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Pini F, Grigoriu B, Lieveke A, Meert AP. Management and outcome of oncological patients under immune checkpoint inhibitors presenting at the emergency department. Emerg Med J 2024:emermed-2023-213605. [PMID: 38688713 DOI: 10.1136/emermed-2023-213605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION With the rising use of immune checkpoint inhibitors (ICIs) in oncology, emergency physicians are increasingly confronted with their immune-related adverse events (irAEs). We described the types of irAEs presenting to the ED of a Belgian cancer centre and determined associations with the development of an irAE and other patient's characteristics. Secondary objectives describe the therapeutic management and determine 7 and 30-day mortality. METHODS A retrospective chart review of ED visits of patients on ICI from 15 December 2016 to 6 December 2020 was performed. Clinical presentation, cancer characteristics and type of ICI were extracted by a single abstractor. We recorded any suspicion of irAE in the ED and confirmation of an irAE was based on the patient's oncologist report. Outcome was based on mortality at date of last follow-up. RESULTS 227 patients on ICI presented to the ED, with a total of 451 visits. 54 (12%) of the visits resulted in a diagnosis of irAE. Four clinical features were associated with an irAE: gastrointestinal complaints (p=0.01), skin rashes (p=0.02), acute renal failure (p=0.002) and abnormal liver function (p=0.04). An irAE was also associated with three different factors: a cancer status in remission (OR=5.33, 95% CI 2.57 to 11.04), a combination of two ICIs (OR=4.43, 95% CI 2.09 to 9.42) and a medical history of irAE (OR=2.44, 95% CI 1.27 to 4.68). 30-day mortality was lower in the irAE group (0%) than in the non-irAE group (13%, 95% CI 9% to 19%). CONCLUSIONS Oncological patients under ICI presenting in the ED are more likely to have an irAE if they present with gastrointestinal and dermatological complaints, acute renal failure and abnormal liver function. This is also true for patients with any history of irAE, a concomitant use of two ICIs and with a cancer status in remission.
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Toffart AC, Meert AP, Wallet F, Gibelin A, Guisset O, Gonzalez F, Seguin A, Kouatchet A, Delaunay M, Debieuvre D, Duchemann B, Rousseau-Bussac G, Nyunga M, Grimaldi D, Levrat A, Azoulay E, Lemiale V. ICU admission for solid cancer patients treated with immune checkpoint inhibitors. Ann Intensive Care 2023; 13:29. [PMID: 37072645 PMCID: PMC10113402 DOI: 10.1186/s13613-023-01122-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/24/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have revolutionized the management of cancer. They can induce immune-related adverse events (irAE) leading to intensive care unit (ICU) admission. We aimed to describe irAEs for ICU admissions in solid cancer patients treated with ICIs. METHODS This prospective multicenter study was conducted in France and Belgium. Adult patients with solid tumor and treated with systemic ICIs within the last 6 months, requiring non-programmed ICU admission were included. Patients admitted for microbiologically documented sepsis were excluded. Imputability of irAEs in ICU admissions was described according to the WHO-UMC classification system at ICU admission and at ICU discharge. The use of immunosuppressant treatment was reported. RESULTS 115 patients were eligible. Solid tumor was mainly lung cancer (n = 76, 66%) and melanoma (n = 18, 16%). They were mainly treated with an anti-PD-(L)1 alone (n = 110, 96%). Main ICU admission reasons were acute respiratory failure (n = 66, 57%), colitis (n = 14, 13%), and cardiovascular disease (n = 13, 11%). ICU admission was considered "likely" associated with irAE for 48% (n = 55) of patients. Factors independently associated with irAE were a good ECOG performance status (PS) (ECOG-PS of 0 or 1 vs. ECOG-PS of 2-3, odds ratio [OR] = 6.34, 95% confidence interval [95% CI] 2.13-18.90, and OR = 3.66, 95% CI 1.33-10.03, respectively), and a history of irAE (OR = 3.28, 95% CI 1.19-9.01). Steroids were prescribed for 41/55 (75%) patients with ICU admission "likely" related to irAE. Three patients were subsequently treated with immunosuppressants. CONCLUSION IrAEs accounted for half of ICU admissions in cancer patients receiving ICIs. They could be treated with steroids. Identifying the imputability of irAEs in ICU admissions remains a challenge.
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Affiliation(s)
- Anne-Claire Toffart
- Department of Pneumology and Physiology, CHU Grenoble Alpes, Grenoble, France.
| | - Anne-Pascale Meert
- Department of Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Florent Wallet
- Department of Resuscitation, Hospices Civils de Lyon, Lyon, France
| | - Aude Gibelin
- Department of Resuscitation, Hôpital Tenon, AP-HP, Paris, France
| | - Olivier Guisset
- Department of Intensive Care and Resuscitation, Hôpital Saint André, CHU Bordeaux, Bordeaux, France
| | | | - Amélie Seguin
- Department of Resuscitation, CHU de Nantes, Nantes, France
| | | | | | | | - Boris Duchemann
- Department of Thoracic Oncology, Hôpital Avicenne, Bobigny, France
| | | | - Martine Nyunga
- Department of Resuscitation, CH de Roubaix, Roubaix, France
| | - David Grimaldi
- Department of Resuscitation, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Albrice Levrat
- Department of Resuscitation, CH Annecy Genevois, Annecy, France
| | - Elie Azoulay
- Department of Resuscitation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Virginie Lemiale
- Department of Resuscitation, Hôpital Saint-Louis, AP-HP, Paris, France
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Benguerfi S, Dumas G, Soares M, Meert AP, Martin-Loeches I, Pene F, Bauer P, Mehta S, Metaxa V, Burghi G, Kouatchet A, Montini L, Mokart D, Van de Louw A, Azoulay E, Lemiale V. Etiologies and Outcome of Patients with Solid Tumors Admitted to ICU with Acute Respiratory Failure: A Secondary Analysis of the EFRAIM Study. Respir Care 2023; 68:740-748. [PMID: 37072164 DOI: 10.4187/respcare.10604] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Acute respiratory failure (ARF) remains the most frequent reason for ICU admission in patients who are immunocompromised. This study reports etiologies and outcomes of ARF in subjects with solid tumors. METHODS This study was a post hoc analysis of the EFRAIM study, a prospective multinational cohort study that included 1611 subjects who were immunocompromised and with ARF admitted to the ICU. Subjects with solid tumors admitted to the ICU with ARF were included in the analysis. RESULTS Among the subjects from the EFRAIM cohort, 529 subjects with solid tumors (32.8%) were included in the analysis. At ICU admission, the median (interquartile range) Sequential Organ Failure Assessment score was 5 (3-9). The types of solid tumor were mostly lung cancer (n = 111, 21%), breast cancer (n = 52, 9.8%), and digestive cancer (n = 47, 8.9%). A majority, 379 subjects (71.6%) were full code at ICU admission. The ARF was caused by bacterial or viral infection (n = 220, 41.6%), extrapulmonary sepsis (n = 62, 11.7%), or related to cancer or treatment toxicity (n = 83, 15.7%), or fungal infection (n = 23, 4.3%). For 63 subjects (11.9%), the ARF etiology remained unknown after an extensive diagnostic workup. The hospital mortality rate was 45.7% (n = 232/508). Hospital mortality was independently associated with chronic cardiac failure (odds ratio 1.78, 95% CI 1.09-2.92; P = .02), lung cancer (odds ratio 2.50, 95% CI 1.51-4.19; P < .001), day 1 Sequential Organ Failure Assessment score (odds ratio 1.97, 95% CI 1.32-2.96; P < .001). ARF etiologies other than infectious, related to cancer, or treatment toxicity were associated with better outcomes (odds ratio 0.32, 95% CI 0.16-0.61; P < .001). CONCLUSIONS Infectious diseases remained the most frequent cause of ARF in subjects with solid tumors admitted to the ICU. Hospital mortality was related to severity at ICU admission, previous comorbidities, and ARF etiologies related to non-malignant causes or pulmonary embolism. Lung tumor was also independently associated with higher mortality.
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Affiliation(s)
- Soraya Benguerfi
- Department of Intensive-Resuscitation Medicine, APHP, Hôpital Saint-Louis, Paris Diderot Sorbonne Université, Paris, France.
| | - Guillaume Dumas
- Department of Intensive-Resuscitation Medicine, APHP, Hôpital Saint-Louis, Paris Diderot Sorbonne Université, Paris, France
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Programa de Pós-Graduaçãoem Clínica Médica, Rio De Janeiro, Brazil
| | - Anne-Pascale Meert
- Internal Medicine Service, Soins Intensifs & Urgences Oncologique, Institut Jules Bordet, Brussels, Belgium
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland
| | - Frederic Pene
- Medical ICU, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and Paris Descartes University, Paris, France
| | - Philippe Bauer
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health System, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gaston Burghi
- Terapia Intensiva, Hospital Maciel, Montevideo, Uruguay
| | - Achille Kouatchet
- Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France
| | - Luca Montini
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Djamel Mokart
- Multipurpose Resuscitation Service and Department of Anesthesia and Resuscitation, Institut Paoli-Calmettes, Marseille, France
| | - Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Elie Azoulay
- Department of Intensive-Resuscitation Medicine, APHP, Hôpital Saint-Louis, Paris Diderot Sorbonne Université, Paris, France
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Meert AP, Toffart AC, Picard M, Jaubert P, Gibelin A, Bauer P, Mokart D, Van De Louw A, Hatzl S, Moreno-Gonzales G, Rousseau-Bussac G, Bruneel F, Montini L, Moreau AS, Carpentier D, Seguin A, Hemelaar P, Azoulay E, Lemiale V. Erratum to "When targeted therapy for cancer leads to ICU admission. RETRO-TARGETICU multicentric study" [Bull. Cancer 109 (2022) 916-24]. Bull Cancer 2023; 110:467-468. [PMID: 36805208 DOI: 10.1016/j.bulcan.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Anne-Pascale Meert
- Institut Jules-Bordet, université Libre de Bruxelles (ULB), service de médecine interne, soins intensifs et urgences oncologiques, Brussels, Belgium
| | | | - Muriel Picard
- Institut universitaire du cancer de Toulouse-Oncopole, CHU de Toulouse, Intensive Care Unit, Toulouse, France
| | - Paul Jaubert
- AP-HP Cochin, Intensive care unit, Paris, France
| | | | - Philippe Bauer
- Mayo Clinic, Pulmonary and Critical Care Medicine, Rochester, MN, USA
| | - Djamel Mokart
- Institut Paoli-Calmette, réanimation polyvalente et département d'anesthésie et de réanimation, Marseille, France
| | - Andry Van De Louw
- Pennsylvania State University, Division of Pulmonary and Critical Care, Hershey, PA, USA
| | - Stefan Hatzl
- Medical University of Graz, Department of Internal Medicine, Graz, Austria
| | | | | | | | - Luca Montini
- Intensive Care Unit, Department of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Amelie Seguin
- Hôtel Dieu-HME, University Hospital of Nantes, Medical Intensive Care Unit, Nantes, France
| | - Pleun Hemelaar
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, The Netherlands
| | - Elie Azoulay
- AP-HP Saint-Louis, Intensive Care Unit, Paris, France
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Blum TG, Morgan RL, Durieux V, Chorostowska-Wynimko J, Baldwin DR, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hardavella G, Hauptmann M, Jakobsen E, Jovanovic D, Knaut P, Massard G, McPhelim J, Meert AP, Milroy R, Muhr R, Mutti L, Paesmans M, Powell P, Putora PM, Rawlinson J, Rich AL, Rigau D, de Ruysscher D, Sculier JP, Schepereel A, Subotic D, Van Schil P, Tonia T, Williams C, Berghmans T. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61:13993003.03201-2021. [PMID: 36396145 DOI: 10.1183/13993003.03201-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | | | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Bogdan Grigoriu
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Georgia Hardavella
- Department of Respiratory Medicine, King's College Hospital London, London, UK
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Paul Knaut
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg and Department of Thoracic Surgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - John McPhelim
- Lung Cancer Nurse Specialist, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Anne-Pascale Meert
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Robert Milroy
- Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo Muhr
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- SHRO/Temple University, Philadelphia, PA, USA
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Paul Martin Putora
- Departments of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | - Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Erasmus Medical Center, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Jean-Paul Sculier
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Schepereel
- Pulmonary and Thoracic Oncology, Université de Lille, Inserm, CHU Lille, Lille, France
| | - Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Thierry Berghmans
- Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
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Lemiale V, Mabrouki A, Miry L, Mokart D, Pène F, Kouatchet A, Mayaux J, Bruneel F, Perez P, Meert AP, Moreau AS, Benoit D, Darmon M, Zafrani L, Clere-Jehl R. Sepsis-associated coagulopathy in onco-hematology patients presenting with thrombocytopenia: a multicentric observational study. Leuk Lymphoma 2023; 64:197-204. [PMID: 36305707 DOI: 10.1080/10428194.2022.2136971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coagulation disorders increase mortality rate during septic shock, but the impact of concomitant hematological malignancies remains unknown. The study assessed coagulation disorders in onco-hematological patients with thrombocytopenia (<100 G/L) admitted to ICU for septic shock. Among 146 included patients, 50 patients had lymphoma and 49 patients had acute leukemia. ICU mortality rate was 43.8% (n = 64). Median increase in prothrombin time (PT) at day(d) 1 was 4.7 s (IQR 3.2-7.9) in ICU survivors vs. 6.4 s (IQR 4.5-13.7; p < 0.01) in non-survivors. Fibrinogen kinetics (increase in fibrinogen levels between d1 and d2) was +0.55 (-0.22-1.55) vs. +0.10 g/L (-0.40-0.50; p = 0.03) in surviving and non-surviving patients, respectively. PT increase ≥6 s at d1 (OR 5.5; 95% CI 1.1-6.0; p = 0.03) and mechanical ventilation (OR 7.4; 95% CI 3.3-17.7; p < 0.001) were independently associated with ICU mortality. This study provides information and new ways to identify hematological patients with high-risk mortality.
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Affiliation(s)
- Virginie Lemiale
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Asma Mabrouki
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Loïc Miry
- Neuro-Intensive Care Unit, Rothschild Foundation Hospital, France
| | - Djamel Mokart
- Medical and Surgical Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Frédéric Pène
- Service de Médecine Intensive-réanimation, Hôpital Cochin, AP-HP, Centre & Université Paris Cité, Paris, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers University Hospital, Angers, France
| | - Julien Mayaux
- Service de Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Fabrice Bruneel
- Department of Critical Care, Versailles Hospital, Le Chesnay, France
| | - Pierre Perez
- Medical Intensive Care Unit, Hôpital Brabois, Vandoeuvre Les Nancy, France
| | - Anne-Pascale Meert
- Soins intensifs et urgences oncologiques, Service de Médecine interne, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Bruxelles, Belgique
| | - Anne-Sophie Moreau
- Pôle de médecine intensive réanimation, Hôpital Roger Salengro, CHU Lille, Lille cedex, France
| | - Dominique Benoit
- Medical Unit, Department of Intensive Care, Ghent University Hospitalc, Ghent, Belgium
| | - Michael Darmon
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lara Zafrani
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U976, Human Immunology, Pathophysiology and Immunotherapy, Saint-Louis Teaching Hospital, Paris University, Paris, France
| | - Raphaël Clere-Jehl
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM (French National Institute of Health and Medical Research), UMR_S1109, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg Cedex, France
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Goudsmit A, Brandao M, Oullai A, Engelman D, Ghorra N, Daif T, Buelens T, Meert AP. Optic neuritis in lung adenocarcinoma: A challenging diagnosis. Respir Med Res 2022; 82:100966. [DOI: 10.1016/j.resmer.2022.100966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
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8
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Meert AP, Toffart AC, Picard M, Jaubert P, Gibelin A, Bauer P, Mokart D, Van De Louw A, Hatzl S, Moreno-Gonzales G, Rousseau-Bussac G, Bruneel F, Montini L, Moreau AS, Carpentier D, Seguin A, Hemelaar P, Azoulay E, Lemiale V. When targeted therapy for cancer leads to ICU admission. RETRO-TARGETICU multicentric study. Bull Cancer 2022; 109:916-924. [PMID: 35718570 DOI: 10.1016/j.bulcan.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To study prevalence of targeted therapy (TT)-related adverse events requiring ICU admission in solid tumor patients. METHODS Retrospective multicenter study from the Nine-i research group. Adult patients who received TT for solid tumor within 3 months prior to ICU admission were included. Patients admitted for TT-related adverse event were compared to those admitted for other reasons. RESULTS In total, 140 patients, median age of 63 (52-69) years were included. Primary cancer site was mostly digestive (n=27, 19%), kidney (n=27, 19%), breast (n=24, 17%), and lung (n=20, 14%). Targeted therapy was anti-VEGF/VEGFR for 27% (n=38) patients, anti-EGFR for 22% (n=31) patients, anti-HER2 for 14% (n=20) patients and anti-BRAF for 9% (n=5) patients. ICU admission was related to TT adverse events for 30 (21%) patients. The most frequent complications were interstitial pneumonia (n=7), cardiac failure (n=5), anaphylaxis (n=4) and bleeding (n=4). At ICU admission, no significant difference was found between patients admitted for a TT-related adverse event and the other patients. One-month survival rate was higher in patients admitted for TT adverse event (OR=5.733 [2.031-16.182] P<0.001). CONCLUSIONS Adverse events related to targeted therapy accounted for 20% of ICU admission in our population and carried a 16% one-month mortality. Outcome was associated with admission for TT related to adverse event, breast cancer and good performance status.
