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Chemotherapy in ICU

Lauren E Arthur, Russell S Kizor, Adrian G Selim, Mieke L van Driel, Leonardo Seoane
BACKGROUND: Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality, complicating the medical course of approximately 10% of mechanically-ventilated patients, with an estimated attributable mortality of 13%. To treat VAP empirically, the American Thoracic Society currently recommends antibiotic therapy based on the patients' risk of colonisation by an organism with multidrug resistance. The selection of initial antibiotic therapy in VAP is important, as inappropriate initial antimicrobial treatment is associated with higher mortality and longer hospital stay in intensive care unit (ICU) patients...
October 20, 2016: Cochrane Database of Systematic Reviews
Beejal R Ganti, Bernard L Marini, Jerod Nagel, Dale Bixby, Anthony J Perissinotti
PURPOSE: This study evaluated the impact of antibacterial prophylaxis with levofloxacin in relapsed/refractory acute myeloid leukemia (AML) patients. METHODS: This was a retrospective, single-center, cohort study. Adult patients with relapsed/refractory AML admitted for reinduction chemotherapy between November 1, 2006 and June 15, 2015 were screened for inclusion. A protocol initiating levofloxacin prophylaxis was implemented on December 1, 2013. Patients receiving hypomethylating agents (decitabine/azacitidine) were not administered antibacterial prophylaxis and thus not included in this analysis...
October 14, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Tarek Assi, Elie El Rassy, Tony Ibrahim, Tania Moussa, Aline Tohme, Fadi El Karak, Fadi Farhat, Salma Faddoul, Marwan Ghosn, Joseph Kattan
INTRODUCTION: One major health care issue encountered in elderly cancer patients is the alteration of the quality of life. The purpose of our study is to evaluate the administration of chemotherapy in the last month of life (CLML) and to evaluate the impact of the palliative care consult (PCC) in the elderly patients. METHODS: We conducted a retrospective observational study that included elderly patients diagnosed with an end-stage cancer and who were deceased between the 1st of January 2012 and the 31st of December 2015...
October 13, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
G Lachmann, P La Rosée, T Schenk, F M Brunkhorst, C Spies
BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) has well been studied as a genetic disorder in children (primary HLH). Mutations in the regulatory complex of the cellular immune synapse lead to a loss of function of cytotoxic T‑cells and natural killer cells with excessive inflammation based on a cytokine storm. During the last decade, an increasing number of adult HLH patients without a family history of HLH (secondary or acquired HLH) have been reported. Various triggers - infections, malignancies or autoimmune diseases - result in an acquired loss of function of these cells and a sepsis-like disease...
October 2016: Der Anaesthesist
John Spiliotis, Eleftherios-Orestis Argiriou, Nikolaos Kopanakis, Nikolaos Vaos, Athanasios Rogdakis, Kalliopi Kastrinaki, Archondia Vaxevanidou, Maria Zakka, Urania Kalaidopoulou, Elias Efstathiou
PURPOSE: Peritoneal metastasis (PM) is nowadays treated with the complex procedure of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS+HIPEC). Given the fact that the procedure presents high morbidity and mortality rates, admitting patients to the Intensive Care Unit (ICU) seems inevitable. In our study, we have tried to determine the factors that indicate when admission in the ICU is necessary. METHODS: We retrospectively analyzed 230 patients (140 females, 90 males) with PM, who were operated on from November 2005 until October 2015, and underwent CRS+HIPEC...
May 2016: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
Shi-Yi Wang, Jane Hall, Craig E Pollack, Kerin Adelson, Amy J Davidoff, Jessica B Long, Cary P Gross
BACKGROUND: The purpose of this study was to examine the extent to which patterns of intensive end-of-life care explain geographic variation in end-of-life care expenditures among cancer decedents. METHODS: Using the SEER-Medicare database, we identified 90,465 decedents who were diagnosed with cancer in 2004-2011. Measures of intensive end-of-life care included chemotherapy received within 14 days of death; more than 1 emergency department visit, more than 1 hospitalization, or 1 or more intensive care unit (ICU) admissions within 30 days of death; in-hospital death; and hospice enrollment less than 3 days before death...
August 2016: Journal of the National Comprehensive Cancer Network: JNCCN
Kelly D Getz, Tamara P Miller, Alix E Seif, Yimei Li, Yuan-Shung Huang, Todd Alonzo, Robert Gerbing, Lillian Sung, Matthew Hall, Rochelle Bagatell, Alan Gamis, Brian T Fisher, Richard Aplenc
Previous data suggest that patients enrolled on clinical trials for treatment of cancer have better overall survival than patients who do not enroll; however, short-term outcomes relative to trial enrollment and corresponding mediators have not been assessed. A cohort of pediatric patients with newly-diagnosed acute myeloid leukemia was assembled from the Pediatric Health Information System. We evaluated whether patients not enrolled onto Children's Oncology Group trial AAML0531 had greater intensive care unit (ICU)-level requirements than enrolled patients and whether early discharge after chemotherapy administration mediated this association...
