Critically ill cancer patient in intensive care unit: Issues that arise

Kostakou, Eirini; Rovina, Nikoletta; Kyriakopoulou, Magdalini; Koulouris, Nikolaos; Koutsoukou, Antonia

doi:10.1016/j.jcrc.2014.04.007

Cited by 78 publications

(56 citation statements)

References 80 publications

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“…Only one of the selected studies did address such an important comorbidity (25). Since the diagnosis 'cancer' influences intensive care markedly (29) and has certain consequences on the long-term care of surviving ARDSpatients, the high number of cancer patients in the cohort by Vincent et al (25) and in the present cohort has an impact for the health care system and should be re-evaluated in large cohorts.…”

Section: Discussionmentioning

confidence: 82%

Characteristics and provision of care of patients with the acute respiratory distress syndrome: descriptive findings from the DACAPO cohort baseline and comparison with international findings

Dodoo‐Schittko¹,

Brandstetter²,

Brandl³

et al. 2017

J. Thorac. Dis.

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Background: Little is known about the characteristics and real world life circumstances of ARDS (acute respiratory distress syndrome) patient populations. This knowledge is essential for transferring evidencebased therapy into routine healthcare. The aim of this study was to report socio-demographic and clinical characteristics in an unselected population of ARDS patients and to compare these results to findings from other large ARDS cohorts. Methods: A German based cross-sectional observational study was carried out. A total of 700 ARDS patients were recruited in 59 study sites between September 2014 and January 2016. Socio-demographic, disease and care related variables were recorded. Additionally, characteristics of other large ARDS cohorts identified by a systematic literature search were extracted into evidence tables.Results: Median age of ARDS patients was 58 years, 69% were male. Sixty percent had no employment, predominantly due to retirement. Seventy-one percent lived with a partner. The main cause of ARDS was a pulmonary 'direct' origin (79%). The distribution of severity was as follows: mild (14%), moderate (48%), severe (38%). Overall ICU mortality was calculated to be 34%. The observed prevalence of critical events (hypoxemia, hypoglycemia, re-intubation) was 47%. Supportive measures during ICU-treatment were applied to 60% of the patients. Other ARDS cohorts revealed a high heterogeneity in reported concomitant diseases, but sepsis and pneumonia were most frequently reported. Mean age ranged from 54 to 71 years and most patients were male. Other socio-demographic factors have been almost neglected.

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Section: Discussionmentioning

confidence: 82%

Characteristics and provision of care of patients with the acute respiratory distress syndrome: descriptive findings from the DACAPO cohort baseline and comparison with international findings

Dodoo‐Schittko¹,

Brandstetter²,

Brandl³

et al. 2017

J. Thorac. Dis.

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“…(10) Ethical dilemmas and conflicts mainly stem from lack of alignment with palliative care principles, as per the recommendations of the World Health Organization, when dealing with life-threatening chronic diseases and the need to implement palliative measures from the time of diagnosis, although the usefulness of these is much clearer and more evident as the disease progresses and reaches high levels of suffering, where medicine can no longer work against the disease, but in favor of the person. (11)(12)(13)(14) The need for early integration of curative and palliative care in ICUs has been addressed in the literature. Among the various strategies to promote this practice, there is unanimous agreement about ongoing investment in health professionals, since, regardless of the model to be followed, they will have the means to recognize patients in need of palliative care, make a better diagnosis and even screen those eligible or not for intensive care.…”

Section: "I've Worked In Other Icus and There Is A Comparison Of End-mentioning

confidence: 99%

Planejamento da assistência ao paciente em cuidados paliativos na terapia intensiva oncológica

et al. 2017

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Objective: To study the understanding of health professionals in relation to end-of-life patient care in an oncology intensive care unit, and discuss the objectives they seek to achieve when planning care from a palliative point of view. Methods: Descriptive study, with a qualitative approach, conducted in the adult ICU of a cancer hospital. Twenty-five professionals participated in the study: 12 nurses, eight physicians, two nutritionists and three physiotherapists. The inclusion criterion was: working in the sector for one year or more. Professionals on vacation or medical leave during the data collection, which took place between December 2015 and May 2016, were excluded. The data collection technique used was the semi-structured interview. Thematic content analysis was employed to analyze the data, in the following stages: preanalysis; exploration of the material or codification; treatment of the results, inference and interpretation. Results: The three categories encompass contextual particularities according to the severity of the cases, disease stages and treatments, end-of-life condition, medication and management difficulties. However, a need was noted to promote comfort, attend to families and invest in the integration of palliative and critical care. Conclusion: Care planning from a palliative perspective in this context is in the initial stages; challenges for putting it into practice are listed, with a concern to humanize care. It is suggested to use an interconsultive model for integration of specialties, through institutional characteristics. ResumoObjetivo: Analisar o entendimento dos profissionais de saúde acerca da assistência ao paciente em cuidados ao fim da vida na unidade de terapia intensiva (UTI) oncológica, e discutir os objetivos que buscam alcançar ao planejar a assistência na perspectiva dos cuidados paliativos. Métodos: Estudo descritivo, com abordagem qualitativa, realizado na UTI adulto de um Hospital do Câncer. Participaram do estudo 25 profissionais: 12 enfermeiros, oito médicos, dois nutricionistas e três fisioterapeutas. Respeitou-se o critério de inclusão: estar atuando no setor por tempo maior ou igual a um ano. Foram excluídos profissionais de férias e de licença médica durante o período de coleta de dados, que transcorreu entre dezembro de 2015 a maio de 2016. A técnica de coleta de dados foi a entrevista semiestruturada. Para análise dos dados utilizou-se a análise de conteúdo temática, seguindo as etapas: pré-análise; exploração do material ou codificação; tratamento dos resultados, inferência e interpretação. Resultados: As três categorias abrangem particularidades contextuais pela gravidade dos casos, fases da doença e tratamentos, terminalidade da vida, medicalização e dificuldades gerenciais. Entretanto, evidenciou-se a necessidade de promover conforto, atender a família, e investir na integração dos cuidados paliativos e críticos. Conclusão: O planejamento assistencial na perspectiva dos cuidados paliativos no contexto é incipiente; elencam-se desafios para a...