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Affiliation(s)
- Anne-Pascale Meert
- Institut Jules-Bordet, université Libre de Bruxelles (ULB), service de médecine interne, soins intensifs et urgences oncologiques, Brussels, Belgium
| | | | - Muriel Picard
- Institut universitaire du cancer de Toulouse-Oncopole, CHU de Toulouse, Intensive Care Unit, Toulouse, France
| | - Paul Jaubert
- AP-HP Cochin, Intensive care unit, Paris, France
| | | | - Philippe Bauer
- Mayo Clinic, Pulmonary and Critical Care Medicine, Rochester, MN, USA
| | - Djamel Mokart
- Institut Paoli-Calmette, réanimation polyvalente et département d'anesthésie et de réanimation, Marseille, France
| | - Andry Van De Louw
- Pennsylvania State University, Division of Pulmonary and Critical Care, Hershey, PA, USA
| | - Stefan Hatzl
- Medical University of Graz, Department of Internal Medicine, Graz, Austria
| | | | | | | | - Luca Montini
- Intensive Care Unit, Department of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Amelie Seguin
- Hôtel Dieu-HME, University Hospital of Nantes, Medical Intensive Care Unit, Nantes, France
| | - Pleun Hemelaar
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, The Netherlands
| | - Elie Azoulay
- AP-HP Saint-Louis, Intensive Care Unit, Paris, France
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Gueuning C, Ameye L, Loizidou A, Grigoriu B, Meert AP. PARIS score for evaluation of probability of SARS-CoV-2 infection in cancer patients. Support Care Cancer 2022; 30:7635-7643. [PMID: 35678883 PMCID: PMC9178543 DOI: 10.1007/s00520-022-07199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/31/2022] [Indexed: 11/08/2022]
Abstract
Control of transmissible diseases as COVID-19 needs a testing and an isolation strategy. The PARIS score developed by Torjdman et al. was aimed at improving patient selection for testing and quarantining but was derived from a general population. We performed a retrospective analysis of the validity of the PARIS score in a cancer patient population. We included 164 patients counting for 181 visits at the emergency department of the Jules Bordet Institute between March 10th and May 18th which had a SARS-CoV-2 RT-PCR test at admission. Twenty-six cases (14.3%) were tested positive with a higher proportion of positive tests among hematological patients compared to those with solid tumors (26% vs 11% p = 0.02). No clinical symptoms were associated with a positive SARS-CoV-2 PCR. No association between anticancer treatment and SARS-CoV-2 infection was found. The PARIS score failed to differentiate SARS-CoV-2-positive and SARS-CoV-2-negative groups (AUC 0.61 95% CI 0.48–0.73). The negative predictive value of a low probability PARIS score was 0.89 but this concerned only 11% of the patients. A high probability PARIS score concerned 49% patients but the positive predictive value was 0.18. CT scan had a sensitivity of 0.77, specificity 0.51, a positive predictive value of 0.24, and a negative predictive value of 0.92. The performance of the PARIS score is thus very poor in this cancer population. A low-risk score can be of some utility but this concerns a minority of patients.
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Affiliation(s)
- Candice Gueuning
- Service de Médecine Interne, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lieveke Ameye
- Data Center, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Angela Loizidou
- Service de Médecine Interne, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Bogdan Grigoriu
- Service de Médecine Interne, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Pascale Meert
- Service de Médecine Interne, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Coussement J, Zuber B, Garrigues E, Gros A, Vandueren C, Epaillard N, Voiriot G, Tandjaoui-Lambiotte Y, Lascarrou JB, Boissier F, Lemiale V, Contou D, Hraiech S, Meert AP, Sauneuf B, Munting A, Ricome S, Messika J, Muller G, Njimi H, Grimaldi D. Characteristics and Outcomes of Patients in the ICU With Respiratory Syncytial Virus Compared With Those With Influenza Infection: A Multicenter Matched Cohort Study. Chest 2022; 161:1475-1484. [PMID: 35063450 DOI: 10.1016/j.chest.2021.12.670] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/13/2021] [Accepted: 12/28/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The characteristics and outcomes of adult patients with respiratory syncytial virus (RSV) infection who require ICU admission are poorly defined. Although several studies in adults with RSV infection have been published in recent years, they did not focus specifically on patients with critical illness. RESEARCH QUESTION What are the characteristics and outcomes of adult patients in the ICU with RSV infection and how do they compare with those of patients in the ICU with influenza infection? STUDY DESIGN AND METHODS This retrospective, multicenter study in France and Belgium (17 sites) compared the characteristics and outcomes of adult patients in the ICU with RSV infection vs those with influenza infection between November 2011 and April 2018. Each patient with RSV infection was matched by institution and date of diagnosis with a patient with influenza infection. In-hospital mortality was compared between the two groups, with adjustment for prognostic factors in a multivariate model (sex, age, main underlying conditions, and concurrent bloodstream infection). RESULTS Data from 618 patients (309 with RSV infection and 309 with influenza infection) were analyzed. Patients with RSV infection were significantly more likely to have an underlying chronic respiratory condition (60.2% vs 40.1%; P < .001) and to be immunocompromised (35% vs 26.2%; P = .02) than patients with influenza infection. Several differences in clinical signs and biological data at diagnosis were found between the groups. In-hospital mortality was not significantly different between the two groups (23.9% in the RSV group vs 25.6% in the influenza group; P = .63), even after adjustment for prognostic factors in a multivariate model. INTERPRETATION Adult patients in the ICU with RSV infection differ from adult patients in the ICU with influenza in terms of comorbidities and characteristics at diagnosis. RSV infection was associated with high in-hospital mortality, approaching 25%. In multivariate analysis, RSV infection was associated with a similar odds of in-hospital death compared with influenza infection.
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Affiliation(s)
- Julien Coussement
- Department of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Eve Garrigues
- Médecine Intensive Réanimation, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Antoine Gros
- Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Charlotte Vandueren
- Intensive Care Unit, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Epaillard
- Service de Réanimation Médicale, Hopital Saint Antoine, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Yacine Tandjaoui-Lambiotte
- Service de Réanimation Médico-Chirurgicale, CHU Avicenne, Assistance Publique-Hôpitaux de Paris, France; INSERM U1272 Hypoxie & Poumon, Bobigny, France
| | | | - Florence Boissier
- Service de Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France; INSERM CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Contou
- Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Sami Hraiech
- Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Marseille, France; Centre d'Études et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Marseille, France
| | - Anne-Pascale Meert
- Service de Médecine Interne, Soins Intensifs & Urgences Oncologiques, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Bertrand Sauneuf
- Intensive Care Unit, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Aline Munting
- Department of Infectious Diseases, CHU UCL Namur, Yvoir, Belgium
| | - Sylvie Ricome
- Service de Réanimation Polyvalente, Centre Hospitalier Robert Ballanger, Aulnay-sous-Bois, France
| | - Jonathan Messika
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, DMU ESPRIT, PHERE UMRS 1152, INSERM, Paris, France
| | - Gregoire Muller
- Medical Intensive Care Unit, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Hassane Njimi
- Intensive Care Unit, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Grimaldi
- Intensive Care Unit, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Chicoisneau M, Paesmans M, Ameye L, Sculier JP, Meert AP. Initiation of a new anti-cancer medical treatment in ICU: a retrospective study. Acta Clin Belg 2022; 77:337-345. [PMID: 33416021 DOI: 10.1080/17843286.2020.1870854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of our study is to evaluate the characteristics of patients whose medical anti-cancer treatment has been initiated at the ICU and to release prognostic factors for hospital mortality in these patients. MATERIAL AND METHODS We analyzed retrospectively all the records of cancer patients admitted between 01/01/2007 and 31/12/2017 in our ICU and for whom a new anti-cancer medical treatment was initiated during their ICU stay. RESULTS Our study includes 147 patients, 78 men (53%) and 69 women (47%), with a median age of 58 years. Eighty patients (54%) had a solid tumor and 67 (46%) a hematological malignancy. ICU mortality was 23% and hospital mortality 32%. The poor prognostic factors for hospital mortality were: higher SOFA, higher Charslon comorbidity index and the presence of a therapeutic limitation (introduced at the time of admission or within 24 hours of admission to the ICU). One-year survival for patients who survived hospital stay was 37% (17% for those with a solid tumor and 61% for the ones with a hematological malignancy). CONCLUSION Initiation of an anti-cancer medical treatment is feasible and can lead to good 1 year survival rate, especially for those with a hematological tumor.
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Affiliation(s)
- Maxence Chicoisneau
- Service de médecine interne, Soins intensifs et urgences oncologiques, Institut Jules Bordet, Université libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Lieveke Ameye
- Data Centre, Institut Jules Bordet, Brussels, Belgium
| | - Jean-Paul Sculier
- Service de médecine interne, Soins intensifs et urgences oncologiques, Institut Jules Bordet, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Pascale Meert
- Service de médecine interne, Soins intensifs et urgences oncologiques, Institut Jules Bordet, Université libre de Bruxelles (ULB), Brussels, Belgium
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Goudsmit A, Cubilier E, Meert AP, Aftimos P, Stathopoulos K, Spilleboudt C, Loizidou A. Poster: ABCL-013: Factors Associated with SARS-CoV-2 Infection and Outcome in Patients with Solid Tumors or Hematological Malignancies: A Single-Center Study. Clinical Lymphoma Myeloma and Leukemia 2021. [PMCID: PMC8404073 DOI: 10.1016/s2152-2650(21)01529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Lemiale V, Dumas G, Demoule A, Pène F, Kouatchet A, Bisbal M, Nseir S, Argaud L, Kontar L, Klouche K, Barbier F, Seguin A, Louis G, Constantin JM, Mayaux J, Wallet F, Peigne V, Girault C, Oziel J, Nyunga M, Terzi N, Bouadma L, Lautrette A, Bige N, Raphalen JH, Papazian L, Bruneel F, Lebert C, Benoit D, Meert AP, Jaber S, Mokart D, Darmon M, Azoulay E. Correction to: Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure. Ann Intensive Care 2021; 11:105. [PMID: 34241716 PMCID: PMC8271041 DOI: 10.1186/s13613-021-00894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Virginie Lemiale
- Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
| | - Guillaume Dumas
- Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Alexandre Demoule
- Medical Intensive Care Unit and Respiratory Division, APHP, Hopital Pitie-Salpetriere, Sorbonne University, Paris, France
| | - Frederic Pène
- Medical Intensive Care Unit, Hopital Cochin, APHP, Universite Paris Descartes, Paris, France
| | | | - Magali Bisbal
- Intensive Care Unit, Paoli Calmettes Institut, Marseille, France
| | - Saad Nseir
- Critical Care Center, CHU de Lille, Lille, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hopital Edouard Herriot, Lyon, France
| | - Loay Kontar
- Medical Intensive Care Unit, INSERM U1088, Amiens University Hospital, Amiens, France
| | - Kada Klouche
- Medical Intensive Care Unit, CHU de Montpellier, Montpellier, France
| | - Francois Barbier
- Medical Intensive Care Unit, La Source Hospital, CHR Orleans, Orleans, France
| | - Amelie Seguin
- Medical Intensive Care Unit, Hotel Dieu, CHU de Nantes, Nantes, France
| | | | | | - Julien Mayaux
- Medical Intensive Care Unit and Respiratory Division, APHP, Hopital Pitie-Salpetriere, Sorbonne University, Paris, France
| | - Florent Wallet
- Intensive Care Unit, Lyon Sud Medical Center, Lyon, France
| | - Vincent Peigne
- Intensive Care Unit, Centre Hospitalier Metropole-Savoie, Chambery, France
| | | | - Johanna Oziel
- Medical Intensive Care Unit, Avicenne University Hospital, Bobigny, France
| | | | - Nicolas Terzi
- Medical Intensive Care Unit, CHU de Grenoble Alpes, Grenoble, France
| | - Lila Bouadma
- Medical Intensive Care Unit, CHU Bichat, Paris, France
| | - Alexandre Lautrette
- Medical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Naike Bige
- Medical Intensive Care Unit, CHU St-Antoine, Paris, France
| | | | - Laurent Papazian
- Reanimation Des Detresses Respiratoires Et Infections Severes, Assistance Publique-Hopitaux de Marseille, Hopital Nord, Aix-Marseille Universite, Faculte de Medecine, Marseille, France
| | - Fabrice Bruneel
- Medical Intensive Care Unit, Andre Mignot Hospital, Versailles, France
| | - Christine Lebert
- Intensive Care Unit, Centre Hospitalier Departemental Les Oudairies, La Roche Sur Yon, France
| | - Dominique Benoit
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Anne-Pascale Meert
- Service de Médecine Interne, Soins Intensifs & Urgences Oncologiques, Institut Jules Bordet, Bruxelles, Université Libre de Bruxelles (ULB), Brussels, France
| | - Samir Jaber
- PhyMedExp, INSERM U-1046, CNRS, Montpellier University Hospital, 34295, Montpellier, France
| | - Djamel Mokart
- Intensive Care Unit, Paoli Calmettes Institut, Marseille, France
| | - Michael Darmon
- Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
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14
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Goudsmit A, Cubilier E, Meert AP, Aftimos P, Stathopoulos K, Spilleboudt C, Loizidou A. Factors associated with SARS-CoV-2 infection and outcome in patients with solid tumors or hematological malignancies: a single-center study. Support Care Cancer 2021; 29:6271-6278. [PMID: 33851236 PMCID: PMC8043836 DOI: 10.1007/s00520-021-06175-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immunocompromised cancer patients are presumed to be at high risk of developing COVID-19 infection. Predisposing factors to contracting COVID-19 and to severe outcomes have been described in registries but were not compared between solid tumors and hematological malignancies. METHOD This retrospective single oncologic center study included adults with solid tumors or hematological malignancies referred to testing by naso-pharyngeal swab for a SARS-CoV-2 RT-PCR from March 10 to May 18, 2020. RESULTS A total of 212 patients were included in the study. Forty-five (21%) were tested positive with SARS-CoV-2. The univariate analysis with positive SARS-CoV-2 PCR as a dependent variable reveals significant odds ratios (ORs) for age-with a mean of 62.5 years-(OR: 1.05, 95% CI: 1.02-1.08), performance status ≥2 (OR: 2.38, 95% CI: 1.22-4.70), inpatient status (OR: 2.36, 95%CI: 1.11-4.91), and hematological malignancies (OR: 2.48, 95% CI: 1.23-4.96). In contrast, OR for solid tumors reveals a negative association (OR: 0.40, 95% CI: 0.20-0.81). When integrating severe outcome (ICU admission or COVID-19-related death) as a dependent variable, the univariate logistic regression model shows significant ORs for pre-existing lymphopenia (OR: 4.0, 95% CI: 1.17-15.04), hematological malignancies (OR: 3.73, 95% CI: 1.09-13.80), and a negative association for solid tumors (OR: 0.27; 95% CI: 0.07-0.92). CONCLUSION In patients referred for SARS-CoV-2 testing, hematological malignancies were associated with a higher risk of COVID-19 infection and severe outcomes. Other factors were age and inpatient status.
