospitalo-universitaire de pneumologie et physiologie, pôle thorax et vaisseaux, centre hospitalier universitaire Grenoble Alpes, 38043 Grenoble cedex 9, France
| | - M Darrason
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon Sud, Lyon, France; Institut de recherches philosophiques de Lyon, université Lyon 3, Lyon, France
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Gonzalez F, Starka R, Ducros L, Bisbal M, Chow-Chine L, Servan L, de Guibert JM, Pastene B, Faucher M, Sannini A, Leone M, Mokart D. Critically ill metastatic cancer patients returning home after unplanned ICU stay: an observational, multicentre retrospective study. Ann Intensive Care 2023; 13:73. [PMID: 37605072 PMCID: PMC10441975 DOI: 10.1186/s13613-023-01170-5] [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: 04/14/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Data about critically ill metastatic cancer patients functional outcome after unplanned admission to the ICU are scarce. The aim of this study was to assess factors associated with 90-day return home and 1-year survival in this population. STUDY DESIGN AND METHODS A multicenter retrospective study included all consecutive metastatic cancer patients admitted to the ICU for unplanned reason between 2017 and 2020. RESULTS Among 253 included metastatic cancer patients, mainly with lung cancer, 94 patients (37.2%) could return home on day 90. One-year survival rate was 28.5%. Performance status 0 or 1 (OR, 2.18; 95% CI 1.21-3.93; P = 0.010), no malnutrition (OR, 2.90; 95% CI 1.61-5.24; P < 0.001), female gender (OR, 2.39; 95% CI 1.33-4.29; P = 0.004), recent chemotherapy (OR, 2.62; 95% CI 1.40-4.90; P = 0.003), SOFA score ≤ 5 on admission (OR, 2.62; 95% CI 1.41-4.90; P = 0.002) were significantly predictive for 90-day return home. Malnutrition (HR, 1.66; 95% CI 1.18-2.22; P = 0.003), acute respiratory failure (ARF) as reason for admission (HR, 1.40; 95% CI 1.10-1.95; P = 0.043), SAPS II on admission (HR, 1.03; 95% CI 1.02-1.05; P < 0.001) and decisions to forgo life-sustaining therapies (DFLST) (HR, 2.80; 95% CI 2.04-3.84; P < 0.001) were independently associated with 1-year mortality. CONCLUSIONS More than one out of three metastatic cancer patients could return home within 3 months after an unplanned admission to the ICU. Previous performance and nutritional status, ongoing specific treatment and low severity of the acute illness were found to be predictive for return home. Such encouraging findings should help change the dismal perception of critically ill metastatic cancer patients.
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Affiliation(s)
- Frédéric Gonzalez
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Rémi Starka
- Polyvalent Intensive Care Unit, Sainte Musse Hospital, Toulon, France
| | - Laurent Ducros
- Polyvalent Intensive Care Unit, Sainte Musse Hospital, Toulon, France
| | - Magali Bisbal
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Laurent Chow-Chine
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Luca Servan
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Jean-Manuel de Guibert
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Bruno Pastene
- Department of Anesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaire de Marseille, Aix Marseille University, Marseille, France
| | - Marion Faucher
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Antoine Sannini
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaire de Marseille, Aix Marseille University, Marseille, France
| | - Djamel Mokart
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
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Shaz D, Pastores SM, Dayal L, Berkowitz J, Kostelecky N, Tan KS, Halpern N. Analysis of Intent and Reason for Oncologic Therapy Administration in Cancer Patients Admitted to the Intensive Care Unit. J Intensive Care Med 2022; 37:1305-1311. [PMID: 34898322 PMCID: PMC11143967 DOI: 10.1177/08850666211065993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the intent of, and reason for, administration of oncologic therapies in the intensive care unit (ICU). METHODS Single center, retrospective, cohort study of patients with cancer who received oncologic therapies at a tertiary cancer center ICU between April 1, 2019 and March 31, 2020. Oncologic therapies included traditional cytotoxic chemotherapy, targeted therapy, immunotherapy, hormonal or biologic therapy directed at a malignancy and were characterized as initiation (initial administration) or continuation (part of an ongoing regimen). RESULTS 84 unique patients (6.8% of total ICU admissions) received oncologic therapies in the ICU; 43 (51%) had hematologic malignancies and 41 (49%) had solid tumors. The intent of oncologic therapy was palliative in 63% and curative in 27%. Twenty-two (26%) patients received initiation and 62 (74%) received continuation oncologic therapies. The intent of oncologic therapy was significantly different by regimen type (initiation vs. continuation, p = <0.0001). Initiation therapy was more commonly prescribed with curative intent and continuation therapy was more commonly administered with palliative intent (p = <0.0001). Oncologic therapies were given in the ICU mainly for an oncologic emergency (56%) and because the patients happened to be in the ICU for a non-oncologic critical illness when their oncologic therapy was due (34.5%). CONCLUSION Our study provides intensivists with a better understanding of the context and intent of oncologic therapies and why these therapies are administered in the ICU.
