Medline ® Abstracts for References 3,6-16

of 'Intensive care for oncology patients: Short-term prognosis'

3
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Outcome of children with hematologic malignancy who are admitted to an intensive care unit.
AU
Butt W, Barker G, Walker C, Gillis J, Kilham H, Stevens M
SO
Crit Care Med. 1988;16(8):761.
 
Sixty-four (48%) of 133 children with hematologic malignancy who were admitted to three pediatric ICUs died. Children who required management because of airway obstruction or after general anesthesia had the best outlook (mortality rate of 7% or less); those children who required major circulatory support or mechanical ventilation for hypoxemia did poorly (mortality rate of 84% or greater). Certain conditions in children with hematologic malignancy that require intensive care are associated with a mortality rate of approximately 75%. These include the following: suspected sepsis, interstitial pneumonitis, encephalopathy due to sepsis or hemorrhage. In children with these life-threatening conditions, therapy must be improved because at this stage, the patients do not benefit from admission to the ICU.
AD
Intensive Care Unit, Royal Children's Hospital, Victoria, Australia.
PMID
6
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Critical care issues in bone marrow transplantation.
AU
Brochstein JA
SO
Crit Care Clin. 1988;4(1):147.
 
Allogeneic bone marrow transplantation (BMT) is an often used therapeutic modality for patients with refractory leukemia as well as for those with other lethal disorders of the lymphohematopoietic system. The extremely high doses of chemotherapy and/or radiation therapy required to prepare patients for BMT, however, render these individuals susceptible to a variety of disorders in the first few months following transplantation. This article reviews the primary causes of nonleukemic mortality in the early post-transplant period.
AD
Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
PMID
7
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Outcome of recipients of bone marrow transplants who require intensive-care unit support.
AU
Afessa B, Tefferi A, Hoagland HC, Letendre L, Peters SG
SO
Mayo Clin Proc. 1992;67(2):117.
 
To determine the outcome and prognostic factors associated with bone marrow transplantation (BMT), we reviewed the clinical course of 35 adult recipients of such a transplant who were admitted to our intensive-care unit (ICU). This constituted 24% of patients who underwent BMT for treatment of hematologic disorders during the study period. The reasons for admission to the ICU were postsurgical care in 5, respiratory failure in 25, shock in 4, and renal failure in 1. The in-hospital mortality was 20% for the postsurgical patients and 87% for the others. None of the postsurgical patients required mechanical ventilation, whereas 90% of the others did, and the associated mortality was 93%. Infection was the cause of the respiratory failure in all but 3 of the 25 patients and was associated with 95% mortality. Complications that involved multiple organs increased the mortality to 100%. No significant differences were found in age, sex, type of BMT, serologic tests for cytomegalovirus, history of graft-versus-host disease, conditioning regimen for BMT, and duration of stay in the ICU and the hospital between survivors and nonsurvivors. The APACHE II (acute physiology and chronic health evaluation) prognostic scoring system underestimated mortality and had no correlation with the duration of stay in the ICU or the hospital. Vasopressors, total parenteral nutrition, and transfusion of blood components in the ICU had no influence on the outcome. Open-lung biopsy was helpful in making specific diagnoses, and pulmonary artery catheters were used in most patients to guide therapy but did not improve survival.(ABSTRACT TRUNCATED AT 250 WORDS)
AD
Critical Care Service, Mayo Clinic, Rochester, MN 55905.
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8
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Survival of adult bone marrow transplant patients receiving mechanical ventilation: a case for restricted use.
AU
Faber-Langendoen K, Caplan AL, McGlave PB
SO
Bone Marrow Transplant. 1993;12(5):501.
 
A retrospective study of all adults receiving BMT over a 13 year period at a large transplant center was performed to determine overall survival and prognostic indicators of poor outcome among patients receiving mechanical ventilation (MV). Of 653 adult BMT patients, 191 (29%) received MV after transplant. Of these 191, 161 (84%) died on the ventilator or within hours of extubation; 18 (10%) survived 1 week after extubation and 6 (3%) survived 6 months. Survival was not predicted by type of graft, use of total body irradiation (TBI) or reason for intubation. The patient's age and the timing of intubation were predictive of survival. Of patients>or = 40 years, 98% died within a week of extubation and all died within 30 days. Similarly, of those intubated within 90 days of transplant, 94% died within a week of extubation and all died by day 100. These results suggest that MV is rarely effective in achieving long-term survival in adult BMT recipients, especially older patients and those early in their transplant course. An argument, based on cost/benefit considerations and medical futility, can be developed to withhold MV in certain patient subsets apart from a clinical research trial.
AD
Department of Medicine, University of Minnesota Health Sciences Center, Minneapolis 55455.
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9
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Outcome of patients requiring medical ICU admission following bone marrow transplantation.
AU
Paz HL, Crilley P, Weinar M, Brodsky I
SO
Chest. 1993;104(2):527.
 