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Affiliation(s)
- Anouk Goudsmit
- Internal Medicine, Institut Jules Bordet, rue Heger 1, 1000, Brussels, Belgium.
| | - Edouard Cubilier
- Internal Medicine, Institut Jules Bordet, rue Heger 1, 1000, Brussels, Belgium
| | - Anne-Pascale Meert
- Internal Medicine, Institut Jules Bordet, rue Heger 1, 1000, Brussels, Belgium
| | - Philippe Aftimos
- Clinical Trials Conduct Unit, Institut Jules Bordet, rue Heger 1, 1000, Brussels, Belgium
| | | | - Chloe Spilleboudt
- Hematology Department, Institut Jules Bordet, rue Heger 1, 1000, Brussels, Belgium
| | - Angela Loizidou
- Internal Medicine, Institut Jules Bordet, rue Heger 1, 1000, Brussels, Belgium
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15
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Bisbal M, Darmon M, Saillard C, Mallet V, Mouliade C, Lemiale V, Benoit D, Pene F, Kouatchet A, Demoule A, Vincent F, Nyunga M, Bruneel F, Lebert C, Renault A, Meert AP, Hamidfar R, Jourdain M, Azoulay E, Mokart D. Hepatic dysfunction impairs prognosis in critically ill patients with hematological malignancies: A post-hoc analysis of a prospective multicenter multinational dataset. J Crit Care 2020; 62:88-93. [PMID: 33310587 DOI: 10.1016/j.jcrc.2020.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE Hyperbilirubinemia is frequent in patients with hematological malignancies admitted to the intensive care unit (ICU). Literature about hepatic dysfunction (HD) in this context is scarce. METHODS We investigated the prognostic impact of HD analyzing a prospective multicenter cohort of 893 critically ill hematology patients. Two groups were defined: patients with HD (total bilirubin ≥33 μmol/L at ICU admission) and patients without HD. RESULTS Twenty one percent of patients were found to have HD at ICU admission. Cyclosporine, antimicrobials before ICU admission, abdominal symptoms, ascites, history of liver disease, neutropenia, increased serum creatinine and myeloma were independently associated with HD. Etiology remained undetermined in 73% of patients. Hospital mortality was 56.3% and 36.3% respectively in patients with and without HD (p < 0.0001). Prognostic factors independently associated with hospital mortality in HD group were, performance status >1 (OR = 2.07, 95% CI = 1.49-2.87, p < 0.0001), invasive mechanical ventilation (OR = 3.92, 95% CI = 2.69-5.71, p < 0.0001), renal replacement therapy (OR = 1.74, 95% CI = 1.22-2.47, p = 0.002), vasoactive drug (OR = 1.81, 95% CI = 1.21-2.71, p = 0.004) and SOFA score without bilirubin level at ICU admission (OR = 1.09, 95% CI = 1.04-1.14, p < 0.0001). CONCLUSIONS HD is common, underestimated, infrequently investigated, and is associated with impaired outcome in critically ill hematology patients. HD should be considered upon ICU admission and managed as other organ dysfunctions.
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Affiliation(s)
- Magali Bisbal
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France.
| | - Michael Darmon
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Diderot Sorbonne University, Paris, France
| | - Colombe Saillard
- Departement of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Vincent Mallet
- Departement of Hepatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Charlotte Mouliade
- Departement of Hepatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Diderot Sorbonne University, Paris, France
| | | | - Frederic Pene
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP) and University Paris Descartes, Paris, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers Teaching Hospital, Angers, France
| | - Alexandre Demoule
- Intensive Care Unit, Pitié Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | | | | | - Fabrice Bruneel
- Intensive Care Unit, Versailles Hospital, Versailles, France
| | - Christine Lebert
- Intensive Care Unit, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | - Anne Renault
- Intensive Care Unit, Brest Hospital, Brest, France
| | | | - Rebecca Hamidfar
- Intensive Care Unit, Grenoble Teaching Hospital, Grenoble, France
| | - Merce Jourdain
- Intensive Care Unit, Roger Salengro Hospital, CHU, Lille, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Diderot Sorbonne University, Paris, France
| | - Djamel Mokart
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
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16
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Hourmant Y, Kouatchet A, López R, Mokart D, Pène F, Mayaux J, Bruneel F, Lebert C, Renault A, Meert AP, Benoit D, Lemiale V, Azoulay E, Darmon M. Impact of early ICU admission for critically ill cancer patients: Post-hoc analysis of a prospective multicenter multinational dataset. J Crit Care 2020; 62:6-11. [PMID: 33227593 DOI: 10.1016/j.jcrc.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Early intensive care unit (ICU) admission, in Critically Ill Cancer Patients (CICP), is believed to have contributed to the prognostic improvement of critically ill cancer patients. The primary objective of this study was to assess the association between early ICU admission and hospital mortality in CICP. DESIGN Retrospective analysis of a prospective multicenter dataset. Early admission was defined as admission in the ICU < 24 h of hospital admission. We assessed the association between early ICU admission and hospital mortality in CICP via survival analysis and propensity score matching. RESULTS Of the 1011patients in our cohort, 1005 had data available regarding ICU admission timing and were included. Overall, early ICU admission occurred in 455 patients (45.3%). Crude hospital mortality in patients with early and delayed ICU admission was 33.6% (n = 153) vs. 43.1% (n = 237), respectively (P = 0.02). After adjustment for confounders, early compared to late ICU admission was not associated with hospital mortality (HR 0.92; 95%CI 0.76-1.11). After propensity score matching, hospital mortality did not differ between patients with early (35.2%) and late (40.6%) ICU admission (P = 0.13). In the matched cohort, early ICU admission was not associated with mortality after adjustment on SOFA score (HR 0.89; 95%CI 0.71-1.12). Similar results were obtained after adjustment for center effect. CONCLUSION In this cohort, early ICU admission was not associated with a better outcome after adjustment for confounder and center effect. The uncertainty with regard to the beneficial effect of early ICU on hospital mortality suggests the need for an interventional study.
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Affiliation(s)
- Yannick Hourmant
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Achille Kouatchet
- Intensive Care Unit, Centre hospitalier régional universitaire, Angers, France
| | - René López
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Djamel Mokart
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Frédéric Pène
- Medical ICU, Cochin University Hospital, AP-HP, Paris, France
| | - Julien Mayaux
- Medical ICU and Pneumology, Pitié-Salpétrière University Hospital, APHP, Paris, 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
| | - Anne Renault
- Medical ICU, La Cavale Blanche University Hospital, Brest, France
| | - Anne-Pascale Meert
- Intensive Care Unit, Institut Jules Bordet, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Dominique Benoit
- Service soins intensifs et urgences oncologiques, Institut Jules Bordet, Brussels, Belgium
| | - 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 de Paris, 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 de Paris, 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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Munshi L, Darmon M, Soares M, Pickkers P, Bauer P, Meert AP, Martin-Loeches I, Staudinger T, Pene F, Antonelli M, Barratt-Due A, Demoule A, Metaxa V, Lemiale V, Taccone F, Mokart D, Azoulay E, Mehta S. Acute Respiratory Failure Outcomes in Patients with Hematologic Malignancies and Hematopoietic Cell Transplant: A Secondary Analysis of the EFRAIM Study. Transplant Cell Ther 2020; 27:78.e1-78.e6. [PMID: 33011289 DOI: 10.1016/j.bbmt.2020.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/30/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022]
Abstract
Patients with allogeneic hematopoietic cell transplantation (HCT) who develop acute respiratory failure (ARF) are perceived to have worse outcomes than autologous HCT recipients and non-transplant patients with hematologic malignancy (HM). Within a large international prospective cohort, we evaluated clinical outcomes in these 3 populations. We conducted a secondary analysis of the EFRAIM study, a multicenter observational study of immunocompromised adults with ARF admitted to 62 intensive care units (ICUs) in 16 countries. We described characteristics and compared outcomes of patients with HM who did not undergo transplantation and patients who underwent autologous or allogeneic HCT using multivariable logistic regression and propensity score-matched analyses. A total of 801 patients were included: 570 who did not undergo transplantation, 86 autologous HCT recipients and 145 allogeneic HCT recipients. Acute myelogenous leukemia (171 of 570; 30%) was the most common HM and most common indication for allogeneic HCT (76 of 145; 52%). Compared with the patients who did not undergo HCT and autologous HCT recipients, allogeneic HCT recipients were younger, had fewer comorbid conditions, and were more likely to undergo diagnostic bronchoscopy in the ICU. Unadjusted ICU and hospital mortality were 35% and 45%, respectively, across the entire cohort. In multivariable regression analysis, autologous HCT (odds ratio [OR], 1.07; 95% confidence interval [CI], .57 to 2.03; P = .82) and allogeneic HCT (OR, .99; 95% CI, .60 to 1.66; P = .98) were not associated with higher hospital mortality compared with the no-HCT cohort, adjusting for demographic, functional, clinical, malignancy, and ARF characteristics. The results were similar when analyzed using propensity score-matching techniques. Our findings indicate that autologous and allogeneic HCT recipients who develop ARF and require ICU admission have similar hospital mortality as patients with HM not treated with HCT.
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Affiliation(s)
- Laveena Munshi
- Department of Medicine, Sinai Health System, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Michael Darmon
- Department of Intensive-Resucitation Medicine, APHP, Hôpital Saint-Louis, Paris Diderot Sorbonne Université, Paris, France
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Programa de Pós-Graduaçãoem Clínica Médica, Rio De Janeiro, Brazil
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philippe Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anne-Pascale Meert
- Internal Medicine Service, Soins Intensifs and Urgences Oncologique, Institute Jule Bordet, Brussels, Belgium
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland; Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain
| | - Thomas Staudinger
- Department of Medicine, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Frederic Pene
- Medical ICU, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University Paris Descartes, Paris, France
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Institute of Anesthesiology and Resuscitation, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andreas Barratt-Due
- Department of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Virginie Lemiale
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Djamel Mokart
- Multipurpose Resuscitation Service and Department of Anesthesia and Resuscitation, Institut Paoli-Calmettes, Marseille, France
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health System, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Coureau M, Meert AP, Berghmans T, Grigoriu B. Efficacy and Toxicity of Immune -Checkpoint Inhibitors in Patients With Preexisting Autoimmune Disorders. Front Med (Lausanne) 2020; 7:137. [PMID: 32457912 PMCID: PMC7220995 DOI: 10.3389/fmed.2020.00137] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
Immunotherapy is an important armamentarium for cancer treatment nowadays. Apart from their significant effectiveness in controlling disease they also generate potential severe immune related adverse effects. Preexistence of immune related conditions may eventually predispose to the development of more severe complication and extreme caution have been taken in treating these patients. We performed a literature review searching for case reports and case series in order to offer evidence-based data for clinical management of these patients. Preexisting serological-only immune abnormalities or presence of a predisposing genetic background does not seem to confer significant risk but existing data is scarce. Most patients with preexistent autoimmune diseases can probably treated with checkpoint inhibitors as they seem to have at least the same response rate as the general cancer population. Under treatment, a significant part of them (at least 30%) can experience a flare of their baseline disease which can sometime be severe. Life-threatening cases seems rare and disease flare can be generally managed with steroids. The volume of available data is more important for rheumatologic diseases than for inflammatory bowel diseases were more caution should be observed. However, it has to be kept in mind that new immune related adverse effects (IrAE) are seen with a similar frequency as the flare of the baseline disease. Both flare-up's and newly developed IrAE are generally manageable with a careful clinical follow-up and prompt therapy.
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Affiliation(s)
- Michelle Coureau
- Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Berghmans
- Service d'Oncologie Medicale, Unité d'Oncologie Thoracique, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Bogdan Grigoriu
- Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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19
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Legoff J, Zucman N, Lemiale V, Mokart D, Pène F, Lambert J, Kouatchet A, Demoule A, Vincent F, Nyunga M, Bruneel F, Contejean A, Mercier-Delarue S, Rabbat A, Lebert C, Perez P, Meert AP, Benoit D, Schwebel C, Jourdain M, Darmon M, Resche-Rigon M, Azoulay E. Clinical Significance of Upper Airway Virus Detection in Critically Ill Hematology Patients. Am J Respir Crit Care Med 2020; 199:518-528. [PMID: 30230909 DOI: 10.1164/rccm.201804-0681oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Noninvasive diagnostic multiplex molecular tests may enable the early identification and treatment of viral infections in critically ill immunocompromised patients. OBJECTIVES To assess the association between viral detection in nasopharyngeal swabs and ICU mortality in critically ill hematology patients. METHODS This was a post hoc analysis of a prospective cohort of critically ill hematology patients admitted to 17 ICUs. Nasal swabs sampled and frozen at ICU admission were tested using a multiplex PCR assay. Predictors of ICU mortality and assay positivity were identified. MEASUREMENTS AND MAIN RESULTS Of the 747 patients (447 with acute respiratory failure [ARF]), 21.3% had a virus detected (56.4% rhinovirus/enterovirus and 30.7% influenza/parainfluenza/respiratory syncytial viruses). Overall ICU and hospital mortality rates were 26% and 37%, respectively. Assay positivity was associated with lymphoproliferative disorders, hematopoietic stem cell transplantation, treatment with steroids or other immunosuppressants, ARF (25.5% vs. 16.3%; P = 0.004), and death in the ICU (28.9% vs. 19.3%; P = 0.008). The association with ICU mortality was significant for all viruses and was strongest for influenza/parainfluenza/respiratory syncytial viruses. In patients with ARF, detection of any respiratory virus was independently associated with ICU mortality (odds ratio, 2.07; 95% confidence interval, 1.22-3.50). CONCLUSIONS Respiratory virus detection in the upper airway by multiplex PCR assay is common in critically ill hematology patients. In patients with ARF, respiratory virus detection was independently associated with ICU mortality. Multiplex PCR assay may prove helpful for the risk stratification of hematology patients with ARF. Studies to understand whether respiratory tract viruses play a causal role in outcomes are warranted.
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Affiliation(s)
| | | | | | - Djamel Mokart
- 3 Intensive Care Unit, Paoli Calmette Institute, Marseille, France
| | - Frédéric Pène
- 4 Intensive Care Unit, AP-HP, Cochin Teaching Hospital, Paris, France
| | - Jérôme Lambert
- 5 Statistics Department, AP-HP, Saint Louis Teaching Hospital, Paris, France
| | | | - Alexandre Demoule
- 7 Intensive Care Unit, AP-HP, Pitié Salpêtrière Teaching Hospital, Paris, France
| | - François Vincent
- 8 Intensive Care Unit, AP-HP, Avicennes Teaching Hospital, Bobigny, France
| | - Martine Nyunga
- 9 Intensive Care Unit, Roubaix Regional Hospital Center, Roubaix, France
| | - Fabrice Bruneel
- 10 Intensive Care Unit, Versailles Teaching Hospital, Le Chesnay, France
| | | | | | - Antoine Rabbat
- 4 Intensive Care Unit, AP-HP, Cochin Teaching Hospital, Paris, France
| | - Christine Lebert
- 11 Intensive Care Unit, District Hospital Center, La Roche sur Yon, France
| | - Pierre Perez
- 12 Intensive Care Unit, Brabois Teaching Hospital, Nancy, France
| | | | - Dominique Benoit
- 14 Intensive Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Carole Schwebel
- 15 Intensive Care Unit, Grenoble Teaching Hospital, Grenoble, France; and
| | - Mercé Jourdain
- 16 Intensive Care Unit, Regional Teaching Hospital, Lille, France
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20
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Nathan N, Sculier JP, Ameye L, Paesmans M, Bogdan-Dragos G, Meert AP. Sepsis and Septic Shock Definitions in Patients With Cancer Admitted in ICU. J Intensive Care Med 2019; 36:255-261. [PMID: 31868072 DOI: 10.1177/0885066619894933] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In 2016, a new definition of sepsis and septic shock was adopted. Some studies based on the general population demonstrated that the Sequential Organ Failure Assessment (SOFA) score is more accurate than the systemic inflammatory response syndrome (SIRS) criteria to predict hospital mortality of infected patients requiring intensive care. PATIENTS AND METHOD We have analyzed all the records of patients with cancer admitted for a suspected infection between January 1, 2013, and December 31, 2016, in our oncological intensive care unit (ICU). Sequential Organ Failure Assessment score and quick SOFA (qSOFA) score as well as SIRS criteria were calculated. We analyzed the accuracy of each score to predict hospital mortality in the setting of the new and old definitions of septic shock. RESULTS Our study includes 241 patients with a solid tumor and 112 with a hematological malignancy. The hospital mortality rate is 37% (68% in patients with septic shock according to the new definition and 60% according to old definition) between 2013 and 2016. To predict hospital mortality, the SOFA score has an area under the receiver operating characteristic curve of 0.74 (95% confidence interval [CI], 0.68-0.79), the qSOFA of 0.65 (95% CI, 0.59-0.70), and the SIRS criteria of 0.58 (95% CI, 0.52-0.63). In multivariate analysis, a higher SOFA score or a higher qSOFA score indicates poor prognosis: odds ratio (OR) per 1-point increase by 1.28 (95% CI, 1.18-1.39) and 1.48 (95% CI, 1.04-2.11), respectively. Complete remission is a good prognostic factor for hospital mortality: OR 0.39 (95% CI, 0.22-0.67). CONCLUSION The new definition of sepsis and septic shock is applicable in an ICU oncological population with the same reliability as in the general population. The SOFA score is more accurate than qSOFA and SIRS criteria to predict hospital mortality.