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Affiliation(s)
- David Shaz
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen M. Pastores
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lokesh Dayal
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Justin Berkowitz
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Natalie Kostelecky
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil Halpern
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Hutt D, Arjona ET, Mekelenkamp H, Galimard JE, Kozijn A, Schröder T, Gjergji M, Dalissier A, Liptrott SJ, Murray J, Kenyon M, van Gestel JPJ, Corbacioglu S, Bader P. Safe transfer of pediatric patients from hematopoietic stem cell transplant unit into the pediatric intensive care unit: views of nurses and physicians. Bone Marrow Transplant 2022; 57:734-741. [PMID: 35190674 DOI: 10.1038/s41409-021-01559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/26/2021] [Accepted: 12/22/2021] [Indexed: 11/09/2022]
Abstract
Sufficient communication between hematopoietic stem cell transplantation (HSCT) and pediatric intensive care unit (PICU) teams is pivotal for a successful advanced support in the PICU for HSCT-related complications. We evaluated perceived communication and barriers between both teams with the aim of providing recommendations for improvement. In this cross-sectional survey, a self-designed online questionnaire was distributed among ESPNIC and EBMT members. Data were analyzed using descriptive statistics. Over half of HSCT respondents employed a transfer indication protocol and patient assessment tool, but less structured checklist prior to patient transfer. Nearly all PICU respondents perceived this checklist as improvement for communication. Most HSCT and PICU physicians have daily rounds upon patient transfer while this is mostly missing between nursing teams. Half of both HSCT and PICU nurses indicated that HSCT training for PICU nurses could improve communication and patient transfer. Most respondents indicated that structured meetings between HSCT and PICU nurses could improve communication. Overall there is good communication between HSCT and PICU units, although barriers were noted between members of both teams. Based on our findings, we recommend use of a structured and specific checklist by HSCT teams, HSCT training for PICU personnel, and structured meetings between HSCT and PICU nurses.
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Affiliation(s)
- Daphna Hutt
- Division of Pediatric Hematology and Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, 52621, Israel.
