Abstract:
UNLABELLED:Admission of cancer patients with serious medical complications to the ICU remains controversial primarily because of the high short-term mortality rates in these patients. However, the cancer patient population is heterogeneous regarding age, underlying conditions, and curability of their disease, suggesting that large variations may occur in the effectiveness of intensive care within this subgroup of critically ill patients. OBJECTIVES:To identify factors predicting 30-day mortality in patients with solid tumors admitted to a medical ICU. PATIENTS AND METHODS:We conducted a retrospective study in 120 consecutive cancer patients (excluding patients with hematological malignancies) admitted to the medical ICU of a 650-bed university hospital between January 1990 and July 1997. Medical history, physical and laboratory test findings at admission, and therapeutic interventions within the first 24 h in the ICU were recorded. The study endpoint was vital status 30 days after ICU admission. Stepwise logistic regression was used to identify independent prognostic factors. RESULTS:The observed 30-day mortality rate was 58.7 % (n = 68), with most deaths (92 %) occurring in the ICU. Univariate predictors of 30-day mortality were either protective [prior surgery for the cancer (p = 0.01) and complete remission (p = 0.01)] or associated with higher mortality [Knaus scale C or D (p = 0.02), shock (p = 0.04), need for vasopressors (p = 0.0006) or for mechanical ventilation (p = 0.0001), SAPS II score greater than 36 (p = 0.0001), LOD score greater than 6 (p = 0.0001), and ODIN score > 2 (p = 0.0001)]. Three variables were independent predictors: previous surgery for the cancer (OR 0.20, 95 % CI 0.07-0.58), LOD score > 6 (OR 1.26, 95 % CI 1.09-1.44), and need for mechanical ventilation (OR 3.55, 95 % CI; 1.26-6.7). Variables previously thought to be indicative of a poor prognosis (i. e., advanced age, metastatic or progressive disease, neutropenia or bone marrow transplantation) were not predictive of outcome. CONCLUSION:When transfer to an ICU is considered an option by patients and physicians, 30-day mortality is better estimated by an evaluation of acute organ dysfunction than by the characteristics of the underlying malignancy.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Azoulay E,Moreau D,Alberti C,Leleu G,Adrie C,Barboteu M,Cottu P,Levy V,Le Gall JR,Schlemmer Bdoi
10.1007/s001340051350keywords:
subject
Has Abstractpub_date
2000-12-01 00:00:00pages
1817-23issue
12eissn
0342-4642issn
1432-1238journal_volume
26pub_type
杂志文章abstract:PURPOSE:The early diagnosis of traumatic internal carotid artery dissection (TICAD) is essential for initiating appropriate treatment and improving outcome. We searched for criteria from transcranial Doppler (TCD) measurements on admission that could be associated with subsequent TICAD diagnosis in patients with trauma...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-1919-0
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVE:To determine the frequency and the eventual clinical characteristics of nosocomial sinusitis with anaerobic bacteria isolation in patients in the intensive care unit (ICU). DESIGN:Retrospective study. SETTING:A 12-bed medical ICU in a teaching hospital. PATIENTS:30 adult patients with documented nosocomial...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051013
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVE:To determine the relation of malnutrition and underlying diagnosis to the length of stay in the Intensive Care Unit (ICU) and to mortality after lung transplantation (LTX). DESIGN:Retrospective ICU chart review. SETTING:Cardiothoracic ICU in a University hospital. PATIENTS:Fifty-one consecutive patients wh...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709333
更新日期:1996-11-01 00:00:00
abstract::An 18-month-old male infant presented with hypoglycemic coma and clinical signs of bronchopneumonia. He was suspected of suffering from septic shock. The patient progressed to irreversible multiple organ failure before the diagnosis of adrenal crisis was established. Plasma levels of ACTH and cortisol remained undetec...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050021
更新日期:2000-01-01 00:00:00
abstract:PURPOSE:This study explored differences in end-of-life (EOL) decisions and respect for patient autonomy of religious members versus those only affiliated to that particular religion (affiliated is a member without strong religious feelings). METHODS:In 2005 structured questionnaires regarding EOL decisions were distri...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2554-8
更新日期:2012-07-01 00:00:00
abstract::Conventional PEEP ventilation has been recently reported to be deleterious in some cases of ARF with unilateral pneumonia. In such respect, two cases of unilateral bacterial pneumonia were intubated with a Carlens tracheal tube. Measurement of tidal volume, static compliance, and functional residual capacity of each l...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01683935