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Affiliation(s)
- Neveux Nathan
- Soins intensifs et urgences oncologiques, service de médecine interne, 60210Institut Jules Bordet, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Jean-Paul Sculier
- Soins intensifs et urgences oncologiques, service de médecine interne, 60210Institut Jules Bordet, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Lieveke Ameye
- Data Centre, 60210Institut Jules Bordet, Bruxelles, Belgium
| | | | - Grigoriu Bogdan-Dragos
- Soins intensifs et urgences oncologiques, service de médecine interne, 60210Institut Jules Bordet, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Anne-Pascale Meert
- Soins intensifs et urgences oncologiques, service de médecine interne, 60210Institut Jules Bordet, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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21
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Van den Bulcke B, Metaxa V, Reyners AK, Rusinova K, Jensen HI, Malmgren J, Darmon M, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Kompanje EJO, Vlerick P, Roels J, Vansteelandt S, Decruyenaere J, Azoulay E, Vanheule S, Piers R, Benoit D. Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States. Intensive Care Med 2019; 46:46-56. [PMID: 31690968 PMCID: PMC6954133 DOI: 10.1007/s00134-019-05829-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/10/2019] [Indexed: 11/13/2022]
Abstract
Purpose Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one’s job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics. Methods Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries. Results Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62–0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77–0.98]) were all associated with a lower intent to leave. Conclusion This is the first large multicenter study showing an independent association between clinicians’ intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL. Electronic supplementary material The online version of this article (10.1007/s00134-019-05829-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bo Van den Bulcke
- Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
| | | | - Anna K Reyners
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Katerina Rusinova
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Hanne I Jensen
- Department of Intensive Care Medicine, Institute of Regional Research, Vejle Hospital, Vejle, Denmark
| | - J Malmgren
- Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.,University of Southern Denmark, Odense, Denmark
| | - Michael Darmon
- Hôpital Saint-Louis and University Paris-7, Paris, France
| | - Daniel Talmor
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anne-Pascale Meert
- Service des Medicine Interne, Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Brussels, Belgium
| | - Laura Cancelliere
- SCDU Anestesia e Rianimazione, Azienda and Ospedaliero Universitaria, Maggiore della Carità, Novara, Italy
| | - László Zubek
- Semmelweis University Budapest, Budapest, Hungary
| | - Paulo Maia
- Intensive Care Department, Hospital S.António, Porto, Portugal
| | | | - Erwin J O Kompanje
- Department of Intensive Care Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Vlerick
- Faculty of Psychology and Educational Sciences, Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium
| | - Jolien Roels
- Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.,London School of Hygiene and Tropical Medicine, London, UK
| | - Johan Decruyenaere
- Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - Elie Azoulay
- Hôpital Saint-Louis and University Paris-7, Paris, France
| | - Stijn Vanheule
- Department of Psycho-analysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Bauer PR, Chevret S, Yadav H, Mehta S, Pickkers P, Bukan RB, Rello J, van de Louw A, Klouche K, Meert AP, Martin-Loeches I, Marsh B, Socias Crespi L, Moreno-Gonzalez G, Buchtele N, Amrein K, Balik M, Antonelli M, Nyunga M, Barratt-Due A, Bergmans DCJJ, Spoelstra-de Man AME, Kuitunen A, Wallet F, Seguin A, Metaxa V, Lemiale V, Burghi G, Demoule A, Karvunidis T, Cotoia A, Klepstad P, Møller AM, Mokart D, Azoulay E. Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy. Eur Respir J 2019; 54:13993003.02442-2018. [PMID: 31109985 DOI: 10.1183/13993003.02442-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/21/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. PATIENTS AND METHODS This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching. RESULTS Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40% versus 28%; p<0.0001) and hospital mortality (49% versus 41%; p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (OR 1.41, 95% CI 1.08-1.81). CONCLUSIONS Bronchoscopy was associated with improved diagnosis and changes in management, but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further.
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Affiliation(s)
- Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sylvie Chevret
- ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, INSERM, Paris Diderot Sorbonne University and Service de Biostatistique et Information Médicale, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sangeeta Mehta
- Dept of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Peter Pickkers
- Dept of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ramin B Bukan
- Dept of Anesthesiology I, Herlev University Hospital, Herlev, Denmark
| | - Jordi Rello
- CIBERES, Instituto Salud Carlos III and Vall d'Hebron Institut of Research Barcelona, Barcelona, Spain
| | - Andry van de Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA
| | - Kada Klouche
- Dept of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Anne-Pascale Meert
- Service de Médecine Interne, Unité de Soins Intensifs et Urgences Oncologiques, Université de Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Ignacio Martin-Loeches
- Dept of Intensive Care Medicine, Universidad de Barcelona IDIBAPS, Barcelona, Spain.,Dept of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland
| | - Brian Marsh
- Dept of Critical Care, Mater Misericordiae, Dublin, Ireland
| | | | | | - Nina Buchtele
- Dept of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Karin Amrein
- Dept of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz and Thyroid Endocrinology Osteoporosis Institute Dobnig, Graz, Austria
| | - Martin Balik
- Dept of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Massimo Antonelli
- Dept of Anesthesiology Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martine Nyunga
- Medical Intensive Care Unit, CHG Victor Provo, Roubaix, France
| | - Andreas Barratt-Due
- Dept of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Dennis C J J Bergmans
- Dept of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Anne Kuitunen
- Dept of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Florent Wallet
- Dept of Critical Care, University Hospital Lyon Sud, Pierre Benite, France
| | | | - Victoria Metaxa
- Dept of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Virginie Lemiale
- Medical Intensive Care Unit, AP-HP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Gaston Burghi
- Terapia Intensiva, Hospital Maciel, Montevideo, Uruguay
| | - Alexandre Demoule
- Service de Pneumologie et Réanimation, CHU Pitié-Salpétrière, Paris, France
| | - Thomas Karvunidis
- Medical ICU, First Dept of Internal Medicine, Teaching Hospital, Faculty of Medicine and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
| | - Antonella Cotoia
- Dept of Anesthesia, Intensive Care, and Pain Therapy, University of Foggia, Policlinico "OO Riuniti", Foggia, Italy
| | - Pål Klepstad
- Dept of Intensive Care Medicine, St Olav's University Hospital, Trondheim, Norway
| | - Ann M Møller
- Dept of Anesthesiology, Herlev University Hospital, UCPH, Herlev, Denmark
| | - Djamel Mokart
- Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Elie Azoulay
- Medical Intensive Care Unit, AP-HP, Hôpital Saint-Louis, Famirea Study Group, 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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Lemiale V, Meert AP, Vincent F, Darmon M, Bauer PR, Van de Louw A, Azoulay E. Severe toxicity from checkpoint protein inhibitors: What intensive care physicians need to know? Ann Intensive Care 2019; 9:25. [PMID: 30707321 PMCID: PMC6358632 DOI: 10.1186/s13613-019-0487-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 01/12/2019] [Indexed: 12/13/2022] Open
Abstract
Checkpoint protein inhibitor antibodies (CPI), including cytotoxic T-lymphocyte-associated antigen 4 inhibitors (ipilimumab, tremelimumab) and the programmed cell death protein 1 pathway/programmed cell death protein 1 ligand inhibitors (pembrolizumab, nivolumab, durvalumab, atezolizumab), have entered routine practice for the treatment of many cancers. They improve the outcome for many cancers, and more patients will be treated with CPI in the future. Although CPI can lead to adverse events (AE) less frequently than for chemotherapy, their use can require intensive care unit admission in case of severe immune-related adverse events (IrAE). Moreover, some of these events, particularly late events, are poorly documented, so a high level of suspicion should be maintained for patients receiving CPI. Intensivists should be aware in general of the known complications and appropriate management of these AE. Nevertheless, a multidisciplinary collaboration remains essential for their diagnosis and management. This review described the most severe complications related to CPI.
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Affiliation(s)
- Virginie Lemiale
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France.
| | - Anne-Pascale Meert
- Soins Intensifs et urgences oncologiques, Institut Jules Bordet (ULB), Brussels, Belgium
| | - François Vincent
- Medical Surgical ICU, GHIC Le Raincy-Montfermeil, 93370, Montfermeil, France
| | - Michael Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France.,ECSTRA, Saint Louis SBIM, APHP, Paris, France
| | | | - Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France.,ECSTRA, Saint Louis SBIM, APHP, Paris, France
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25
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Ehooman F, Biard L, Lemiale V, Contou D, de Prost N, Mokart D, Pène F, Kouatchet A, Mayaux J, Demoule A, Vincent F, Nyunga M, Bruneel F, Rabbat A, Lebert C, Perez P, Meert AP, Benoit D, Hamidfar R, Darmon M, Azoulay E, Zafrani L. Long-term health-related quality of life of critically ill patients with haematological malignancies: a prospective observational multicenter study. Ann Intensive Care 2019; 9:2. [PMID: 30612249 PMCID: PMC6320707 DOI: 10.1186/s13613-018-0478-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/24/2018] [Indexed: 12/18/2022] Open
Abstract
Background Although outcomes of critically ill patients with haematological malignancies (HMs) have been fully investigated in terms of organ failure and mortality, data are scarce on health-related quality of life (HRQOL) in this population. We aim to assess post-intensive care unit (ICU) burden and HRQOL of critically ill patients with HMs and to identify risk factors for quality-of-life (QOL) impairment. Results In total, 1011 patients with HMs who required ICU admission in 17 ICUs in France and Belgium were included in the study; 278 and 117 patients were evaluated for QOL at 3 months and 1 year, respectively, after ICU discharge. HRQOL was determined by applying the interview form of the Short Form 36 (SF-36) questionnaire. Psychological distress symptoms were evaluated using the Hospital Anxiety Depression Score (HADS) and the Impact of Event Scale (IES). In-hospital mortality rates at 3 months and 1 year were, respectively, 39.1, 50.7 and 57.2%, respectively. At 3 months, median [IQR] physical and mental component summary scores (PCS and MCS) (SF-36) were 37 [28–46] and 51 [45–58], respectively. PCS was lower in ICU patients with HMs when compared to general ICU septic patients (52 [5–13], p = 0.00001). The median combined HAD score was 8 [5–13], and the median IES score was 8 [3–16]. However, recovery during the first year after ICU discharge was not consistent in all dimensions of HRQOL. Three months after ICU discharge, the maximum daily Sequential Organ Failure Assessment score and status of the underlying malignancy at ICU admission were significantly associated with MCS impairment (− 0.54 points [95% CI − 0.99; − 0.1], p = 0.018 and − 4.83 points [95% CI − 8.44; − 1.22], p = 0.009, respectively). Conclusion HRQOL is strongly impaired in critically ill patients with HMs at 3 months and 1 year after ICU discharge. Organ failure and disease status are strongly associated with QOL. The kinetic evaluation of QOL at 3 months and 1 year offers the opportunity to focus on QOL aspects that may be improved by therapeutic interventions during the first year after ICU discharge. Electronic supplementary material The online version of this article (10.1186/s13613-018-0478-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Franck Ehooman
- Medical ICU, Saint-Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Lucie Biard
- Biostatistics Department, Saint-Louis Teaching Hospital, Paris, France
| | - Virginie Lemiale
- Medical ICU, Saint-Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Damien Contou
- Medical ICU, Henri Mondor Teaching Hospital, Paris, France.,ICU, Albert Michallon University Hospital, Grenoble, France.,ICU, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nicolas de Prost
- Medical ICU, Henri Mondor Teaching Hospital, Paris, France.,ICU, Albert Michallon University Hospital, Grenoble, France.,ICU, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Djamel Mokart
- Medical ICU, Henri Mondor Teaching Hospital, Paris, France
| | | | | | - Julien Mayaux
- Medical ICU, Angers Teaching Hospital, Angers, France
| | | | | | | | | | | | | | | | | | - Dominique Benoit
- Service soins intensifs et urgences oncologiques, Institut Jules Bordet, Brussels, Belgium
| | | | - Michael Darmon
- ICU, Albert Michallon University Hospital, Grenoble, France
| | - Elie Azoulay
- Medical ICU, Saint-Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Lara Zafrani
- Medical ICU, Saint-Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France.
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26
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Rich AL, Baldwin DR, Beckett P, Berghmans T, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hansen NCG, Hardavella G, Jakobsen E, Jovanovic D, Konsoulova A, Massard G, McPhelim J, Meert AP, Milroy R, Mutti L, Paesmans M, Peake MD, Putora PM, de Ruysscher DK, Sculier JP, Schepereel A, Subotic DR, Van Schil P, Blum T. ERS statement on harmonised standards for lung cancer registration and lung cancer services in Europe. Eur Respir J 2018; 52:13993003.00610-2018. [DOI: 10.1183/13993003.00610-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/03/2018] [Indexed: 12/25/2022]
Abstract
The European Respiratory Society (ERS) task force for harmonised standards for lung cancer registration and lung cancer services in Europe recognised the need to create a single dataset for use in pan-European data collection and a manual of standards for European lung cancer services.The multidisciplinary task force considered evidence from two different sources, reviewing existing national and international datasets alongside the results of a survey of clinical data collection on lung cancer in 35 European countries. A similar process was followed for the manual of lung cancer services, with the task force using existing guidelines and national or international recommendations for lung cancer services to develop a manual of standards for services in Europe.The task force developed essential and minimum datasets for lung cancer registration to enable all countries to collect the same essential data and some to collect data with greater detail. The task force also developed a manual specifying standards for lung cancer services in Europe.Despite the wide variation in the sociopolitical landscape across Europe, the ERS is determined to encourage the delivery of high-quality lung cancer care. Both the manual of lung cancer services and the minimum dataset for lung cancer registration will support this aspiration.
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Berghmans T, Durieux V, Holbrechts S, Jungels C, Lafitte JJ, Meert AP, Moretti L, Ocak S, Roelandts M, Girard N. Systemic treatments for thymoma and thymic carcinoma: A systematic review. Lung Cancer 2018; 126:25-31. [PMID: 30527189 DOI: 10.1016/j.lungcan.2018.10.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022]
Abstract
Thymic tumours are rare diseases that for most of the cases are cured with surgery and eventually adjuvant radiotherapy. However, about 30% of patients present with advanced stage or relapsing tumours, which require administration of chemotherapy. While cisplatin-adriamycin-cyclophosphamide combination is regularly prescribed, other drugs have been assessed in the literature. Our aim is to evaluate the effectiveness (response rate) of systemic treatments, whatever the therapeutic line, including chemotherapy, targeted therapies and immunotherapies, in thymoma and thymic carcinoma, using the principles of evidence-based medicine. A systematic review was designed using the PICO system, by an experienced librarian and clinicians' experts in thoracic oncology, through the Ovid Medline system. Only phase II-IV trials and retrospective studies including at least 14 patients treated with the same regimen were considered. Articles were independently selected by at least two investigators. Fifty-five eligible articles were retrieved. Sixty% were dealing with platinum-based regimens, mainly cisplatin, and showed overall similar activity (mostly response rate above 50%) independently of the line of treatment or histological type (thymoma versus thymic carcinoma). Non-platinum based regimens included octreotide-prednisone and capecitabine-gemcitabine. Promising data of immunotherapy with antiPDL1 antibody (pembrolizumab) requires confirmation. Based on available data, the most popular and active regimens are cisplatin-anthracycline (CAP or ADOC) or cisplatin-etoposide combinations that should be recommended when considering first-line chemotherapy in thymoma or thymic carcinoma.