Despite encouraging results seen following bone marrow transplantation (BMT), it has been observed that once these patients become critically ill and require medical intensive care unit (MICU) admission, the chances of survival are poor. We hypothesized that while mechanical ventilation would be an important predictor for death in the MICU, those patients not requiring mechanical ventilation could be successfully discharged from the MICU. The records of 36 patients with 43 admissions to the MICU following BMT were analyzed. Of these admissions, 33 (76.7 percent) patients had allogeneic and 10 (23.3 percent) had autologous transplants, respectively. Overall, 14 (32.6 percent) of the admissions resulted in a satisfactory discharge from the MICU. There was no significant difference in the survival rates between those patients undergoing allogeneic or autologous transplantations, 11 (33.3 percent) vs 3 (30.0 percent), respectively. Twenty-seven (62.8 percent) of the admissions resulted in mechanical ventilation and were performed in 20 (66.7 percent) patients with allogeneic BMTs and 7 (70.0 percent) patients with autologous BMTs, which was not significantly different. The survival rate for those requiring mechanical ventilation was significantly less than for those not mechanically ventilated during their MICU stay, 1 (3.7 percent) vs 13 (81.3 percent), respectively (p<0.001). Those patients who did not survive their MICU stay had a significantly higher mean APACHE II score of 21.2 +/- 4.7 than the survivors' score of 15.8 +/- 3.8 (p<0.001). The average length of stay for the survivors was 4.4 + 3.0 days, which was significantly less than the 17.8 +/- 24.0 days for those patients not surviving (p<0.001). These data indicate that admission to the MICU may result in a beneficial outcome for critically ill patients with BMTs, but for those requiring mechanical ventilation due to respiratory failure, the chances of survival are poor. This information may be useful for providing patients with BMTs and their families with realistic estimates of prognosis prior to transfer to the MICU and mechanical ventilation.
AD
Department of Medicine, Hahnemann University, Philadelphia 19102.
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10
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Efficacy of intensive care for bone marrow transplant patients with respiratory failure.
AU
Denardo SJ, Oye RK, Bellamy PE
SO
Crit Care Med. 1989;17(1):4.
 
We reviewed the ICU courses of 50 bone marrow transplant recipients treated for respiratory problems. Seven of nine postoperative patients survived compared to one of 40 patients with progressive interstitial pneumonia. Nonsurvivors accounted for 94% of the ICU days, 98% of intubated days, and 99% of blood products used. All survivors were extubated within 4 days. Intensive respiratory care is effective for patients with readily reversible causes of respiratory failure, but is generally futile for patients with progressive interstitial pneumonia. We recommend providing these patients with realistic prognostic estimates early in their treatment.
AD
Division of General Internal Medicine and Health Services Research, UCLA School of Medicine 90024-1736.
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11
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Prognosis of patients receiving intensive care for lifethreatening medical complications of haematological malignancy.
AU
Lloyd-Thomas AR, Wright I, Lister TA, Hinds CJ
SO
Br Med J (Clin Res Ed). 1988;296(6628):1025.
 
The mortality of patients admitted to intensive care units with haematological malignancy is high. A humane approach to the management of the critically ill as well as efficient use of limited resources requires careful selection of those patients who are most likely to benefit from intensive care. To delineate more accurately the factors influencing outcome in these patients the records of 60 consecutive admissions to the intensive care unit (37 male, 23 female) with haematological malignancy were reviewed retrospectively. Fifty patients were in acute respiratory failure, most commonly (34 patients) with a combination of pneumonia and septicaemic shock. The severity of the acute illness was assessed by the APACHE II (acute physiology and chronic health evaluation II) score and number of organ systems affected. Thirteen patients survived to leave hospital. The mortality of patients with haematological malignancy was consistently higher than predicted from a large validation study of APACHE II in a mixed population of critically ill patients. Moreover, no patient with an APACHE II score of greater than 26 survived. Mortality among the 22 patients with relapsed malignancy (21 deaths), was significantly higher than among the 35 patients at first presentation (26 deaths). On discharge from the intensive care unit all survivors had responded well to chemotherapy and had normal or raised peripheral white cell counts. They includedseven patients who had recovered from leucopenia (white cell count less than 0.5 X 10(9)/l). In contrast, 36 of the 47 patients who died were leucopenic at the time of death. The overall mortality of critically ill patients with haematological malignancy is higher than equivalently ill patients without cancer. The dysfunction of an increasing number of organ systems, an APACHE II score of greater than 30, failure of the malignancy to respond to chemotherapy, and persistent leucopenia all point to a poor outcome.
AD
St Bartholomew's Hospital, London.
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12
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Precedents for meaningful recovery during treatment in a medical intensive care unit. Outcome in patients with hematologic malignancy.
AU
Schuster DP, Marion JM
SO
Am J Med. 1983;75(3):402.
 
