Clinical characteristics of critically ill cancer patients who are undergoing isolated limb perfusion

Abstract

The aim of the present study was to investigate the incidence of organ dysfunction, and to describe the clinical characteristics and intensive care unit (ICU) outcomes of critically ill cancer patients who were admitted to an oncological ICU during the isolated limb perfusion post-operative period. The present study was an observational investigation of 42 critically ill cancer patients who were admitted to the ICU of the Instituto Nacional de Cancerología, during the isolated limb perfusion post-operative period, between July 2010 and February 2016. The mean age of the patients was 45.7±16.9 years, and 45.2% (19 cases) were female. Soft tissue sarcoma was the most common pre-operative diagnosis (38.1%), and the mean duration of surgery was 267.6±50.1 min. Furthermore, a mean blood loss volume of 732.3±526.1 ml during the procedure was recorded, and the patients received a mean volume of 3.88±1.28 l crystalloid fluid during the surgical procedure, subsequently requiring an additional 2.95±6.28 l on the first post-operative day. The incidence of organ dysfunction was 90.5% and was most frequently noted in the respiratory (81%), hepatic (33%), hematologic (31%) and renal (11.9%) systems. No patients succumbed to the disease during the ICU and hospital stay. Nevertheless, <10% of the patients required vasopressors. Additionally, <5% of the patients required invasive mechanical ventilation. Therefore, ICU admission directly following isolated limb perfusion should not be standardized.

The Use of Regional Anesthesia to Reduce Blood Loss in Isolated Limb Perfusion (ILP)—A Novel Approach

“…Due to these complex processes, ILP regularly leads to a blood loss of approx. 1000-1500 mL/patient [14,15]. With >200 ILPs in the last 15 years, we observed a constant low-threshold systemic blood loss from the central blood circulation to the limb circulation with the start of ILP.…”

“…Neither of these conditions are met during ILP. Namendys-Silva et al [15] reported on the clinical characteristics of critically ill cancer patients undergoing ILP with TNF-a and melphalan. Parameters such as diagnosis, localization, duration of surgery, and perioperative volume replacement were comparable to our cohort.…”