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Affiliation(s)
- Thierry Berghmans
- Department of Intensive Care and Oncological Emergencies & Thoracic oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Laboratoire Facultaire de Médecine Factuelle de l'Université Libre de Bruxelles, Belgium.
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles, Belgium
| | | | - Christiane Jungels
- Department of Oncological Medicine and Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Anne-Pascale Meert
- Department of Intensive Care and Oncological Emergencies & Thoracic oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Luigi Moretti
- Department of Radiotherapy, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sebahat Ocak
- Division of Pneumology, CHU UCL Namur (Godinne Site), Université catholique de Louvain (UCL), Yvoir, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL et Dermatologie (PNEU), UCL, Brussels, Belgium
| | - Martine Roelandts
- Department of Radiotherapy, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France
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Mignard X, Biard L, Lemiale V, Mokart D, Pène F, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Lebert C, Perez P, Meert AP, Benoit D, Hamidfar R, Darmon M, Azoulay E, Zafrani L. Granulocyte colony-stimulating factor and respiratory status of critically ill neutropenic patients with hematologic malignancies. Leuk Lymphoma 2018; 60:1156-1163. [PMID: 30277108 DOI: 10.1080/10428194.2018.1516874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In patients with hematologic malignancies, respiratory status may deteriorate during neutropenia recovery. This multicenter, observational study aims to evaluate granulocyte colony-stimulating factor (G-CSF) impact on respiratory status in critically ill neutropenic patients. Among 1011 critically ill patients with hematologic malignancies, 288 were neutropenic and included in this study. 201 (70%) did not receive G-CSF at day 1 or 2. After propensity score matching for the probability of receiving G-CSF at day 1 or 2, there was no association between G-CSF and respiratory deterioration at day 14 (OR =1.19; 95%CI (0.57-2.51); p = .64). Additional sensitivity analysis in patients admitted for acute respiratory failure showed similar results (OR =1.34; 95%CI (0.5-3.59); p = .57). Among patients who recovered from neutropenia, 75% experienced respiratory deterioration during neutropenia recovery. This study confirms that neutropenia recovery is a situation at risk of respiratory deterioration. However, whether G-CSF is an aggravating factor cannot be supported by our results.
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Affiliation(s)
- Xavier Mignard
- a Medical ICU , Saint-Louis Teaching Hospital , Paris , France
| | - Lucie Biard
- b Department of Biostatistics , Saint-Louis Teaching Hospital , Paris , France
| | | | - Djamel Mokart
- c ICU , Paoli Calmette Institute , Marseille , France
| | | | | | - Julien Mayaux
- f Medical ICU , Pitié-Salpétrière Teaching Hospital , Paris , France
| | | | | | | | - Antoine Rabbat
- j Respiratory Unit , Cochin Teaching Hospital , Paris , France
| | | | - Pierre Perez
- l ICU , Brabois Teaching Hospital , Nancy , France
| | - Anne-Pascale Meert
- m Service soins intensifs et urgences oncologiques , Institut Jules Bordet , Brussels , Belgium
| | | | - Rebecca Hamidfar
- o ICU , Albert Michallon University Hospital , Grenoble , France
| | - Michael Darmon
- p ICU , Saint-Etienne University Hospital , Saint-Etienne , France
| | - Elie Azoulay
- a Medical ICU , Saint-Louis Teaching Hospital , Paris , France
| | - Lara Zafrani
- a Medical ICU , Saint-Louis Teaching Hospital , Paris , France
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29
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Pistone A, Durieux V, Grigoriu B, Meert AP. Management of Acute Complications of Targeted Therapy in Patients With Cancer: A Review of Cases Managed in ICU. J Intensive Care Med 2018; 34:435-448. [PMID: 30165779 DOI: 10.1177/0885066618787788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Targeted therapies, molecules in full expansion, are not free of side effects that can lead patients to intensive care. We performed an extensive review of the published evidence and propose a management strategy for acute complications of targeted therapy in critically ill patients with cancer. METHODS The literature search was performed in August 2017 using the Ovid Medline system by a scientific librarian and physicians. We made a review of cases admitted in intensive care unit (ICU) and a review of toxicities of grades greater or equal to 3. RESULTS Our search selected 59 articles. The main cardiovascular side effects requiring ICU are heart failure, which is generally reversible, severe hypertension, thrombotic and ischemic events, and rhythm disturbances. The main pulmonary side effects are interstitial lung disease essentially caused by crizotinib, respiratory infections, pneumothorax, and alveolar hemorrhage. The main gastrointestinal side effects are fulminant hepatitis that may be fatal, colitis that may be complicated by hemorrhage, and perforation. The main neurological side effect is posterior reversible encephalopathy syndrome essentially caused by bevacizumab. The main other side effects are Steven-Johnson syndrome, necrotizing fasciitis, and anaphylactic reactions. CONCLUSIONS The side effects induced by targeted therapies may be fatal but are generally potentially reversible. The main treatment includes stopping current therapy and symptomatic management. Treatment rechallenge should be discussed on a case-by-case basis.
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Affiliation(s)
- Aureliano Pistone
- 1 Unité de soins intensifs et urgences oncologiques, service de médecine interne, Institut Jules Bordet, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Valérie Durieux
- 2 Bibliothèque des Sciences de la Santé, Université libre de Bruxelles (ULB), Bruxelles, Belgium.,3 Laboratoire de Médecine Factuelle, Faculté de Médecine, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Bogdan Grigoriu
- 1 Unité de soins intensifs et urgences oncologiques, service de médecine interne, Institut Jules Bordet, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Anne-Pascale Meert
- 1 Unité de soins intensifs et urgences oncologiques, service de médecine interne, Institut Jules Bordet, Université libre de Bruxelles (ULB), Bruxelles, Belgium
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30
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Benoit DD, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Vanheule S, Kompanje EJO, Decruyenaere J, Vandenberghe S, Vansteelandt S, Gadeyne B, Van den Bulcke B, Azoulay E, Piers RD. Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA. Intensive Care Med 2018; 44:1039-1049. [PMID: 29808345 PMCID: PMC6061457 DOI: 10.1007/s00134-018-5231-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/14/2018] [Indexed: 01/01/2023]
Abstract
Purpose Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis. Results Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former. Conclusion Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life. Electronic supplementary material The online version of this article (10.1007/s00134-018-5231-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium.
| | - H I Jensen
- Department of Intensive Care Medicine, Vejle Hospital, Vejle, Denmark
- Institute of Regional Research, University of Southern Denmark, Odense C, Denmark
| | - J Malmgren
- Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - V Metaxa
- King's College Hospital, London, UK
| | - A K Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Darmon
- Hôpital Saint-Louis and University, Paris-7, Paris, France
| | - K Rusinova
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - D Talmor
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - A P Meert
- Service des soins intensifs et urgences oncologiques, Institut Jules Bordet, ULB, Brussels, Belgium
| | - L Cancelliere
- SCDU Anestesia e Rianimazione, Azienda and Ospedaliero Universitaria, "Maggiore della Carità", Novara, Italy
| | - L Zubek
- Semmelweis University Budapest, Budapest, Hungary
| | - P Maia
- Intensive Care Department, Hospital S.António, Porto, Portugal
| | | | - S Vanheule
- Department of Psycho-analysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - E J O Kompanje
- Department of Intensive Care Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J Decruyenaere
- Department of Intensive Care Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - S Vandenberghe
- Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium
| | - S Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium
- London School of Hygiene and Tropical Medicine, London, UK
| | - B Gadeyne
- Department of Intensive Care Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - B Van den Bulcke
- Department of Intensive Care Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - E Azoulay
- Hôpital Saint-Louis and University, Paris-7, Paris, France
| | - R D Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Meert AP, Noël JL, Gamarra F. The thoracic oncology specialist: curriculum recommendations in thoracic oncology training. Eur Respir J 2018; 48:628-31. [PMID: 27581409 DOI: 10.1183/13993003.01069-2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/02/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques, Oncologie Thoracique, Institut Jules Bordet, Brussels, Belgium
| | - Julie-Lyn Noël
- Educational Activities Dept, European Respiratory Society, Lausanne, Switzerland
| | - Fernando Gamarra
- Division of Respiratory Medicine, Klinikum Straubing GmbH, Straubing, Germany For a list of the Thoracic Oncology HERMES Task Force members and their affiliations see the Acknowledgements section
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32
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Van den Bulcke B, Piers R, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje EJO, Azoulay E, Meganck R, Van de Sompel A, Vansteelandt S, Vlerick P, Vanheule S, Benoit DD. Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool. BMJ Qual Saf 2018; 27:781-789. [DOI: 10.1136/bmjqs-2017-007390] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/26/2017] [Accepted: 02/01/2018] [Indexed: 11/04/2022]
Abstract
BackgroundLiterature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU).ObjectivesTo better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates.MethodsUsing a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups.ResultsOf 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner.ConclusionsThe 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians’ behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.
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Costantini A, Grynovska M, Lucibello F, Moisés J, Pagès F, Tsao MS, Shepherd FA, Bouchaab H, Garassino M, Aerts JGJV, Mazières J, Mondini M, Berghmans T, Meert AP, Cadranel J. Immunotherapy: a new standard of care in thoracic malignancies? A summary of the European Respiratory Society research seminar of the Thoracic Oncology Assembly. Eur Respir J 2018; 51:51/2/1702072. [PMID: 29444918 DOI: 10.1183/13993003.02072-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/28/2017] [Indexed: 01/20/2023]
Abstract
In May 2017, the second European Respiratory Society research seminar of the Thoracic Oncology Assembly entitled "Immunotherapy, a new standard of care in thoracic malignancies?" was held in Paris, France. This seminar provided an opportunity to review the basis of antitumour immunity and to explain how immune checkpoint inhibitors (ICIs) work. The main therapeutic trials that have resulted in marketing authorisations for use of ICIs in lung cancer were reported. A particular focus was on the toxicity of these new molecules in relation to their immune-related adverse events. The need for biological selection, currently based on immunohistochemistry testing to identify the tumour expression of programmed death ligand (PD-L)1, was stressed, as well as the need to harmonise PD-L1 testing and techniques. Finally, sessions were dedicated to the combination of ICIs and radiotherapy and the place of ICIs in nonsmall cell lung cancer with oncogenic addictions. Finally, an important presentation was dedicated to the future of antitumour vaccination and of all ongoing trials in thoracic oncology.
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Affiliation(s)
- Adrien Costantini
- Dept of Respiratory Medicine, Hôpital Tenon AP-HP, Université Paris 6 Pierre et Marie Curie, Paris, France.,These authors contributed equally
| | - Marta Grynovska
- Anaesthesia and Intensive Care Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.,These authors contributed equally
| | - Francesca Lucibello
- INSERM Research Unit 981, Gustave Roussy, Villejuif, France.,These authors contributed equally
| | - Jorge Moisés
- Servei de Pneumologia i Al·lèrgia, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain.,These authors contributed equally
| | - Franck Pagès
- Dept of Immunology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes, University, Paris, France
| | - Ming S Tsao
- University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Frances A Shepherd
- Cancer Clinical Research Unit (CCRU), Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hasna Bouchaab
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Marina Garassino
- Dept of Medical Oncology, Fondazione IRCCS, Instituto Nazionale Tumori, Milan, Italy
| | | | - Julien Mazières
- Dept of Respiratory Medicine and Allergology, Toulouse University Hospital, Toulouse, France
| | - Michele Mondini
- Inserm U1030, SIRIC SOCRATE, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Thierry Berghmans
- Dept of Intensive Care, Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Pascale Meert
- Dept of Intensive Care, Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jacques Cadranel
- Dept of Respiratory Medicine, Hôpital Tenon AP-HP, Université Paris 6 Pierre et Marie Curie, Paris, France
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Azoulay E, Guigue N, Darmon M, Mokart D, Lemiale V, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Bretagne S, Lebert C, Meert AP, Benoit D, Pene F. (1, 3)-β-D-glucan assay for diagnosing invasive fungal infections in critically ill patients with hematological malignancies. Oncotarget 2017; 7:21484-95. [PMID: 26910891 PMCID: PMC5008300 DOI: 10.18632/oncotarget.7471] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/19/2016] [Indexed: 11/30/2022] Open
Abstract
Invasive fungal infections (IFIs) are life-threatening complications of hematological malignancies that must be diagnosed early to allow effective treatment. Few data are available on the performance of serum (1–3)-β-D-glucan (BG) assays for diagnosing IFI in patients with hematological malignancies admitted to the intensive care unit (ICU). In this study, 737 consecutive patients with hematological malignancies admitted to 17 ICUs routinely underwent a BG assay at ICU admission. IFIs were diagnosed using standard criteria applied by three independent specialists. Among the 737 patients, 439 (60%) required mechanical ventilation and 273 (37%) died before hospital discharge. Factors known to alter BG concentrations were identified in most patients. IFIs were documented in 78 (10.6%) patients (invasive pulmonary aspergillosis, n = 54; Pneumocystis jirovecii pneumonia, n = 13; candidemia, n = 13; and fusarium infections, n = 3). BG concentrations (pg/mL) were higher in patients with than without IFI (144 (77–510) vs. 50 (30–125), < 0.0001). With 80 pg/mL as the cutoff, sensitivity was 72%, specificity 65%, and area-under-the-curve 0.74 (0.68–0.79). Assuming a prevalence of 10%, the negative and positive predictive values were 94% and 21%. By multivariable analysis, factors independently associated with BG > 80 pg/mL were IFI, admission SOFA score, autologous bone-marrow or hematopoietic stem-cell transplantation, and microbiologically documented bacterial infection. In conclusion, in unselected critically ill hematology patients with factors known to affect serum BG, this biomarker showed only moderate diagnostic performance and rarely detected IFI. However, the negative predictive value was high. Studies are needed to assess whether a negative BG test indicates that antifungal de-escalation is safe.
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Affiliation(s)
- Elie Azoulay
- Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France
| | - Nicolas Guigue
- Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France
| | - Michael Darmon
- Medical-Surgical ICU, Saint-Etienne University Hospital, Saint-Étienne, France
| | - Djamel Mokart
- Medical-Surgical ICU Paoli Calmette Cancer Institute, Marseille, France
| | - Virginie Lemiale
- Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France
| | | | | | | | - Martine Nyunga
- Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France
| | - Fabrice Bruneel
- Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France
| | - Antoine Rabbat
- Medical ICU and Pulmonary Department, Cochin Hospital, Paris, France
| | - Stéphane Bretagne
- Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France
| | - Christine Lebert
- Medical-Surgical ICU, La Roche Sur Yon Hospital, La Roche Sur Yon, France
| | | | | | - Frédéric Pene
- Medical ICU and Pulmonary Department, Cochin Hospital, Paris, France
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Mirouse A, Resche-Rigon M, Lemiale V, Mokart D, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Lebert C, Perez P, Renault A, Meert AP, Benoit D, Hamidfar R, Jourdain M, Darmon M, Azoulay E, Pène F. Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies. Ann Intensive Care 2017; 7:62. [PMID: 28608137 PMCID: PMC5468360 DOI: 10.1186/s13613-017-0292-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/02/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Indications for red blood cell (RBC) transfusion in septic acute circulatory failure remain unclear. We addressed the practices and the prognostic impact of RBC transfusion in the early resuscitation of severe sepsis and septic shock in patients with hematological malignancies. METHODS We performed a retrospective analysis of a prospectively collected database of patients with hematological malignancies who required intensive care unit (ICU) admission in 2010-2011. Patients with a main admission diagnosis of severe sepsis or septic shock were included in the present study. We assessed RBC transfusion during the first two days as part of initial resuscitation. RESULTS Among the 1011 patients of the primary cohort, 631 (62.4%) were admitted to the ICU for severe sepsis (55%) or septic shock (45%). Among them, 210 (33.3%) patients received a median of 2 [interquartile 1-3] packed red cells during the first 48 h. Hemoglobin levels were lower in transfused patients at days 1 and 2 and became similar to those of non-transfused patients at day 3. Early RBC transfusion was more likely in patients with myeloid neoplasms and neutropenia. Transfused patients displayed more severe presentations as assessed by higher admission SOFA scores and blood lactate levels and the further requirements for organ failure supports. RBC transfusion within the first two days was associated with higher day 7 (20.5 vs. 13.3%, p = 0.02), in-ICU (39 vs. 25.2%, p < 0.001) and in-hospital (51 vs. 36.6%, p < 0.001) mortality rates. RBC transfusion remained independently associated with increased in-hospital mortality in multivariate logistic regression (OR 1.52 [1.03-2.26], p = 0.03) and propensity score-adjusted (OR 1.64 [1.05-2.57], p = 0.03) analysis. CONCLUSIONS RBC transfusion is commonly used in the early resuscitation of septic patients with hematological malignancies. Although it was preferentially provided to the most severe patients, we found it possibly associated with an increased risk of death.
