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Susilo Chandra, Hrishikesh Kulkarni, Martin Westphal
Red blood cell (RBC) transfusion might be life-saving in settings with acute blood loss, especially uncontrolled haemorrhagic shock. However, there appears to be a catch-22 situation reflected by the facts that preoperative anaemia represents an independent risk factor for postoperative morbidity and mortality, and that RBC transfusion might also contribute to adverse clinical outcomes. This dilemma is further complicated by the difficulty to define the "best" transfusion trigger and strategy. Since one size does obviously not fit all, a personalised approach is merited...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
Saadia A Faiz, Priyanka Pathania, Juhee Song, Liang Li, Diwakar D Balachandran, David E Ost, Rodolfo C Morice, Vickie R Shannon, Lara Bashoura, Georgie A Eapen, Carlos A Jimenez
RATIONALE: Placement of an indwelling pleural catheter is an established modality for symptom relief and pleurodesis in the treatment of malignant pleural effusion. Concerns remain regarding possible infectious complications, risk of hemorrhage, and the rate of pleurodesis with the use of pleural catheters in the treatment of hematologic malignancies. OBJECTIVES: The goals of our study were: (1) to evaluate the safety and cumulative incidence of pleurodesis with indwelling pleural catheters for patients with hematologic malignancies, and (2) to evaluate overall survival of this cohort of patients with pleural effusions...
June 2017: Annals of the American Thoracic Society
Jeffrey I Weitz
Direct oral anticoagulants (DOACs) are increasingly used for prevention and treatment of venous thromboembolism and for prevention of stroke in patients with nonvalvular atrial fibrillation. In phase III clinical trials that included more than 100,000 patients, the DOACs were at least as effective as vitamin K antagonists (VKAs) and were associated with less serious bleeding, particularly less intracranial bleeding. Real-world evidence supports these outcomes. Despite this, some physicians and patients are concerned about serious bleeding or emergencies unless specific reversal agents for the DOACs are available...
February 2017: Seminars in Respiratory and Critical Care Medicine
Sam Schulman
Patients treated with anticoagulants have an unavoidable risk of bleeding complications. There are, for all oral anticoagulants, several potential options for management of major bleeding. The first action is to assess the causative role of the anticoagulant in the current bleeding. Supportive measures have been assessed in several post hoc analyses of the phase III pivotal trials with the non-vitamin K antagonist oral anticoagulants (NOACs). Those results will be reviewed here together with emerging data on the efficacy and safety of the specific antidotes idarucizumab (for dabigatran) and andexanet-α (for factor Xa inhibitors)...
November 2017: Seminars in Thrombosis and Hemostasis
Silvia Fabiani, Simona Fortunato, Mario Petrini, Fabrizio Bruschi
BACKGROUND: Allogeneic hematopoietic stem cell transplant (HSCT) recipients are at substantial risk for a variety of infections depending upon numerous factors, such as degree of immunosuppression, host factors, and period after transplantation. Bacterial, fungal, viral, as well as parasitic infections can occur with high morbidity and mortality. OBJECTIVES: The aim of this study was to evaluate the magnitude of the occurrence of parasitic infections in allogeneic HSCT recipients...
April 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Kenneth K Sakata, Christine L Klassen, Kathryn B Bollin, Thomas E Grys, James L Slack, Lewis J Wesselius, Holenarasipur R Vikram
PURPOSE: Stem cell transplant (SCT) recipients commonly undergo bronchoalveolar lavage (BAL) collection as an infectious pulmonary work-up. Previous studies report the utility and overall diagnostic yield of fiberoptic bronchoscopy with BAL in this vulnerable population, though none focused purely on microbiologic yield or made comparisons with less invasive means of pathogen detection. We sought to determine and elaborate on the microbiologic yield of BAL in SCT recipients, assess a correlation between BAL studies and less invasive means of pathogen detection, and assess the utility of repeating a BAL within 30 days...