The medical records of 77 patients with hematologic malignancy who were admitted to a medical intensive care unit over a 21-month period were reviewed. The overall hospital mortality rate was 80 percent. Sixteen patients (21 percent) were discharged from the intensive care unit but eventually died in the hospital. The cause of death was the result of a new problem in only three of these 16 patients. Hypotension (shock) and acute respiratory failure were the reasons prompting admission to the intensive care unit in 75 percent, but death in the intensive care unit was almost always the result of intractable hypotension rather than refractory hypoxemia. Only four of 52 patients who required mechanical ventilation left the hospital. In all four, the duration of ventilatory support was less than five days and the cause of respiratory failure was noninfectious in nature. Factors such as congestive heart failure, leukopenia, and abnormalities in mental status modified the hospital course, but did not alter outcome once prolonged mechanical ventilation became necessary. The data suggest that once acute respiratory failure develops in patients with lymphoma or leukemia, presumably as a result of infection, and mechanical ventilation for more than a relatively brief period is required, the prognosis is uniformly grim. Decisions to limit aggressive therapies is subsets of intensive care patients such as these should be aided by data that show a lack of precedent for meaningful recovery.
AD
PMID
13
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Survival outcome among 54 intubated pediatric bone marrow transplant patients.
AU
Todd K, Wiley F, Landaw E, Gajewski J, Bellamy PE, Harrison RE, Brill JE, Feig SA
SO
Crit Care Med. 1994;22(1):171.
 
OBJECTIVES: To assess the outcome of children who required endotracheal intubation after bone marrow transplantation and to determine whether prognostic indicators that might assist decision-making regarding the institution of mechanical ventilation could be identified.
DESIGN: Retrospective chart review.
SETTING: Critical care, reverse isolation unit at a university hospital.
PATIENTS: Fifty-four pediatric bone marrow transplant recipients who required endotracheal intubation.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The following variables were assessed for effect on survival: a) the presence of additional nonhematoporetic organ system failure; b) the duration of required ventilatory assistance; c) the etiology of respiratory failure; d) the presence of significant graft vs. host disease; and e) the underlying disease for which the transplant was done. Six of 54 intubated pediatric bone marrow transplant recipients were extubated and discharged from the hospital. No patient with a diagnosis of leukemia or with multiple organ system failure could be extubated or discharged from the hospital. The presence of pulmonary parenchymal disease indicated poor prognosis for survival.
CONCLUSIONS: The decision to intubate a pediatric bone marrow transplant patient remains a difficult one. In this population, multiple organ system failure and primary pulmonary parenchymal disease were associated with a high mortality rate. These factors should be taken into account before and throughout the course of mechanical ventilation in this patient population.
AD
Gwynne Hazen Cherry Memorial Laboratories, Department of Pediatrics, UCLA School of Medicine 90024-1752.
PMID
14
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The role of an intensive care unit in a cancer center. An analysis of 1035 critically ill patients treated for life-threatening complications editorial.
AU
Turnbull A, Goldiner P, Silverman D, Howland W
SO
Cancer. 1976;37(1):82.
 