September 2016: Cancer Medicine
Rohan Gupta, Neda Heshami, Chouhan Jay, Naveen Ramesh, Juhee Song, Xiudong Lei, Erfe Jean Rose, Kristen Carter, Dejka M Araujo, Robert S Benjamin, Shreyaskumar Patel, Joseph L Nates, Vinod Ravi
BACKGROUND: Advances in treatment of sarcoma patients has prolonged survival but has led to increased disease- or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU). Survival and long-term outcome information about such critically ill patients with sarcoma is unknown. METHODS: The primary objective of the study was to determine the ICU and post-ICU survival rates of critically ill sarcoma patients. Secondary objectives included determining the modifiable and non-modifiable predictors of poor survival...
2016: Clinical Sarcoma Research
M Osseis, J Weyrech, E Gayat, S Dagois, R Lo Dico, M Pocard, C Eveno
BACKGROUND: Although Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) confers health benefits in peritoneal carcinomatosis (PC) treatment, it is associated with significant postoperative morbidity and mortality rate with increased length of hospital stay. The goal of this study is to determine whether a new comprehensive physiotherapy program including epidural loco-regional analgesia can improve the quality of care and patients recovery. METHODS: Between 2009 and 2013, 124 patients with PC were operated for CRS and HIPEC procedures...
June 27, 2016: European Journal of Surgical Oncology
Deborah Dudgeon, Vickie E Baracos
PURPOSE OF REVIEW: Loss of skeletal muscle mass and cachexia are important manifestations of chronic obstructive pulmonary disease and have been associated with breathlessness, functional limitation and poor prognosis. A number of other life-limiting illnesses, including cancer and chronic heart failure as well as acute conditions seen in ICU such as sepsis, are characteristically associated with cachexia and sarcopenia. These conditions may have respiratory muscle atrophy of sufficient magnitude to contribute to the development of breathlessness and associated functional limitation...
September 2016: Current Opinion in Supportive and Palliative Care
M Cardona-Morrell, Jch Kim, R M Turner, M Anstey, I A Mitchell, K Hillman
PURPOSE: To investigate the extent of objective 'non-beneficial treatments (NBTs)' (too much) anytime in the last 6 months of life in routine hospital care. DATA SOURCES: English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995-April 2015). STUDY SELECTION: All study types assessing objective dimensions of non-beneficial medical or surgical diagnostic, therapeutic or non-palliative procedures administered to older adults at the end of life (EOL)...
September 2016: International Journal for Quality in Health Care
Laura A Hatfield, Haiden A Huskamp, Elizabeth B Lamont
PURPOSE: Elderly patients with cancer are under-represented in clinical trials and risk greater toxicity from chemotherapy. These patients and their physicians need better evidence to decide among guideline-recommended regimens. We test whether patients with extensive-stage small-cell lung cancer (ES SCLC) have noninferior survival and less hospital-based health care after carboplatin/etoposide compared with cisplatin/etoposide. METHODS: We analyzed SEER-Medicare data for beneficiaries with ES SCLC diagnosed at age 67 years and older between 1995 and 2009...
July 2016: Journal of Oncology Practice
Lanocha Aleksandra, Zdziarska Barbara, Lanocha-Arendarczyk Natalia, Kosik-Bogacka Danuta, Guzicka-Kazimierczak Renata, Marzec-Lewenstein Ewa
In industrialized countries, risk groups for parasitic diseases include travelers, recent immigrants, and patients with immunodeficiency following chemotherapy and radiotherapy and AIDS. A 66-year-old Polish male was admitted in December 2012 to the Department of Haematology in a fairly good general condition. On the basis of cytological, cytochemical, immunophenotypic, and cytogenetic analysis of bone marrow, the patient was diagnosed with acute myeloblastic leukemia. On the 7th day of hospitalization in the Department of Haematology, patient was moved to the Intensive Care Unit (ICU) due to acute respiratory and circulatory failure...