June 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Ernest Suresh
A wide variety of conditions can present with acute thrombocytopenia, ranging from those that are relatively benign and self-limiting to those that require urgent therapeutic intervention. Initial decision-making relies on a good history and the results of some simple investigations. Although a precise diagnosis of the underlying cause might often not be possible in the acute setting, supportive treatments should be provided to all patients. This article describes a practical approach to the diagnosis and initial management of patients presenting with acute thrombocytopenia, with the aid of a case vignette...
2017: Acute Medicine
Lara Bashoura, George A Eapen, Saadia A Faiz
Pulmonary manifestations of lymphoma and leukemia may involve multiple structures within the thoracic cavity. Malignant lymphoma typically originates in lymph nodes, but concomitant or primary presentations with parenchymal, pleural, or tracheobronchial disease may occur. Once infection is excluded, leukemic infiltrates may be related to malignancy, hemorrhage, or secondary pulmonary alveolar proteinosis. Confirmation with cytology or flow cytometry is recommended to diagnose malignant pleural effusions in hematologic malignancies...
June 2017: Clinics in Chest Medicine
Trevor J Bledsoe, Sameer K Nath, Roy H Decker
Radiation-induced lung injury is a well-known complication of thoracic radiation for patients with breast, lung, thymic, and esophageal malignancies, and mediastinal lymphomas. Improvements in radiation technique, as well as the understanding of the pathophysiology of radiation injury, have led to lower rates of pneumonitis and improved symptom control. Here, the authors provide an overview of the pathophysiology, diagnosis, and management of patients with radiation pneumonitis as a complication of treatment of chest malignancies...
June 2017: Clinics in Chest Medicine
Paul Leger, Andrew H Limper, Fabien Maldonado
Despite significant recent progress in precision medicine and immunotherapy, conventional chemotherapy remains the cornerstone of the treatment of most cancers. Chemotherapy-induced lung toxicity represents a serious diagnostic challenge for health care providers and requires careful consideration because it is a diagnosis of exclusion with significant impact on therapeutic decisions. This review aims to provide clinicians with a valuable guide in assessing their patients with possible chemotherapy-induced lung toxicity...
June 2017: Clinics in Chest Medicine
Lisa K Vande Vusse, David K Madtes
This article reviews the noninfectious pulmonary syndromes that cause morbidity and mortality early after hematopoietic cell transplantation with an emphasis on risk factors, clinical manifestations, treatment, and outcomes. The first section covers idiopathic pneumonia syndrome and its subtypes: peri-engraftment respiratory distress syndrome, diffuse alveolar hemorrhage, delayed pulmonary toxicity syndrome, and cryptogenic organizing pneumonia. The second section covers pulmonary toxicities of chemotherapies and immunosuppressive agents used in this setting...
June 2017: Clinics in Chest Medicine
Anne Bergeron
Late-onset noninfectious pulmonary complications (LONIPCs), most of which occur between 3 months and 2 years following allogeneic hematopoietic stem cell transplantation (HSCT), have a significant effect on patient outcomes and are highly associated with mortalities and morbidities. LONIPCs can involve all anatomic lung regions: bronchi, parenchyma, vessels, and pleura; this diversity can lead to various clinical entities. Bronchiolitis obliterans syndrome is the most frequent LONIPC. Most LONIPCs are associated with graft-versus-host disease...
June 2017: Clinics in Chest Medicine
Justin L Wong, Scott E Evans
Bacterial pneumonias exact unacceptable morbidity on patients with cancer. Although the risk is often most pronounced among patients with treatment-induced cytopenias, the numerous contributors to life-threatening pneumonias in cancer populations range from derangements of lung architecture and swallow function to complex immune defects associated with cytotoxic therapies and graft-versus-host disease. These structural and immunologic abnormalities often make the diagnosis of pneumonia challenging in patients with cancer and impact the composition and duration of therapy...