Life-threatening complications of cancer therapy often involve multiple organ systems and offer a therapeutic challenge which can be met with efficiency and success by concentrating personnel and equipment in a facility devoted to these problems. Three years ago, an Intensive Care Unit was created at Memorial Cancer Center to offer such patients the benefit of highly skilled nursing, advanced monitoring and supportive techniques, and full-time attendance by physicians and surgeons with a particular interest in Critical Care Medicine. Since then, 1035 patients have been admitted to the eight-bed unit with a mortality rate of 22.3%, which compares favorably with those reported from other institutions. Analysis of this experience has revealed that an average of 16% of those who survived their acute problems after considerable effort and expense, subsequently died of their underlying disease within 2 months. This experience has suggested the need for prognostic criteria to facilitate recognition of those patients for whom intensive supportive measures offer a reasonable chance of worthwhile palliation.
AD
PMID
15
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Improved survival of critically ill cancer patients with septic shock.
AU
LarchéJ, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G, Darmon M, Le Gall JR, Schlemmer B
SO
Intensive Care Med. 2003;29(10):1688.
 
OBJECTIVE: To identify predictors of 30-day mortality in critically ill cancer patients with septic shock.
DESIGN: Retrospective study over a 6-year period.
SETTING: Twelve-bed medical intensive care unit (ICU).
PATIENTS: Eighty-eight patients (55 men, 33 women) aged 55 (43.5-63) years admitted to the ICU for septic shock.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Eighty (90.9%) patients had hematological malignancies and eight (9.1%) had solid tumors; 47 patients (53.4%) were neutropenic, 19 (21.6%) were hematopoietic stem cell transplantation (HSCT) recipients, and 27 (30.7%) were in remission. Microbiologically documented infections were found in 60 (68.2%) patients. The Simplified Acute Physiologic Score II (SAPS II) and Logistic Organ Dysfunction (LOD) scores at ICU admission were 66 (47-89) and 7 (5-10), respectively, and the LOD score on day 3 was 8 (4-10). Sixty-eight (78.1%) patients received invasive mechanical ventilation (MV), 12 (13.6%) noninvasive MV, 22 (25%) dialysis. Thirty-day mortality was 65.5% (57/88). By multivariable analysis, mortality was higher when time to antibiotic treatment was>2 h [odds ratio (OR), 7.05; 95% confidence interval (95% CI), 1.17-42.21]and when DLOD (day 3-day 1 LOD score/day 3 LOD score) was high (OR, 3.47; 95% CI, 1.44-8.39); mortality was lower when admission occurred between 1998 and 2000 (OR, 0.23; 95% CI, 0.05-0.98) and when initial antibiotics were adapted (OR, 0.24; 95% CI, 0.06-0.09).
CONCLUSIONS: Earlier ICU admission and antibiotic treatment of critically ill cancer patients with septic shock is associated with higher 30-day survival. The LOD score change on day 3 as compared to admission is useful for predicting survival.
AD
Medical ICU of the Saint-Louis Teaching Hospital and Paris 7 University, Assistance Publique-Hôpitaux de Paris, 1 Av Claude Vellefaux, 75010 Paris, France.
PMID
16
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Prognosis of lung cancer patients with life-threatening complications.
AU
Soares M, Darmon M, Salluh JI, Ferreira CG, Thiéry G, Schlemmer B, Spector N, Azoulay E
SO
Chest. 2007;131(3):840.
 
BACKGROUND: The management of patients with lung cancer has improved recently, and many of them will require admission to the ICU. The aims of this study were to determine hospital mortality and to identify risk factors for death in a large cohort of critically ill patients.
METHODS: Cohort study in two ICUs specialized in the management of patients with cancer, in France and Brazil.
RESULTS: Of the 143 patients (mean age, 61.6 +/- 9.9 years [+/- SD]), 25 patients (17%) had small cell lung cancer and 118 patients (83%) had non-small cell lung cancer. The main reasons for ICU admission were sepsis (44%) and acute respiratory failure (31%). Mechanical ventilation (MV) was used in 100 patients (70%), including 38 patients in whom lung cancer was considered a reason for MV. Hospital mortality was 59% overall and 69% in patients receiving MV. By multivariate logistic regression, airway infiltration or obstruction by cancer, number of organ failures, cancer recurrence or progression, and severity of comorbidities were associated with increased mortality.
CONCLUSIONS: The improved survival previously reported in patients with cancer admitted to the ICU seems to extend to patients with lung cancer, including those who need MV. Mortality increased with the number of organ failures, severity of comorbidities, and presence of respiratory failure due to cancer progression. The type of the cancer per se was not associated with mortality and, therefore, should not be factored into ICU triage decisions.
AD
Instituto Nacional de Câncer, Centro de Tratamento Intensivo, 10 Andar; Pça. Cruz Vermelha, 23, Rio de Janeiro, Brazil. marciosoaresms@yahoo.com.br
PMID