2016: Case Reports in Infectious Diseases
Damien Guinault, Emmanuel Canet, Antoine Huart, Arnaud Jaccard, David Ribes, Laurence Lavayssiere, Marion Venot, Olivier Cointault, Murielle Roussel, Marie-Béatrice Nogier, Claire Pichereau, Virginie Lemiale, Bertrand Arnulf, Michel Attal, Dominique Chauveau, Elie Azoulay, Stanislas Faguer
Amyloidosis is a rare and threatening condition that may require intensive care because of amyloid deposit-related organ dysfunction or therapy-related adverse events. Although new multiple myeloma drugs have dramatically improved outcomes in AL amyloidosis, the outcomes of AL patients admitted into intensive care units (ICUs) remain largely unknown. Admission has been often restricted to patients with low Mayo Clinic staging and/or with a complete or very good immunological response at admission. In a retrospective multicentre cohort of 66 adult AL (n = 52) or AA (n = 14) amyloidosis patients, with similar causes of admission to an ICU, the 28-d and 6-month survival rates of AA patients were significantly higher compared to AL patients (93% vs...
September 2016: British Journal of Haematology
Kathleen Kerrigan, Abigail Shoben, Gregory Otterson
BACKGROUND: Patients with advanced-stage non-small-cell lung cancer (NSCLC) have high mortality rates in the intensive care unit (ICU). Although the benefit of chemotherapy for hematologic malignancies in the ICU has previously been explored, few data exist regarding the use of targeted therapy for NSCLC in such settings. The primary objective of the present study was to report our experience with the use of targeted therapy in patients with NSCLC in the ICU. MATERIALS AND METHODS: We performed a single-institution, retrospective medical record review...
May 5, 2016: Clinical Lung Cancer
Mireen Friedrich-Rust, Beate Wanger, Florian Heupel, Natalie Filmann, Reinhard Brodt, Volkhard Aj Kempf, Johanna Kessel, Thomas A Wichelhaus, Eva Herrmann, Stefan Zeuzem, Joerg Bojunga
AIM: To assess the rate of infection, appropriateness of antimicrobial-therapy and mortality on intensive care unit (ICU). Special focus was drawn on patients with liver cirrhosis. METHODS: The study was approved by the local ethical committee. All patients admitted to the Internal Medicine-ICU between April 1, 2007 and December 31, 2009 were included. Data were extracted retrospectively from all patients using patient charts and electronic documentations on infection, microbiological laboratory reports, diagnosis and therapy...
April 28, 2016: World Journal of Gastroenterology: WJG
Chao Wang, Chang Wang, Zhidong Gao, Bin Liang, Xiaodong Yang, Mujun Yin, Kewei Jiang, Qiwei Xie, Shan Wang, Yingjiang Ye, Peng Guo
OBJECTIVE: To evaluate the factors affecting perineal incision complications after abdominperineal excision(APE) for rectal cancer. METHODS: This was a retrospective study of 167 patients with rectal cancer undergoing APE at Peking University People's Hospital between October 1998 and December 2013. Chi-square test and multivariate Logistic regression analysis were used to identify risk factors. RESULTS: The overall rate of perineal incision complication was 24...
April 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Samantha K Hart, Lori Waddell Dvm
OBJECTIVE: To describe a case of suspected drug-induced infiltrative lung disease (ILD) and acute respiratory failure associated with the administration of cytarabine and prednisone in a dog requiring mechanical ventilation. CASE SUMMARY: A 4.5-year-old, female spayed Yorkshire Terrier presented to the ICU with acute onset of respiratory distress following a 24-hour cytarabine infusion. The patient was previously diagnosed with meningoencephalitis of unknown etiology (MUO), caudal occipital malformation, and syringohydromyelia, and was being treated with oral prednisone and levetiracetam, and cytarabine infusions...
April 8, 2016: Journal of Veterinary Emergency and Critical Care
F Wallet, D Maucort Boulch, S Malfroy, S Ledochowski, C Bernet, V Kepenekian, G Passot, O Vassal, V Piriou, O Glehen, A Friggeri
BACKGROUND: Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) are promising new approaches of peritoneal metastases. However these surgical procedures are associated with a high morbidity rate thus intensive care (IC) management following serious complications may be warranted for these patients. The impact of the prolonged IC stay or re-admission on long-term survival remains unknown. METHODS: We retrospectively analysed 122 consecutive HIPEC procedures over a one year period (2010-2011) in a single academic hospital...
June 2016: European Journal of Surgical Oncology
I Gallais Sérézal, Y Beaussant, P Rochigneux, C Tournigand, R Aubry, B Lindelöf, L Morin
BACKGROUND: Although the aggressiveness of end-of-life cancer care has come under great scrutiny over the past two decades, little is known about the intensity of care and treatments in the last months of life of patients with metastatic melanoma. OBJECTIVES: To measure the prevalence of aggressive cancer care use, and to assess the frequency of palliative care referral over the course of the last 3 months of life of hospitalized patients who died from metastatic melanoma...
September 2016: British Journal of Dermatology
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