| | - Eugenia Trigoso Arjona
- Paediatric Transplant Unit, Hospital University and Polytechnic Hospital LA FE, Valencia, Spain
| | - Hilda Mekelenkamp
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Anne Kozijn
- EBMT Leiden Data Unit, Leiden, The Netherlands
| | | | | | | | | | - John Murray
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Michelle Kenyon
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - J P J van Gestel
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Peter Bader
- Center for Child Health, Dept. of Oncology, Immunology and Stem Cell Transplantation, Goethe University, Frankfurt, Germany
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Man MY, Shum HP, Lam SM, Li J, Yan WW, Yeung MW. Effect of the underlying malignancy on critically ill septic patient's outcome. Asia Pac J Clin Oncol 2021; 18:473-480. [PMID: 34818459 DOI: 10.1111/ajco.13638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sepsis is an important cause of mortality and morbidity among critically ill patients with underlying malignancy. METHODS Patients with sepsis admitted to the intensive care unit (ICU) of the Pamela Youde Nethersole Eastern Hospital from January 1, 2010 to April 30, 2019 were recruited. Demographics, laboratory parameter, and outcome were analyzed. Those with underlying malignancy were matched with those without malignancy based on their severity of organ failure (defined by the sequential organ failure assessment [SOFA] score) and septic source. RESULTS Two hundred sixty-three patients with underlying active malignancy were matched with 259 patients without malignancy. Those with malignancy had higher APACHE IV score (89 vs. 83), lower albumin (22.1 vs. 24.4), neutrophil count (6.0 vs. 9.3), hemoglobin (8.0 vs. 9.8), platelet count (113 vs. 133), less use of mechanical ventilation (35.7% vs. 45.9%), renal replacement therapy (22.1% vs. 28.2%) and vasopressor (66.2% vs. 74.9%), higher 30-day (34.2% vs. 24.3%) ICU (22.4% vs. 18.9%), and 1-year (62.4% vs. 36.7%) mortality compared with those without malignancy. A higher APACHE IV score and pulmonary sepsis were predictors of 30-day mortality by Cox regression analysis. CONCLUSION Disease severity and pulmonary sepsis, but not underlying malignancy, predicted short-term mortality among critically ill septic patients.
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Affiliation(s)
- Man-Yee Man
- Department of Intensive care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Hoi-Ping Shum
- Department of Intensive care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Sin-Man Lam
- Department of Intensive care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Jacky Li
- Department of Intensive care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Wing-Wa Yan
- Department of Intensive care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Mei-Wan Yeung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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8
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Costa RT, Zampieri FG, Caruso P, Nassar Júnior AP. Performance status and acute organ dysfunction influence hospital mortality in critically ill patients with cancer and suspected infection: a retrospective cohort analysis. Rev Bras Ter Intensiva 2021; 33:298-303. [PMID: 34231811 PMCID: PMC8275091 DOI: 10.5935/0103-507x.20210038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/01/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate how performance status impairment and acute organ dysfunction influence hospital mortality in critically ill patients with cancer who were admitted with suspected sepsis. Methods Data were obtained from a retrospective cohort of patients, admitted to an intensive care unit, with cancer and with a suspected infection who received parenteral antibiotics and underwent the collection of bodily fluid samples. We used logistic regression with hospital mortality as the outcome and the Sequential Organ Failure Assessment score, Eastern Cooperative Oncology Group status, and their interactions as predictors. Results Of 450 patients included, 265 (58.9%) died in the hospital. For patients admitted to the intensive care unit with lower Sequential Organ Failure Assessment (≤ 6), performance status impairment influenced the in-hospital mortality, which was 32% among those with no and minor performance status impairment and 52% among those with moderate and severe performance status impairment, p < 0.01. However, for those with higher Sequential Organ Failure Assessment (> 6), performance status impairment did not influence the in-hospital mortality (73% among those with no and minor impairment and 84% among those with moderate and severe impairment; p = 0.1). Conclusion Performance status impairment seems to influence hospital mortality in critically ill cancer patients with suspected sepsis when they have less severe acute organ dysfunction at the time of intensive care unit admission.
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Affiliation(s)
- Ramon Teixeira Costa
- Unidade de Terapia Intensiva, A.C. Camargo Cancer Center - São Paulo (SP), Brasil
| | | | - Pedro Caruso
- Unidade de Terapia Intensiva, A.C. Camargo Cancer Center - São Paulo (SP), Brasil
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9
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Acute and Chronic Respiratory Failure in Cancer Patients. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7123817 DOI: 10.1007/978-3-319-74588-6_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 2016, there was an estimated 1.8 million new cases of cancer diagnosed in the United States. Remarkable advances have been made in cancer therapy and the 5-year survival has increased for most patients affected by malignancy. There are growing numbers of patients admitted to intensive care units (ICU) and up to 20% of all patients admitted to an ICU carry a diagnosis of malignancy. Respiratory failure remains the most common reason for ICU admission and remains the leading causes of death in oncology patients. There are many causes of respiratory failure in this population. Pneumonia is the most common cause of respiratory failure, yet there are many causes of respiratory insufficiency unique to the cancer patient. These causes are often a result of immunosuppression, chemotherapy, radiation treatment, or hematopoietic stem cell transplant (HCT). Treatment is focused on supportive care and specific therapy for the underlying cause of respiratory failure. Noninvasive modalities of respiratory support are available; however, careful patient selection is paramount as indiscriminate use of noninvasive positive pressure ventilation is associated with a higher mortality if mechanical ventilation is later required. Historically, respiratory failure in the cancer patient had a grim prognosis. Outcomes have improved over the past 20 years. Survivors are often left with significant disability.