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Affiliation(s)
- Adrien Mirouse
- Réanimation médicale, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Matthieu Resche-Rigon
- Département de biostatistiques, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
| | - Virginie Lemiale
- Réanimation médicale, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
| | - Djamel Mokart
- Département d’anesthésie-réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Achille Kouatchet
- Réanimation médicale et médecine hyperbare, CHU d’Angers, Angers, France
| | - Julien Mayaux
- Réanimation médicale, Hôpital de la Pitié-Salpêtrière, AP-HP and Université Pierre et Marie Curie, Paris, France
| | - François Vincent
- Réanimation polyvalente, Centre Hospitalier Intercommunal, Montfermeil, France
| | | | - Fabrice Bruneel
- Réanimation polyvalente, Hôpital André Mignot, Le Chesnay, France
| | - Antoine Rabbat
- Unité de soins intensifs respiratoires, Hôpital Cochin, AP-HP and Université Paris Descartes, Paris, France
| | - Christine Lebert
- Réanimation polyvalente, Centre Hospitalier Départemental, La Roche-sur-Yon, France
| | - Pierre Perez
- Réanimation médicale, Hôpital Brabois, Nancy, France
| | - Anne Renault
- Réanimation médicale, Centre Hospitalier de Brest, Brest, France
| | - Anne-Pascale Meert
- Service des soins intensifs et urgences oncologiques, Institut Jules Bordet, Brussels, Belgium
| | | | | | - Mercé Jourdain
- Université de Lille and Réanimation Polyvalente, CHU de Lille, Lille, France
| | - Michaël Darmon
- Réanimation médicale, Centre Hospitalier de Saint-Etienne, Saint-Etienne, France
| | - Elie Azoulay
- Réanimation médicale, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
| | - Frédéric Pène
- Réanimation médicale, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - on behalf of the Groupe de Recherche sur la Réanimation Respiratoire en Onco-Hématologie (Grrr-OH)
- Réanimation médicale, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
- Département de biostatistiques, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
- Réanimation médicale, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
- Département d’anesthésie-réanimation, Institut Paoli-Calmettes, Marseille, France
- Réanimation médicale et médecine hyperbare, CHU d’Angers, Angers, France
- Réanimation médicale, Hôpital de la Pitié-Salpêtrière, AP-HP and Université Pierre et Marie Curie, Paris, France
- Réanimation polyvalente, Centre Hospitalier Intercommunal, Montfermeil, France
- Centre Hospitalier de Roubaix, Roubaix, France
- Réanimation polyvalente, Hôpital André Mignot, Le Chesnay, France
- Unité de soins intensifs respiratoires, Hôpital Cochin, AP-HP and Université Paris Descartes, Paris, France
- Réanimation polyvalente, Centre Hospitalier Départemental, La Roche-sur-Yon, France
- Réanimation médicale, Hôpital Brabois, Nancy, France
- Réanimation médicale, Centre Hospitalier de Brest, Brest, France
- Service des soins intensifs et urgences oncologiques, Institut Jules Bordet, Brussels, Belgium
- Ghent University Hospital, Ghent, Belgium
- Réanimation médicale, CHU Grenoble-Alpes, Grenoble, France
- Université de Lille and Réanimation Polyvalente, CHU de Lille, Lille, France
- Réanimation médicale, Centre Hospitalier de Saint-Etienne, Saint-Etienne, France
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Berghmans T, Scherpereel A, Meert AP, Giner V, Lecomte J, Lafitte JJ, Leclercq N, Paesmans M, Sculier JP. A Phase III Randomized Study Comparing a Chemotherapy with Cisplatin and Etoposide to a Etoposide Regimen without Cisplatin for Patients with Extensive Small-Cell Lung Cancer. Front Oncol 2017; 7:217. [PMID: 28975084 PMCID: PMC5610723 DOI: 10.3389/fonc.2017.00217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/01/2017] [Indexed: 02/04/2023] Open
Abstract
Introduction In a literature meta-analysis, we showed survival benefits for regimens including cisplatin [hazard ratio (HR) 0.61; 95% confidence interval (CI), 0.57–0.66] and for those including etoposide (HR 0.65; 0.61–0.69). That benefit was mainly observed when etoposide alone or in combination with cisplatin was included in the chemotherapy regimens. Our objective was to determine if chemotherapy with both drugs improves survival in comparison to a non-platinum regimen with etoposide. Methods Extensive small-cell lung cancer patients were randomized between cisplatin–etoposide (CE) and ifosfamide + etoposide + epirubicin regimen (IVE) between 2000 and 2013. Results 176 and 170 eligible patients were allocated to CE and IVE (315 deaths were required before analysis), respectively. Objective response rates were not significantly different: 60% with CE and 59% with IVE. No statistically significant difference in median survival and 1-year and 2-year was observed with rates of 9.6 months, 31 and 5% for CE and 10 months, 39 and 9% for IVE, respectively. HR was 0.84 (95% CI 0.68–1.05, p = 0.16). Only two prognostic factors for survival were retained in multivariate analysis: sex with HR = 0.69 (95% CI 0.49–0.97, p = 0.03) and performance status with HR = 0.53 (95% CI 0.49–0.97, p < 0.0001). After adjustment for these prognostic factors, HR for survival was 0.83 (95% CI 0.65–1.08, p = 0.17). There was more thrombopenia in the CE regimen and more leukopenia with IVE. Conclusion Combination of CE failed to improve survival in comparison to an etoposide-containing regimen without cisplatin. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT00658580?term=ELCWP+01994&rank=1, identifier NCT00658580.
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Affiliation(s)
- Thierry Berghmans
- Department of Intensive Care, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Oncological Emergencies, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Thoracic Oncology, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Arnaud Scherpereel
- Pneumologie et Oncologie Thoracique, CHU de Lille, Université de Lille, Lille, France
| | - Anne-Pascale Meert
- Department of Intensive Care, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Oncological Emergencies, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Thoracic Oncology, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | | | - Jean-Jacques Lafitte
- Pneumologie et Oncologie Thoracique, CHU de Lille, Université de Lille, Lille, France
| | - Nathalie Leclercq
- Department of Intensive Care, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Oncological Emergencies, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Thoracic Oncology, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Jean-Paul Sculier
- Department of Intensive Care, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Oncological Emergencies, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Thoracic Oncology, Institut Jules Bordet, Centre des tumeurs, Université Libre de Bruxelles, Bruxelles, Belgium
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Tavares M, Lemiale V, Mokart D, Pène F, Lengliné E, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Lebert C, Perez P, Meert AP, Benoit D, Darmon M, Azoulay E. Determinants of 1-year survival in critically ill acute leukemia patients: a GRRR-OH study. Leuk Lymphoma 2017; 59:1323-1331. [PMID: 28901791 DOI: 10.1080/10428194.2017.1375106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acute leukemia (AL) is the most common hematological malignancy requiring intensive care unit (ICU) management. Data on long-term survival are limited. This is a post hoc analysis of the prospective multicenter data from France and Belgium: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique [A Research Group on Acute Respiratory Failure in Onco-Hematological Patients (French)] Study, to identify determinants of 1-year survival in critically ill AL patients. A total of 278 patients were admitted in the 17 participating ICUs. Median age was 58 years and 70% had newly diagnosed leukemia. ICU mortality rate was 28.6 and 39.6% of the patients alive at 1 year. Admission for intensive monitoring was independently associated with better 1-year survival by multivariate analysis. Conversely, relapsed/refractory disease, secondary leukemia, mechanical ventilation and renal replacement therapy were independently associated with 1-year mortality. This study confirms the impact of organ dysfunction on long-term survival in ICU patients with AL. Follow-up studies to assess respiratory and renal recovery are warranted.
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Affiliation(s)
- Márcio Tavares
- a ICU , Saint Louis University Hospital , Paris , France
| | | | - Djamel Mokart
- b ICU , Paoli Calmettes Institut , Marseille , France
| | | | - Etienne Lengliné
- d Hematology Department , Saint Louis University Hospital , Paris , France
| | | | - Julien Mayaux
- f ICU Pitié Salpétrière University Hospital , Paris , France
| | | | | | | | - Antoine Rabbat
- j Respiratory ICU , Cochin University Hospital , Paris , France
| | - Christine Lebert
- k ICU Les Oudaries La Roche Sur Yon Hospital , Les Oudairies -La Roche-sur-Yon cedex , France
| | - Pierre Perez
- l ICU , Brabois University Hospital , Vandoeuvre-lès-Nancy , France
| | | | | | - Michael Darmon
- o ICU , Saint Etienne University Hospital , Saint-Etienne , France
| | - Elie Azoulay
- a ICU , Saint Louis University Hospital , Paris , France
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Ruelle L, Bentea G, Sideris S, El Koulali M, Holbrechts S, Lafitte JJ, Grigoriu B, Sculier C, Meert AP, Durieux V, Berghmans T, Sculier JP. Autoimmune paraneoplastic syndromes associated to lung cancer: A systematic review of the literature Part 4: Neurological paraneoplastic syndromes, involving the peripheral nervous system and the neuromuscular junction and muscles. Lung Cancer 2017; 111:150-163. [PMID: 28838388 DOI: 10.1016/j.lungcan.2017.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The development of new immune treatment in oncology and particularly for lung cancer may induce new complications, particularly activation or reactivation of auto-immune diseases. In this context, a systematic review on the auto-immune paraneoplastic syndromes that can complicate lung cancer appears useful. This article is the fourth of a series of five and deals mainly with neurological paraneoplastic syndromes involving the peripheral nervous system and the neuromuscular junction and muscles.
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Affiliation(s)
- Lucien Ruelle
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Georgiana Bentea
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Spyridon Sideris
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Mohamed El Koulali
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | | | | | - Bogdan Grigoriu
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Claudine Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Valérie Durieux
- Laboratoire facultaire de Médecine factuelle (ULB), Belgium; Bibliothèque des Sciences de la Santé, Université libre de Bruxelles (ULB), Belgium
| | - Thierry Berghmans
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Jean-Paul Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium.
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Azoulay E, Schellongowski P, Darmon M, Bauer PR, Benoit D, Depuydt P, Divatia JV, Lemiale V, van Vliet M, Meert AP, Mokart D, Pastores SM, Perner A, Pène F, Pickkers P, Puxty KA, Vincent F, Salluh J, Soubani AO, Antonelli M, Staudinger T, von Bergwelt-Baildon M, Soares M. The Intensive Care Medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med 2017; 43:1366-1382. [PMID: 28725926 DOI: 10.1007/s00134-017-4884-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
Abstract
Over the coming years, accelerating progress against cancer will be associated with an increased number of patients who require life-sustaining therapies for infectious or toxic chemotherapy-related events. Major changes include increased number of cancer patients admitted to the ICU with full-code status or for time-limited trials, increased survival and quality of life in ICU survivors, changing prognostic factors, early ICU admission for optimal monitoring, and use of noninvasive diagnostic and therapeutic strategies. In this review, experts in the management of critically ill cancer patients highlight recent changes in the use and the results of intensive care in patients with malignancies. They seek to put forward a standard of care for the management of these patients and highlight important updates that are required to care for them. The research agenda they suggest includes important studies to be conducted in the next few years to increase our understanding of organ dysfunction in this population and to improve our ability to appropriately use life-saving therapies or select new therapeutic approaches that are likely to improve outcomes. This review aims to provide more guidance for the daily management of patients with cancer, in whom outcomes are constantly improving, as is our global ability to fight against what is becoming the leading cause of mortality in industrialized and non-industrialized countries.
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Affiliation(s)
- Elie Azoulay
- ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France. .,Medical Intensive Care Unit, Hôpital Saint-Louis, Paris, France.
| | | | - Michael Darmon
- Saint-Etienne University Hospital, Saint-Etienne, France
| | | | | | | | | | | | | | | | | | | | | | | | - Peter Pickkers
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Jorge Salluh
- Instituto de Ensino e Perquisa da Santa Casa de Belo Horizonte, Rio de Janeiro, Brazil
| | | | | | | | | | - Marcio Soares
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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Meert AP, Grigoriu B, Licker M, Van Schil PE, Berghmans T. Intensive care in thoracic oncology. Eur Respir J 2017; 49:49/5/1602189. [DOI: 10.1183/13993003.02189-2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/06/2017] [Indexed: 01/21/2023]
Abstract
The admission of lung cancer patients to intensive care is related to postprocedural/postoperative care and medical complications due to cancer or its treatment, but is also related to acute organ failure not directly related to cancer.Despite careful preoperative risk management and the use of modern surgical and anaesthetic techniques, thoracic surgery remains associated with high morbidity, related to the extent of resection and specific comorbidities. Fast-tracking processes with timely recognition and treatment of complications favourably influence patient outcome. Postoperative preventive and therapeutic management has to be carefully planned in order to reduce postoperative morbidity and mortality.For patients with severe complications, intensive care unit (ICU) mortality rate ranges from 13% to 47%, and hospital mortality ranges from 24% to 65%. Common predictors of in-hospital mortality are severity scores, number of failing organs, general condition, respiratory distress and the need for mechanical ventilation or vasopressors. When considering long-term survival after discharge, cancer-related parameters retain their prognostic value.Thoracic surgeons, anesthesiologists, pneumologists, intensivists and oncologists need to develop close and confident partnerships aimed at implementing evidence-based patient care, securing clinical pathways for patient management while promoting education, research and innovation. The final decision on admitting a patient with lung to the ICU should be taken in close partnership between this medical team and the patient and his or her relatives.
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Holbrechts S, Gorham J, Sideris S, Meert AP, Durieux V, Berghmans T, Sculier JP. Autoimmune paraneoplastic syndromes associated to lung cancer: A systematic review of the literature: Part 2: Hematologic, cutaneous and vascular syndromes. Lung Cancer 2017; 106:93-101. [PMID: 28285701 DOI: 10.1016/j.lungcan.2017.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The development of new immune treatment in oncology and particularly for lung cancer may induce new complications, particularly activation or reactivation of auto-immune diseases. In this context, a systematic review on the auto-immune paraneoplastic syndromes associated with lung cancer appears useful. This article is the second of a series of five and deals with hematologic, cutaneous and vascular syndromes.
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Affiliation(s)
| | - Julie Gorham
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Spyridon Sideris
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire Facultaire de Médecine Factuelle (ULB), Belgium
| | - Valérie Durieux
- Laboratoire Facultaire de Médecine Factuelle (ULB), Belgium; Bibliothèque des Sciences de la Santé, Université libre de Bruxelles (ULB), Belgium
| | - Thierry Berghmans
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire Facultaire de Médecine Factuelle (ULB), Belgium
| | - Jean-Paul Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire Facultaire de Médecine Factuelle (ULB), Belgium.
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Bentea G, Sculier C, Grigoriu B, Meert AP, Durieux V, Berghmans T, Sculier JP. Autoimmune paraneoplastic syndromes associated to lung cancer: A systematic review of the literature: Part 3: Neurological paraneoplastic syndromes, involving the central nervous system. Lung Cancer 2017; 106:83-92. [PMID: 28285700 DOI: 10.1016/j.lungcan.2017.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The development of new immune treatment in oncology and particularly for lung cancer may induce new complications, particularly activation or reactivation of auto-immune diseases. In this context, a systematic review on the auto-immune paraneoplastic syndromes that can complicate lung cancer appears useful. This article is the third of a series of five and deals mainly with neurological paraneoplastic syndromes involving the central nervous system.
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Affiliation(s)
- Georgiana Bentea
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Claudine Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Bogdan Grigoriu
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Thierry Berghmans
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Jean-Paul Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium.