更新日期:1979-11-01 00:00:00
abstract:BACKGROUND:Peripherally inserted central venous catheters (PICC) have been proposed as an alternative to central venous catheters (CVC). The aim of this study was to determine the thrombosis rate in relation to PICC placement in patients discharged from the intensive care unit (ICU). METHODS:Data of patients admitted ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-2043-x
更新日期:2011-02-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that the rate of degradation of exogenously administered albumin is faster with bolus administration than with continuous infusion and thus that a bolus administration is less efficacious in restoring blood albumin concentration (BAC) in the hypoalbuminemic critically ill pediatric pati...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF01712175
更新日期:1996-05-01 00:00:00
abstract::Arterial catheterization is the second most common invasive procedure performed in the intensive care unit. Despite the ubiquity of the procedure, complications including failure to place the catheter occur. While many clinicians are familiar with the use of ultrasound (US) guidance to decrease complication rates of c...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-009-1699-6
更新日期:2010-02-01 00:00:00
abstract:PURPOSE:Clinical examination is often the first step to diagnose shock and estimate cardiac index. In the Simple Intensive Care Studies-I, we assessed the association and diagnostic performance of clinical signs for estimation of cardiac index in critically ill patients. METHODS:In this prospective, single-centre coho...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-019-05527-y
更新日期:2019-02-01 00:00:00
abstract::Results of the relationships between oxygen supply, demand, and uptake can be used to interpret cardiac output values, identify types of acute circulatory failure, guide attempts to improve cellular function, and thus prevent the development of multiple organ failure and death. Five steps in the interpretation of card...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF01785244
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:To demonstrate bleeding complications encountered in patients after cardiac surgery on continuous venovenous haemofiltration (CVVH) treated with continuous versus intermittent r-hirudin for heparin-induced thrombocytopenia (HIT) type II. DESIGN:Case description. SETTING:Cardiothoracic intensive care unit at...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051064
更新日期:1999-11-01 00:00:00
abstract::Thirty patients with adult respiratory distress syndrome required intermittent positive pressure ventilation; 15 survived. In 25 the syndrome followed bacterial infection or multiple injuries. From the peak upper airway pressure, the oxygen gradient and the age of the patient, an index was obtained which discriminated...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00254517
更新日期:1986-01-01 00:00:00
abstract:OBJECTIVES:Circulating levels of the proinflammatory mediator High Mobility Group Box Protein 1 (HMGB1) are increased in septic patients and may contribute to sepsis-induced organ dysfunction. Although HMGB1 has been shown to activate neutrophils from healthy volunteers, the responses of neutrophils from septic patient...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0748-2
更新日期:2007-10-01 00:00:00
abstract::To examine the right ventricular response to acute respiratory failure, serial studies of biventricular performance were analysed in 34 such patients, specifically detailing the role of associated underlying disease. During the initial study, the 34 patients with acute respiratory failure had a higher right ventricula...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00256963
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the ability of DeltaPP/DeltaP [pulse pressure variations (DeltaPP) adjusted by alveolar pressure variations (DeltaP = Pplat-PEEPtot)] in predicting fluid responsiveness, to compare its accuracy to that of DeltaPP used alone and to evaluate the influence of tidal volume (Vt) on these two indices. ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1478-4
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:Although several advantages are attributed to tracheotomy in ICU patients requiring mechanical ventilation (MV), true benefits and the optimal timing of tracheotomy remain controversial. In this study, we compared early tracheotomy (ET) with prolonged intubation (PI) in severely ill patients requiring prolong...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s00134-008-1195-4
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:To investigate nasal nitric oxide (NO) excretion, pulmonary NO excretion, and autoinhalation of nasally released NO at rest compared with that during moderate exercise in smokers and non-smokers. DESIGN:Prospective observational study. SETTING:University laboratory. PARTICIPANTS:Fourteen healthy adult volu...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051172