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“…En revanche, des facteurs pronostiques ont été explorés dans d'autres tumeurs solides et dans les hémopathies malignes. Ces études, combinées aux études menées en cancéro-logie, ont permis de dégager plusieurs messages importants guidant l'admission en réanimation d'un patient souffrant de cancer [10,11]. En l'absence d'études spécifiques, ces recommandations peuvent être raisonnablement étendues aux patients souffrant de TCPM.…”

Section: Aggravations Liées Au Traitementunclassified

“…diagnostics et traitements non invasifs) réalisées ces dernières décennies dans les stratégies de réanimation ont permis d'améliorer le pronostic des patients souffrant de cancer [10]. Le taux de mortalité globale des patients oncologiques est passé de 90 % en 1990, à 50 % en 2010, [11,12] se rapprochant progressivement de celui de la population générale des patients en réa-nimation.…”

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Avancées dans les tumeurs cérébrales primitives malignes de l’adulte : quels patients transférer en réanimation médicale?

Alentorn

Weiss²,

Delattre

et al. 2015

Réanimation

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International audienceRecent therapeutic advances have allowed improving prognosis and quality of life of adult patients suffering from malignant primary brain tumors (MPBT), sometimes after a transient medical support in the intensive care unit (ICU). Indeed, patients with MPBT may have, during the course of their neuro-oncological disease, organ failure(s) due to: (i) a destabilization of pre-existing chronic conditions; (ii) an acute pathology unrelated to MPBT; (iii) a complication of MPBT; and/or (iv) complications induced by anti-tumor treatments. The short-term and the long-term benefits of an ICU stay for patients with MPBT are not clearly documented in the literature. A dedicated study, including recent advances in the field of MPBT, would participate to remove the historical brake associated with admission of MPBT patients in ICU. Due to the lack of medical and scientific evidences, admission of MPBT patients in ICU requires a multidisciplinary discussion between the neuro-oncologist, the intensivist, the relatives of the patient and the family of the patient. This discussion will also incorporate patient’s advanced directives registered during the first visit, the prognosis and the therapeutic perspectives of the MPBT and the acute affection. Further prospective clinical studies will modulate with higher level of evidence these recommendations.Les progrès thérapeutiques réalisés ces dernières années ont permis d’améliorer de manière significative le pronostic et la qualité de vie des patients souffrant de tumeurs cérébrales primitives malignes (TCPM), au prix parfois d’une prise en charge transitoire en réanimation médicale. En effet, les patients présentant une TCPM peuvent présenter au cours de leur maladie une défaillance d’organe en rapport avec : (i) une décompensation d’une affection chronique préexistante ; (ii) une pathologie aiguë indépendante de leur TCPM ; (iii) une complication de la TCPM ; et/ou (iv) une complication des traitements de la TCPM. Le bénéfice, immédiat et à long terme, d’un séjour en réanimation pour les patients souffrant spécifiquement de TCPM n’est pas clairement documenté dans la littérature. Une étude dédiée, intégrant notamment les progrès thérapeutiques récents dans la thématique, permettrait de lever le frein historique associé à la prise en charge en réanimation des patients présentant une TCPM. En l’absence de standard de prise en charge médicale, le transfert en réanimation nécessite en effet une discussion collégiale entre le neuro-oncologue, le réanimateur, les proches du patient et la personne de confiance du patient. Cette discussion devra également intégrer les directives anticipées du patient consignées lors de la consultation d’annonce, le pronostic et les perspectives thérapeutiques de la TCPM et de l’affection aiguë. Des études cliniques, idéalement prospectives, permettraient de moduler avec un niveau de preuve supérieur ces recommandations

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Critically ill cancer patient in intensive care unit: Issues that arise

Cited by 78 publications

References 80 publications

Characteristics and provision of care of patients with the acute respiratory distress syndrome: descriptive findings from the DACAPO cohort baseline and comparison with international findings

Characteristics and provision of care of patients with the acute respiratory distress syndrome: descriptive findings from the DACAPO cohort baseline and comparison with international findings

Planejamento da assistência ao paciente em cuidados paliativos na terapia intensiva oncológica

Avancées dans les tumeurs cérébrales primitives malignes de l’adulte : quels patients transférer en réanimation médicale?

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