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Kamilia C, Regaieg K, Baccouch N, Chelly H, Bahloul M, Bouaziz M, Jendoubi A, Abbes A, Belhaouane H, Nasri O, Jenzri L, Ghedira S, Houissa M, Belkadi K, Harti Y, Nsiri A, Khaleq K, Hamoudi D, Harrar R, Thieffry C, Wallet F, Parmentier-Decrucq E, Favory R, Mathieu D, Poissy J, Lafon T, Vignon P, Begot E, Appert A, Hadj M, Claverie P, Matt M, Barraud O, François B, Jamoussi A, Jazia AB, Marhbène T, Lakhdhar D, Khelil JB, Besbes M, Goutay J, Blazejewski C, Joly-Durand I, Pirlet I, Weillaert MP, Beague S, Aziz S, Hafiane R, Hattabi K, Bouhouri MA, Hammoudi D, Fadil A, Harrar RA, Zerouali K, Medhioub FK, Allela R, Algia NB, Cherif S, Slaoui MT, Boubia S, Hafiani Y, Khaoudi A, Cherkab R, Elallam W, Elkettani C, Barrou L, Ridaii M, Mehdi RE, Schimpf C, Mizrahi A, Pilmis B, Le Monnier A, Tiercelet K, Cherin M, Bruel C, Philippart F, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Timsit JF, Razazi K, Rosman J, de Prost N, Carteaux G, Jansen C, Decousser JW, Brun-Buisson C, Dessap AM, M’rad A, Ouali Z, Barghouth M, Kouatchet A, Boudon M, Ichai P, Younes A, Nakad L, Coilly A, Antonini T, Sobesky R, De Martin E, Samuel D, Hubert N, Mahieu R, Nay MA, Auchabie J, Giraudeau B, Jean R, Darmon M, Ruckly S, Garrouste-Orgeas M, Gratia E, Goldgran-Toledano D, Jamali S, Weiss E, Dumenil AS, Schwebel C, Brisard L, Bizouarn P, Lepoivre T, Nicolet J, Rigal JC, Roussel JC, Cheurfa C, Abily J, Schnell D, Lescot T, Page I, Warnier S, Nys M, Rousseau AF, Damas P, Uhel F, Lesouhaitier M, Grégoire M, Gaudriot B, Zahar JR, Gacouin A, Le Tulzo Y, Flecher E, Tarte K, Tadié JM, Georges Q, Soares M, Jeon K, Oeyen S, Rhee CK, Artiguenave M, Gruber P, Ostermann M, Hill Q, Depuydt P, Ferra C, Muller A, Aurelie B, Niles C, Herbert F, Pied S, Sophie PP, Loridant S, François N, Bignon A, Sendid B, Lemaitre C, Dupre C, Zayene A, Portier L, De Freitas Caires N, Lassalle P, Espinasse F, Le Neindre A, Selot P, Ferreiro D, Bonarek M, Henriot S, Rodriguez J, Taddei M, Di Bari M, Hickmann C, Castanares-Zapatero D, Sayed FE, Deldicque L, Van Den Bergh P, Caty G, Roeseler J, Francaux M, Laterre PF, Dupuis B, Machayeckhi S, Sarfati C, Moore A, Dinh A, Mendialdua P, Rodet E, Pilorge C, Stephan F, Rezaiguia-Delclaux S, Dugernier J, Hesse M, Jumetz T, Bialais E, Depoortere V, Charron C, Michotte JB, Wittebole X, Jamar F, Geri G, Vieillard-Baron A, Repessé X, Kallel H, Mayence C, Houcke S, Guegueniat P, Hommel D, Dhifaoui K, Hajjej Z, Fatnassi A, Sellami W, Labbene I, Ferjani M, Dachraoui F, Nakkaa S, M’ghirbi A, Adhieb A, Braiek DB, Hraiech K, Ousji A, Ouanes I, Zaineb H, Abdallah SB, Ouanes-Besbes L, Abroug F, Klein S, Miquet M, Thouret JM, Peigne V, Daban JL, Boutonnet M, Lenoir B, Merhbene T, Derreumaux C, Seguin T, Conil JM, Kelway C, Blasco V, Nafati C, Harti K, Reydellet L, Albanese J, Aicha NB, Meddeb K, Khedher A, Ayachi J, Fraj N, Sma N, Chouchene I, Boussarsar M, Yedder SB, Samoud W, Radhouene B, Mariem B, Ammar A, Cheikh AB, Lakhal HB, Khelfa M, Hamdaoui Y, Bouafia N, Trampont T, Daix T, Legarçon V, Karam HH, Pichon N, Essafi F, Foudhaili N, Thabet H, Blel Y, Brahmi N, Ezzouine H, Kerrous M, Haoui SE, Ahdil S, Benslama A, Abidi K, Dendane T, Oussama S, Belayachi J, Madani N, Abouqal R, Zeggwagh AA, Ghadhoune H, Chaari A, Jihene G, Allouche H, Trabelsi I, Brahmi H, Samet M, Ghord HE, Habiba BSA, Hajer N, Tilouch N, Yaakoubi S, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Arcizet J, Leroy B, Abdulmalack C, Renzullo C, Hamet M, Doise JM, Coutet J, Cheikh CM, Quechar Z, Joris M, Beauport DT, Kontar L, Lebon D, Gruson B, Slama M, Marolleau JP, Maizel J, Gorham J, Ameye L, Berghmans T, Paesmans M, Sculier JP, Meert AP, Guillot M, Ledoux MP, Braun T, Maestraggi Q, Michard B, Castelain V, Herbrecht R, Schneider F, Couffin S, Lobo D, Mongardon N, Dhonneur G, Mounier R, Le Borgne P, Couraud S, Herbrecht JE, Boivin A, Lefebvre F, Bilbault P, Zelmat SA, Batouche DD, Mazour F, Chaffi B, Benatta N, Sik AH, Talik I, Perrier M, Gouteix E, Koubi C, Escavy A, Guilbaut V, Fosse JP, Jazia RB, Abdelghani A, Cungi PJ, Bordes J, Nguyen C, Pierrou C, Cruc M, Benois A, Duprez F, Bonus T, Cuvelier G, Ollieuz S, Machayekhi S, Paciorkowski F, Reychler G, Coudroy R, Thille AW, Drouot X, Diaz V, Meurice JC, Robert R, Turki O, Ben HC, Assefi M, Deransy R, Brisson H, Monsel A, Conti F, Scatton O, Langeron O, Ghezala HB, Snouda S, Ben CI, Kaddour M, Armel A, Youness L, Abdelhak B, Youssef M, Najib AH, Mustapha A, Noufel M, Mohamed Z, Salma EK, Ghizlane M, Mohamed B, Benyounes R, Montini F, Moschietto S, Gregoire E, Claisse G, Guiot J, Morimont P, Krzesinski JM, Mariat C, Lambermont B, Cavalier E, Delanaye P, Benbernou S, Ilies S, Azza A, Bouyacoub K, Louail M, Mokhtari-Djebli H, Arrestier R, Daviaud F, Francois XL, Brocas E, Choukroun G, Peñuelas O, Lorente JA, Cardinal-Fernandez P, Rodriguez JM, Aramburu JA, Esteban A, Frutos-Vivar F, Bitker L, Costes N, Le Bars D, Lavenne F, Devouassoux M, Richard JC, Mechati M, Gainnier M, Papazian L, Guervilly C, Garnero A, Arnal JM, Roze H, Richard JC, Repusseau B, Dewitte A, Joannes-Boyau O, Ouattara A, Harbouze N, Amine AM, Olandzobo AG, Herbland A, Richard M, Girard N, Lambron L, Lesieur O, Wainschtein S, Hubert S, Hugues A, Tran M, Bouillard P, Loteanu V, Leloup M, Laurent A, Lheureux F, Prestifilippo A, Cruz MDM, Romain R, Antonelli M, Blanch TL, Bonnetain F, Grazzia-Bocci M, Mancebo J, Samain E, Paul H, Capellier G, Zavgorodniaia T, Soichot M, Malissin I, Voicu S, Garçon P, Goury A, Kerdjana L, Deye N, Bourgogne E, Megarbane B, Mejri O, Hmida MB, Tannous S, Chevillard L, Labat L, Risede P, Fredj H, Léger M, Brunet M, Le Roux G, Boels D, Lerolle N, Farah S, Amiel-Niemann H, Kubis N, Declèves X, Peyraux N, Baud F, Serafini M, Alvarez JC, Heinzelman A, Jozwiak M, Millasseau S, Teboul JL, Alphonsine JE, Depret F, Richard N, Attal P, Richard C, Monnet X, Chemla D, Jerbi S, Khedhiri W, Necib H, Scarfo P, Chevalier C, Piagnerelli M, Lafont A, Galy A, Mancia C, Zerhouni A, Tabeliouna K, Gaja A, Hamrouni B, Malouch A, Fourati S, Messaoud R, Zarrouki Y, Ziadi A, Rhezali M, Zouizra Z, Boumzebra D, Samkaoui MA, Brunet J, Canoville B, Verrier P, Ivascau C, Seguin A, Valette X, Du Cheyron D, Daubin C, Bougouin W, Aissaoui N, Lamhaut L, Jost D, Maupain C, Beganton F, Bouglé A, Dumas F, Marijon E, Jouven X, Cariou A, Poirson F, Chaput U, Beeken T, Maxime L, Haikel O, Vodovar D, Chelly J, Marteau P, Chocron R, Juvin P, Loeb T, Adnet F, Lecarpentier E, Riviere A, De Cagny B, Soupison T, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Leteurtre S, Fresco M, Bubenheim M, Beduneau G, Carpentier D, Grange S, Artaud-Macari E, Misset B, Tamion F, Girault C, Dumas G, Chevret S, Lemiale V, Mokart D, Mayaux J, Pène F, Nyunga M, Perez P, Moreau AS, Bruneel F, Vincent F, Klouche K, Reignier J, Rabbat A, Azoulay E, Frat JP, Ragot S, Constantin JM, Prat G, Mercat A, Boulain T, Demoule A, Devaquet J, Nseir S, Charpentier J, Argaud L, Beuret P, Ricard JD, Teiten C, Marjanovic N, Palamin N, L’Her E, Bailly A, Boisramé-Helms J, Champigneulle B, Kamel T, Mercier E, Le Thuaut A, Lascarrou JB, Rolle A, De Jong A, Chanques G, Jaber S, Hariri G, Baudel JL, Dubée V, Preda G, Bourcier S, Joffre J, Bigé N, Ait-Oufella H, Maury E, Mater H, Merdji H, Grimaldi D, Rousseau C, Mira JP, Chiche JD, Sedghiani I, Benabderrahim A, Hamdi D, Jendoubi A, Cherif MA, Hechmi YZE, Zouheir J, Bagate F, Bousselmi R, Schortgen F, Asfar P, Guérot E, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Dreyfuss D, Radermacher P, Frère A, Martin-Lefèvre L, Colin G, Fiancette M, Henry-Laguarrigue M, Lacherade JC, Lebert C, Vinatier I, Yehia A, Joret A, Menunier-Beillard N, Benzekri-Lefevre D, Desachy A, Bellec F, Plantefève G, Quenot JP, Meziani F, Tavernier E, Ehrmann S, Chudeau N, Raveau T, Moal V, Houillier P, Rouve E, Lakhal K, Gandonnière CS, Jouan Y, Bodet-Contentin L, Balmier A, Messika J, De Montmollin E, Pouyet V, Sztrymf B, Thiagarajah A, Roux D, De Chambrun MP, Luyt CE, Beloncle F, Zapella N, Ledochowsky S, Terzi N, Mazou JM, Sonneville R, Paulus S, Fedun Y, Landais M, Raphalen JH, Combes A, Amoura Z, Jacquemin A, Guerrero F, Marcheix B, Hernandez N, Fourcade O, Georges B, Delmas C, Makoudi S, Genton A, Bernard R, Lebreton G, Amour J, Mazet C, Bounes F, Murat G, Cronier L, Robin G, Biendel C, Silva S, Boubeche S, Abriou C, Wurtz V, Scherrer V, Rey N, Gastaldi G, Veber B, Doguet F, Gay A, Dureuil B, Besnier E, Rouget A, Gantois G, Magalhaes E, Wanono R, Smonig R, Lermuzeaux M, Lebut J, Olivier A, Dupuis C, Radjou A, Mourvillier B, Neuville M, D’ortho MP, Bouadma L, Rouvel-Tallec A, Rudler M, Weiss N, Perlbarg V, Galanaud D, Thabut D, Rachdi E, Mhamdi G, Trifi A, Abdelmalek R, Abdellatif S, Daly F, Nasri R, Tiouiri H, Lakhal SB, Rousseau G, Asmolov R, Grammatico-Guillon L, Auvet A, Laribi S, Garot D, Dequin PF, Guillon A, Fergé JL, Abgrall G, Hinault R, Vally S, Roze B, Chaplain A, Chabartier C, Savidan AC, Marie S, Cabie A, Resiere D, Valentino R, Mehdaoui H, Benarous L, Soda-Diop M, Bouzana F, Perrin G, Bourenne J, Eon B, Lambert D, Trebuchon A, Poncelet G, Le Bourgeois F, Michael L, Camille G, Naudin J, Deho A, Dauger S, Sauthier M, Bergeron-Gallant K, Emeriaud G, Jouvet P, Tiebergien N, Jacquet-Lagrèze M, Fellahi JL, Baudin F, Essouri S, Javouhey E, Guérin C, Lampin M, Mamouri O, Devos P, Karaca-Altintas Y, Vinchon M, Brossier D, Eltaani R, Teyssedre S, Sabine M, Bouchut JC, Peguet O, Petitdemange L, Guilbert AS, Aoul NT, Addou Z, Aouffen N, Anas B, Kalouch S, Yaqini K, Chlilek A, Abdou R, Gravellier P, Chantreuil J, Travers N, Listrat A, Le Reun C, Favrais G, Coppere Z, Blanot S, Montmayeur J, Bronchard R, Rolando S, Orliaguet G, Leger PL, Rambaud J, Thueux E, De Larrard A, Berthelot V, Denot J, Reymond M, Amblard A, Morin-Zorman S, Lengliné E, Pichereau C, Mariotte E, Emmanuel C, Poujade J, Trumpff G, Janssen-Langenstein R, Harlay ML, Zaid N, Ait-Ammar N, Bonnal C, Merle JC, Botterel F, Levesque E, Riad Z, Mezidi M, Yonis H, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Louis B, Forel JM, Bisbal M, Lehingue S, Rambaud R, Adda M, Hraiech S, Marchi E, Roch A, Guerin V, Rozencwajg S, Schmidt M, Hekimian G, Bréchot N, Trouillet JL, Besset S, Franchineau G, Nieszkowska A, Pascal L, Loiselle M, Sarah C, Laurence D, Guillemette T, Jacquens A, Kerever S, Guidet B, Aegerter P, Das V, Fartoukh M, Hayon J, Desmard M, Fulgencio JP, Zuber B, Soufi A, Khaleq K, Hamoudi D, Garret C, Peron M, Coron E, Bretonnière C, Audureau E, Audrey W, Christophe D, Christian J, Daniel A, Cyrille F, Aissaoui W, Rghioui K, Haddad W, Barrou H, Carteaux-Taeib A, Lupinacci R, Manceau G, Jeune F, Tresallet C, Habacha S, Fathallah I, Zoubli A, Aloui R, Kouraichi N, Jouet E, Badin J, Fermier B, Feller M, Serie M, Pillot J, Marie W, Gisbert-Mora C, Vinclair C, Lesbordes P, Mathieu P, De Brabant F, Muller E, Robaux MA, Giabicani M, Marchalot A, Gelinotte S, Declercq PL, Eraldi JP, Bougerol F, Meunier-Beillard N, Devilliers H, Rigaud JP, Verrière C, Ardisson F, Kentish-Barnes N, Jacq G, Chermak A, Lautrette A, Legrand M, Soummer A, Thiery G, Cottereau A, Canet E, Caujolle M, Allyn J, Valance D, Brulliard C, Martinet O, Jabot J, Gallas T, Vandroux D, Allou N, Durand A, Nevière R, Delguste F, Boulanger E, Preau S, Martin R, Cochet H, Ponthus JP, Amilien V, Tchir M, Barsam E, Ayoub M, Georger JF, Guillame I, Assaraf J, Tripon S, Mallet M, Barbara G, Louis G, Gaudry S, Barbarot N, Jamet A, Outin H, Gibot S, Bollaert PE, Holleville M, Legriel S, Chateauneuf AL, Cavelot S, Moyer JD, Bedos JP, Merle P, Laine A, Natalie DS, Cornuault M, Libot J, Asehnoune K, Rozec B, Dantal J, Videcoq M, Degroote T, Jaillette E, Zerimech F, Malika B, Llitjos JF, Amara M, Lacave G, Pangon B, Mavinga J, Makunza JN, Mafuta ME, Yanga Y, Eric A, Ilunga J, Kilembe M, Alby-Laurent F, Toubiana J, Mokline A, Laajili A, Amri H, Rahmani I, Mensi N, Gharsallah L, Tlaili S, Gasri B, Hammouda R, Messadi AA, Allain PA, Gault N, Paugam-Burtz C, Foucrier A, Chatbri B, Bourbiaa Y, Thabet L, Neuschwander A, Vincent L, Beck J, Vibol C, Amelie Y, Resche-Rigon M, Pirracchio JM, Bureau C, Decavèle M, Campion S, Ainsouya R, Niérat MC, Prodanovic H, Raux M, Similowski T, Dubé BP, Demiri S, Dres M, May F, Quintard H, Kounis I, Saliba F, André S. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225389 DOI: 10.1186/s13613-016-0224-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Berghmans T, Meert AP. [Immunotherapy and non-small cell lung cancer : a (r)evolution]. Rev Med Brux 2017; 38:175-177. [PMID: 28653522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Immunotherapy renews in non-small cell lung cancer. Antibodies directed against PD1 and PD-L1, blocking the relationship between the cancer cells and the immune system, allowed in randomised trials to significantly improve cancer control with an interesting survival impact of treated patients. However, it remains to determine the most benefiting populations from this expensive and potentially toxic therapy.