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10
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Song JH, Kim S, Lee HW, Lee YJ, Kim MJ, Park JS, Kim YJ, Yoon HI, Lee JH, Lee JS, Lee CT, Cho YJ. Effect of intensivist involvement on clinical outcomes in patients with advanced lung cancer admitted to the intensive care unit. PLoS One 2019; 14:e0210951. [PMID: 30759088 PMCID: PMC6373899 DOI: 10.1371/journal.pone.0210951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/06/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose Intensive care unit (ICU)-related mortality for lung cancer is ranked highest among the solid tumors and little information exists on the role of intensivists on clinical outcomes. This study aimed to elucidate the intensivist’s contribution toward clinical outcomes. Materials and methods Data of advanced lung cancer patients, including stage IIIB or IV non-small cell lung cancer and extensive-stage small cell lung cancer, admitted to the ICU from 2005 to 2016 were analyzed. Multivariate logistic regression was performed to determine variables associated with ICU and in-hospital mortality. Autoregressive integrated moving average (ARIMA) for time-series was used to assess the intensivist’s impact. Results Of 264 patients, 85 (32.2%) were admitted to the ICU before and 179 (67.8%) after organized intensive care introduction in 2011. Before and after 2011, the changes observed were as follows: ICU mortality rate, 43.5% to 40.2%, respectively (p = 0.610); hospital mortality rate, 82.4% to 65. 9% (p = 0.006). The duration of ICU and hospital stay decreased after 2011 (14.5±16.5 vs. 8.3 ± 8.6, p < 0.001; 36.6 ± 37.2 vs. 22.0 ± 19.6, p < 0.001). On multivariate analysis, admission after 2011 was independently associated with decreased hospital mortality (Odds ratio 0.42, 95% confidence interval 0.21–0.77, p = 0.006). In ARIMA models, intensivist involvement was associated with significantly reduced hospital mortality. (Estimate -17.95, standard error 5.31, p = 0.001) Conclusion In patients with advanced lung cancer, organized intensive care could contribute to improved clinical outcomes.
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Affiliation(s)
- Jin Hwa Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Ihwa-dong, Jongno-gu, Seoul, South Korea
| | - Sooyeon Kim
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Ihwa-dong, Jongno-gu, Seoul, South Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Mi-jung Kim
- Medical Oncology, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University,Seo-gu, Incheon, South Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Jong Seok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
- * E-mail: ,
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11
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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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Palliative Care Communication in the ICU: Implications for an Oncology-Critical Care Nursing Partnership. Semin Oncol Nurs 2017; 33:544-554. [PMID: 29107532 DOI: 10.1016/j.soncn.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To describe the development, launch, implementation, and outcomes of a unique multisite collaborative (ie, IMPACT-ICU [Integrating Multidisciplinary Palliative Care into the ICU]) to teach ICU nurses communication skills specific to palliative care. To identify options for collaboration between oncology and critical care nurses when integrating palliation into nursing care planning. DATA SOURCES Published literature and collective experiences of the authors in the provision of onco-critical-palliative care. CONCLUSION While critical care nurses were the initial focus of education, oncology, telemetry, step-down, and medical-surgical nurses within five university medical centers subsequently participated in this learning collaborative. Participants reported enhanced confidence in communicating with patients, families, and physicians, offering emotional support and involvement in family meetings. IMPLICATIONS FOR NURSING PRACTICE Communication education is a vital yet missing element of undergraduate nursing education. Programs should be offered in the work setting to address this gap in needed nurse competency, particularly within the context of onco-critical-palliative care.
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