June 2017: Clinics in Chest Medicine
Steven A Pergam
Invasive fungal infections, which occur primarily as a consequence of prolonged neutropenia and immunosuppression, are a life-threatening complication seen among patients with hematologic malignancies. The routine use of triazole antifungal prophylaxis, enhanced diagnostics, and newer antifungal agents have led to improvements in the care of fungal pneumonias, but invasive fungal infections remain a major cause of morbidity and mortality. This article covers risk factors for major fungal infections, diagnostic approaches, and treatment options for specific fungal pathogens, including Aspergillus and Mucorales species, and discusses current approved strategies for prevention of common and uncommon fungal pneumonias...
June 2017: Clinics in Chest Medicine
Margaret L Green
Viral pneumonia is a common complication for patients with hematologic malignancies and after hematopoietic cell transplantation causing significant morbidity, and often mortality. Infections are predominantly caused by herpes viruses, either by reactivation of latent infection, or less commonly primary infection, or community respiratory viruses. High-resolution CT scan is useful for diagnosis but is nonspecific; generally, bronchoalveolar lavage is required. Prevention strategies are not pathogen-specific but include vaccination, chemoprophylaxis, preemptive treatment, and effective infection-prevention strategies during community outbreaks...
June 2017: Clinics in Chest Medicine
Guang-Shing Cheng
Pretransplant pulmonary function tests provide baseline data by which to reference subsequent respiratory impairment, as well as important prognostic information, for the hematopoietic cell transplant (HCT) recipient. Abnormalities in forced expiratory volume in 1 second and diffusing capacity of carbon monoxide are associated with early respiratory failure and increased all-cause mortality after allogeneic HCT. These parameters have been incorporated into risk assessment calculators that may aid in clinical decision making...
June 2017: Clinics in Chest Medicine
Bianca Harris, Alexander I Geyer
Pulmonary complications (PC) of hematologic malignancies and their treatments are common causes of morbidity and mortality. Early diagnosis is challenging due to host risk factors, clinical instability, and provider preference. Delayed diagnosis impairs targeted treatment and may contribute to poor outcomes. An integrated understanding of clinical risk and radiographic patterns informs a timely approach to diagnosis and treatment. There is little prospective evidence guiding optimal modality and timing of minimally invasive lung sampling; however, a low threshold for diagnostic bronchoscopy during the first 24 to 72 hours after presentation should be a guiding principle in high-risk patients...
June 2017: Clinics in Chest Medicine
Ayman O Soubani
Advances in cancer treatment and patient survival are associated with increasing number of these patients requiring intensive care. Over the last 2 decades, there has been a steady improvement in the outcomes of critically ill patients with cancer. This review provides data on the use of the intensive care unit (ICU) and short and long-term outcomes of critically ill patients with cancer, the ICU system practices that influence patients outcomes, and the role of the different clinical variables in predicting the prognosis of these patients...
June 2017: Clinics in Chest Medicine
Anne-Sophie Moreau, Olivier Peyrony, Virginie Lemiale, Lara Zafrani, Elie Azoulay
Acute respiratory failure occurs in up to 50% of patients treated for hematologic malignancies and is associated with a high case fatality rate. Because of residual organ dysfunction and time spent receiving respiratory care, underlying disease control is affected. Early admission to an intensive care unit for acute respiratory failure has proven benefit because it is the best place for rapid implementation of noninvasive diagnostic and therapeutic strategies. This article reviews the clinical approach and diagnostic strategies for acute respiratory failure in patients with hematologic malignancies...
June 2017: Clinics in Chest Medicine
Lena M Napolitano
Anemia is common in the intensive care unit (ICU), resulting in frequent administration of red blood cell (RBC) transfusions. Significant advances have been made in understanding the pathophysiology of anemia in the ICU, which is anemia of inflammation. This anemia is related to high hepcidin concentrations resulting in iron-restricted erythropoiesis, and decreased erythropoietin concentrations. A new hormone (erythroferrone) has been identified, which mediates hepcidin suppression to allow increased iron absorption and mobilization from iron stores...
April 2017: Critical Care Clinics
2017-05-07 21:47:07
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