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Affiliation(s)
- T Berghmans
- Service des Soins intensifs et Urgences oncologiques & Oncologie thoracique, Institut Jules Bordet, Centre des Tumeurs, ULB
| | - A P Meert
- Service des Soins intensifs et Urgences oncologiques & Oncologie thoracique, Institut Jules Bordet, Centre des Tumeurs, ULB
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Speybrouck S, Claeys L, Hendlisz A, Meert AP. [Dyspnea and cardia cancer, an unusual etiology]. Rev Med Brux 2017; 38:162-168. [PMID: 28653519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE REPORT a 63-year old man, followed for a metastatic cardia cancer, develop a pericardial effusion with sign of pre-tamponade. A CT scanner suggests the presence of a gastro- esophageal-pericardial fistula. A surgical drainage brings a purulent fluid, infected by a polymicrobial flora. Despite early antibiotics with vancomycin and piperacillin-tazobactam, the patient dies five days after the drainage. DISCUSSION purulent pericarditis associated with gastrointestinal neoplasia may be due to sepsis or a proximity invasion . The diagnosis is based on ultrasound and pericardiocentesis. The most commonly involved organism is Streptococcus pneumoniae. The treatment involves intravenous antibiotics, pericardial drainage and intrapericardial instillation of antibiotics. The mortality rate remains high, especially in cases associated with gastrointestinal neoplasia.
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Affiliation(s)
- S Speybrouck
- Service des Soins intensifs, Urgences oncologiques et Oncologie thoracique, Institut Jules Bordet, ULB
| | - L Claeys
- Service d'Imagerie médicale, Institut Jules Bordet, ULB
| | - A Hendlisz
- Unité de Gastroentérologie oncologique, Service de Médecine, Institut Jules Bordet, ULB
| | - A P Meert
- Service des Soins intensifs, Urgences oncologiques et Oncologie thoracique, Institut Jules Bordet, ULB
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Berghmans T, Lafitte JJ, Meert AP, Scherpereel A, Paesmans M, Leclercq N, Sculier JP. P1.07-040 Prognostic Factors in Extensive Disease (ED) Small Cell Lung Cancer (SCLC): An ELCWP Phase III Randomized Trial. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Neuschwander A, Lemiale V, Darmon M, Pène F, Kouatchet A, Perez P, Vincent F, Mayaux J, Benoit D, Bruneel F, Meert AP, Nyunga M, Rabbat A, Mokart D, Azoulay E. Noninvasive ventilation during acute respiratory distress syndrome in patients with cancer: Trends in use and outcome. J Crit Care 2016; 38:295-299. [PMID: 28038339 DOI: 10.1016/j.jcrc.2016.11.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE The objectives of our study were to describe the outcome of patients with malignancies treated for acute respiratory distress syndrome (ARDS) with noninvasive ventilation (NIV) and to evaluate factors associated with NIV failure. METHODS Post hoc analysis of a multicenter database within 20 years was performed. All patients with malignancies and Berlin ARDS definition were included. Noninvasive ventilation use was defined as NIV lasting more than 1 hour, whereas failure was defined as a subsequent requirement of invasive ventilation. Conditional backward logistic regression analyses were conducted. RESULTS A total of 1004 met the Berlin definition of ARDS. Noninvasive ventilation was used in 387 patients (38.6%) and NIV failure occurred in 71%, with an in-hospital mortality of 62.7%. Severity of ARDS defined by the partial pressure arterial oxygen and fraction of inspired oxygen ratio (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.15-4.19), pulmonary infection (OR, 1.81; 95% CI, 1.08-3.03), and modified Sequential Organ Failure Assessment (SOFA) score (OR, 1.13; 95% CI, 1.06-1.21) were associated with NIV failure. Factors associated with hospital mortality were NIV failure (OR, 2.52; 95% CI, 1.56-4.07), severe ARDS as compared with mild ARDS (OR, 1.89; 95% CI, 1.05-1.19), and modified SOFA score (OR, 1.12; 95% CI, 1.05-1.19). CONCLUSION Noninvasive ventilation failure in ARDS patients with malignancies is frequent and related to ARDS severity, SOFA score, and pulmonary infection-related ARDS. Noninvasive ventilation failure is associated with in-hospital mortality.
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Affiliation(s)
| | - V Lemiale
- ICU, Saint Louis Teaching Hospital, Paris, France
| | - M Darmon
- ICU, Saint Etienne, Teaching Hospital, France
| | - F Pène
- ICU, Cochin Teaching Hospital, Paris, France
| | - A Kouatchet
- ICU, Angers Teaching Hospital, Angers, France
| | - P Perez
- ICU, Brabois Teatching Hospital, Nancy, France
| | - F Vincent
- ICU, Monfermeil Hospital, Montfermeil, France
| | - J Mayaux
- ICU Pitié Salpétrière Teaching Hospital, Paris, France
| | - D Benoit
- ICU, Ghent Teaching Hospital, Ghent, Belgium
| | - F Bruneel
- ICU, Mignot Hospital, Versailles, France
| | - A P Meert
- ICU, Bordet Institut, Bruxelles, Belgium
| | - M Nyunga
- ICU, Roubaix Hospital, Roubaix, France
| | - A Rabbat
- ICU, Cochin Teaching Hospital, Paris, France
| | - D Mokart
- ICU, Paoli Calmettes Institut Marseilles, Marseilles, France
| | - E Azoulay
- ICU, Saint Louis Teaching Hospital, Paris, France.
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Destrebecq V, Lieveke A, Berghmans T, Paesmans M, Sculier JP, Meert AP. Are Intensive Cares Worthwhile for Breast Cancer Patients: The Experience of an Oncological ICU. Front Med (Lausanne) 2016; 3:50. [PMID: 27843912 PMCID: PMC5086595 DOI: 10.3389/fmed.2016.00050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose One among seven women will present with breast cancer for which major therapeutic advances led to a significant increase in survival and cure rates. During or after cancer treatment, severe complications may occur requiring admission in intensive care unit (ICU). Intensivists could be reluctant for accepting cancer patients in the ICU, and there are very few data about causes of admission and prognosis of patients with breast cancer admitted in the ICU for an acute complication. Our study seeks to determine, in a population of patients with breast cancer, the main causes for ICU admission and the predictors of death during hospital stay and prognostic factors for survival after hospital discharge. Methods This retrospective study includes all unplanned ICU admissions of patients with breast cancer in a cancer hospital from January 1, 2009 to December 31, 2014. To search for predictive factors of death during hospitalization, Mann–Whitney or Fisher Exact (or chi-square) tests were used for continuous variables or categorical variables, respectively. A logistic regression model was applied for multivariate analysis. Multivariate analysis of prognostic factors for survival after hospital discharge was performed with a Cox’s proportional hazards model. Results Of 1586 ICU admissions during the study period, 282 (18%) concerned breast cancer of which 175 met the inclusion criteria. The main causes of admission were of cardiovascular (26%), respiratory (19%), neurologic (19%), or infectious (14%) origin. ICU death rate was 15% and, overall, 28% of the patients died during hospitalization. The median survival time after hospitalization was 12.8 months (95% CI: 8.2–20.7). Independent predictors of death during hospitalization were the sequential organ failure assessment (SOFA) score (OR 1.36, 95% CI 1.15–1.60), high GPT values (OR 3.70, 95% CI: 1.52–9.03), and cardiovascular disease (OR 0.23, 95% CI: 0.06–0.86). Independent predictors of death after hospital discharge were metastatic disease (HR 7.90, 95% CI 3.69–16.92), high GOT value (HR 3.22 95% CI: 1.93–5.36), simplified acute physiology score (SAPS) (HR 1.95 95% CI: 1.21–3.16), and therapeutic limitations during the first 24 h after ICU admission (HR 8.52 95% CI: 3.66–19.87). Conclusion Independent predictors of death during hospitalization were related to the acute complications (SOFA score, GPT level and cardiovascular-related admission) while cancer parameters retained their prognostic significance for survival after hospital discharge (metastatic disease, therapeutic limitations).
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Affiliation(s)
- Virginie Destrebecq
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules Bordet, Université Libre de Bruxelles (ULB) , Brussels , Belgium
| | - Ameye Lieveke
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB) , Brussels , Belgium
| | - Thierry Berghmans
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules Bordet, Université Libre de Bruxelles (ULB) , Brussels , Belgium
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB) , Brussels , Belgium
| | - Jean-Paul Sculier
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules Bordet, Université Libre de Bruxelles (ULB) , Brussels , Belgium
| | - Anne-Pascale Meert
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules Bordet, Université Libre de Bruxelles (ULB) , Brussels , Belgium
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Contejean A, Lemiale V, Resche-Rigon M, Mokart D, Pène F, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Hamidfar R, Darmon M, Jourdain M, Renault A, Schlemmer B, Azoulay E. Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology: a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study. Ann Intensive Care 2016; 6:102. [PMID: 27783381 PMCID: PMC5080277 DOI: 10.1186/s13613-016-0202-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 10/11/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute respiratory failure (ARF) is the most frequent complication in patients with hematological malignancies and is associated with high morbidity and mortality. ARF etiologies are numerous, and despite extensive diagnostic workflow, some patients remain with undetermined ARF etiology. METHODS This is a post-hoc study of a prospective multicenter cohort performed on 1011 critically ill hematological patients. Relationship between ARF etiology and hospital mortality was assessed using a multivariable regression model adjusting for confounders. RESULTS This study included 604 patients with ARF. All patients underwent noninvasive diagnostic tests, and a bronchoscopy and bronchoalveolar lavage (BAL) was performed in 155 (25.6%). Definite diagnoses were classified into four exclusive etiological categories: pneumonia (44.4%), non-infectious diagnoses (32.6%), opportunistic infection (10.1%) and undetermined (12.9%), with corresponding hospital mortality rates of 40, 35, 55 and 59%, respectively. Overall hospital mortality was 42%. By multivariable analysis, factors associated with hospital mortality were invasive pulmonary aspergillosis (OR 7.57 (95% CI 3.06-21.62); p < 0.005), use of invasive mechanical ventilation (OR 1.65 (95% CI 1.07-2.55); p = 0.02), a SOFA score >7 (OR 3.32 (95% CI 2.15-5.15); p < 0.005) and an undetermined ARF etiology (OR 2.92 (95% CI 1.71-5.07); p < 0.005). CONCLUSIONS In patients with hematological malignancies and ARF, up to 13% remain with undetermined ARF etiology despite comprehensive diagnostic workup. Undetermined ARF etiology is independently associated with hospital mortality. Studies to guide second-line diagnostic strategies are warranted. ClinicalTrials.Gov NCT01172132.
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Affiliation(s)
| | | | | | - Djamel Mokart
- Réanimation, Institut Paoli Calmettes, Marseille, France.,Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology And Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université Paris Diderot Sorbonne, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Frédéric Pène
- Réanimation médicale, Hôpital Cochin, APHP, Paris, France
| | - Achille Kouatchet
- Service de Reanimation Médicale et Médecine Hyperbare, CHU Angers, Angers, France
| | - Julien Mayaux
- Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - François Vincent
- Réanimation polyvalente, Hôpital Avicenne, APHP, Bobigny, France
| | - Martine Nyunga
- Réanimation polyvalente, Hôpital V.Provo, Roubaix, France
| | - Fabrice Bruneel
- Réanimation polyvalente, Hôpital de Versailles, Le Chesnay, France
| | - Antoine Rabbat
- Réanimation médicale, Hôpital Cochin, APHP, Paris, France
| | - Pierre Perez
- Réanimation médicale, Hôpital Brabois, Nancy, France
| | - Anne-Pascale Meert
- Service des Soins Intensifs Medico-Chirurgicaux et Oncologie Thoracique, Institut Jules Bordet, Brussels, Belgium
| | | | | | - Michael Darmon
- Réanimation polyvalente, CHU de Saint-Etienne, Saint-Piest-en-Jarrez, France
| | | | - Anne Renault
- Réanimation et Urgences Médicales, CHU de la Cavale Blanche, Brest, France
| | | | - Elie Azoulay
- Réanimation médicale, Hôpital Saint Louis, APHP, Paris, France. .,Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology And Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université Paris Diderot Sorbonne, 1, Avenue Claude Vellefaux, 75010, Paris, France.
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Schnell D, Azoulay E, Benoit D, Clouzeau B, Demaret P, Ducassou S, Frange P, Lafaurie M, Legrand M, Meert AP, Mokart D, Naudin J, Pene F, Rabbat A, Raffoux E, Ribaud P, Richard JC, Vincent F, Zahar JR, Darmon M. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF). Ann Intensive Care 2016; 6:90. [PMID: 27638133 PMCID: PMC5025409 DOI: 10.1186/s13613-016-0189-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023] Open
Abstract
Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.
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Affiliation(s)
| | | | | | - Benjamin Clouzeau
- Medical Intensive Care Unit, Pellegrin University Hospital, Bordeaux, France
| | - Pierre Demaret
- Paediatric Intensive Care Unit, Centre Hospitalier Chrétien, Liège, Belgium
| | - Stéphane Ducassou
- Pediatric Hematological Unit, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Frange
- Microbiology Laboratory & Pediatric Immunology - Hematology Unit, Necker University Hospital, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Diseases, Saint-Louis University Hospital, Paris, France
| | - Matthieu Legrand
- Surgical ICU and Burn Unit, Saint-Louis University Hospital, Paris, France
| | - Anne-Pascale Meert
- Thoracic Oncology Department and Oncologic Intensive Care Unit, Institut Jules Bordet, Brussels, Belgium
| | - Djamel Mokart
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmette, Marseille, France
| | - Jérôme Naudin
- Pediatric ICU, Robert Debré University Hospital, Paris, France
| | | | - Antoine Rabbat
- Respiratory Intensive Care Unit, Cochin University Hospital Hospital, Paris, France
| | - Emmanuel Raffoux
- Department of Hematology, Saint-Louis University Hospital, Paris, France
| | - Patricia Ribaud
- Department of Stem Cell Transplantation, Saint-Louis University Hospital, Paris, France
| | | | | | - Jean-Ralph Zahar
- Infection Control Unit, Angers University Hospital, Angers, France
| | - Michael Darmon
- University Hospital, Saint-Etienne, France. .,Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Avenue Albert Raymond, 42270, Saint-Etienne, Saint-Priest-En-Jarez, France.
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