Tribulations of conducting critically ill cancer patients research: Lessons from a failed septic shock trial and Murphy's law

Reyes, María Pérez; Cuenca, John; Heatter, Juliana; Martin, P.R.; Villalobos, Danny; Nates, Joel

doi:10.1016/j.medin.2021.10.007

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…Sixty-six patients (50%) had hematological tumors, 66 (50%) had solid tumors, and most patients had active malignancy (72.6%). The median SOFA scores at ICU admission were similar in both groups (12 [IQR,(8)(9)(10)(11)(12)(13)(14)(15) vs. 10 [IQR, 8-12.5]; p = 0.071). Additional clinical characteristics are displayed in the Table 1.…”

Section: Resultsmentioning

confidence: 91%

“…The relatively small cohort and subgroup sizes could opaque relevant clinical differences. Larger cancer registries that include patients with septic shock defined using Sepsis-3 criteria are needed and could help elucidate the impact of sepsis in their long-term survival; however, such research endeavors can be challenging, especially in critically ill patients (14).…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Survival of Patients With Cancer, Sepsis, and Vasopressor Requirements Based on Lactate Levels

Cuenca,

Nates,

Laserna

et al. 2024

Critical Care Explorations

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A prospective cohort study was conducted to evaluate the 1-year survival of cancer patients with sepsis and vasopressor requirements. Eligible patients were admitted a Comprehensive Cancer Center’s ICU and were compared based on their admission lactate levels. Of the 132 included patients, 87 (66%) had high lactate (HL; > 2.0 mmol/L), and 45 (34%) had normal lactate (NL; ≤ 2.0 mmol/L). The 1-year survival rates of the two groups were similar (HL 16% vs. NL 18%; p = 0.0921). After adjustment for ICU baseline characteristics, HL was not significantly associated with a 1-year survival (Hazards ratio, 1.39; 95% CI, 0.94–2.05). Critically ill cancer patients with sepsis and vasopressor requirements, regardless of the lactate level, had 1-year survival of less than 20%. Large multicenter cancer registries would enable to confirm our findings and better understand the long-term trajectories of sepsis in this vulnerable population.

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Section: Resultsmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Long-Term Survival of Patients With Cancer, Sepsis, and Vasopressor Requirements Based on Lactate Levels

Cuenca,

Nates,

Laserna

et al. 2024

Critical Care Explorations

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“…As the use of checkpoint inhibitors continue to expand, the incidence of rare side effects such as OS will also increase. Despite the difficulties conducting research in critically ill cancer patients [ 48 ], large cohorts studies are required to understand the characteristics and outcomes of patients with OS.…”

Section: Discussionmentioning

confidence: 99%

Management of respiratory failure in immune checkpoint inhibitors-induced overlap syndrome: a case series and review of the literature

Cuenca,

Hanmandlu,

Wegner

et al. 2023

BMC Anesthesiol

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Background Checkpoint inhibitor-induced overlap syndrome ([OS] myocarditis, and myositis with or without myasthenia gravis) is rare but life-threatening. Cases presentation Here we present a case series of four cancer patients that developed OS. High troponinemia raised the concern for myocarditis in all the cases. However, the predominant clinical feature differed among the cases. Two patients showed marked myocarditis with a shorter hospital stay. The other two patients had a prolonged ICU stay due to severe neuromuscular involvement secondary to myositis and myasthenia gravis. Treatment was based on steroids, plasmapheresis, intravenous immunoglobulin, and immunosuppressive biological agents. Conclusion The management of respiratory failure is challenging, particularly in those patients with predominant MG. Along with intensive clinical monitoring, bedside respiratory mechanics can guide the decision-making process of selecting a respiratory support method, the timing of elective intubation and extubation.

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“…Variability in research productivity has also been reported among countries within the same region. Despite the difficulties encountered (64), developing research capacity-building programs in countries with low research productivity is essential to better understand critical illnesses and to improve the outcomes of patients worldwide (65, 66).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs

Nazer

López-Olivo

Brown

et al. 2022

Critical Care Explorations

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Tribulations of conducting critically ill cancer patients research: Lessons from a failed septic shock trial and Murphy's law

Cited by 7 publications

References 7 publications

Long-Term Survival of Patients With Cancer, Sepsis, and Vasopressor Requirements Based on Lactate Levels

Long-Term Survival of Patients With Cancer, Sepsis, and Vasopressor Requirements Based on Lactate Levels

Management of respiratory failure in immune checkpoint inhibitors-induced overlap syndrome: a case series and review of the literature

A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs

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