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVES:To study the pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). DESIGN:A prospective physiological study. SETTING:A 12-bed Intensive Care Unit. PATIENTS:Ten patients with acute exacerbation of COPD. INTERVENTIONS:At th...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-004-2255-z
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:Measurement of functional residual capacity (FRC) during mechanical ventilation is important to standardise respiratory system compliance and adjust the ventilator settings to optimise lung recruitment. In the present study we compared three methods to measure FRC. DESIGN:The bias flow nitrogen washout techn...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-003-2028-0
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVE:To investigate efficacy and safety of enoxaparin for catheter-related arterial thrombosis in infants with congenital heart disease. DESIGN:Prospective observational study. SETTING:Pediatric Intensive Care and Cardiology Unit at the University Children's Hospital of Zurich. PATIENTS:A cohort of 32[Symbol: s...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0718-8
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:Trustworthy clinical practice guidelines (CPGs) require identification and careful management of conflicts of interest (COIs) among all participants in the guideline development. Furthermore, COIs are more common than anticipated. However, there are no universally accepted methods to identify and manage COIs...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-018-5367-6
更新日期:2018-10-01 00:00:00
abstract:PURPOSE:Recalibration and determining discriminative power, internationally, of the existing delirium prediction model (PRE-DELIRIC) for intensive care patients. METHODS:A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The ten predictors (age, APACHE-II, urgen...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-013-3202-7
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of 70-mg and 200-mg doses of intravenous erythromycin in improving gastric emptying in critically ill patients. DESIGN:Gastric emptying was measured on consecutive days; day 1 (pre-treatment), day 2 (post-treatment) after an intravenous infusion of either 70 or 200 mg erythromyci...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-005-2663-8
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:To describe the beliefs and attitudes of intensive care unit (ICU) nurses toward visiting, visiting hours, and open visiting policies in critical care settings. DESIGN:A descriptive, cross-sectional, multicenter survey. SETTING:Seventeen hospitals in Flanders (Dutch-speaking Belgium), including 30 ICUs. Six...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0599-x
更新日期:2007-06-01 00:00:00
abstract:PURPOSE:We assessed feasibility and safety of extracorporeal carbon dioxide removal (ECCO2R) to facilitate ultra-protective ventilation (VT 4 mL/kg and PPLAT ≤ 25 cmH2O) in patients with moderate acute respiratory distress syndrome (ARDS). METHODS:Prospective multicenter international phase 2 study. Primary endpoint w...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-019-05567-4
更新日期:2019-05-01 00:00:00
abstract:PURPOSE:The aim of this study is to examine family members' experiences of end-of-life decision-making processes in Norwegian intensive care units (ICUs) to ascertain the degree to which they felt included in the decision-making process and whether they received necessary information. Were they asked about the patient'...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2253-x
更新日期:2011-07-01 00:00:00
abstract:PURPOSE:Family members of patients who die in the intensive care unit (ICU) may experience symptoms of stress, anxiety, depression, posttraumatic stress disorder (PTSD), and/or prolonged grief. We evaluated whether grief symptoms were alleviated if the physician and the nurse in charge at the time of death sent the clo...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s00134-016-4669-9
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVE:To determine the effects of increasing dosages of continuously infused arginine-vasopressin (AVP) on mucosal tissue oxygen tension and oxygen supply in an auto-perfused, innervated jejunal segment in an acute endotoxic porcine model. DESIGN:Prospective, randomized, experimental study. SETTING:University hos...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-005-2858-z
更新日期:2006-01-01 00:00:00
abstract::Dynamic vectorcardiography (VCG) is increasingly employed for ischaemia monitoring with the use of a computerized method for recording and on-line analysis by the calculation of trend parameters. To elucidate how well the derived electrocardiogram (dECG), calculated from the VCG, compares with the simultaneously regis...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s001340050455
更新日期:1997-10-01 00:00:00