3 research outputs found
Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care
Objectives: Historically, patients with a hematologic malignancy
have one of the highest mortality rates among cancer patients
admitted to the ICU. Therefore, physicians are often reluctant to
admit these patients to the ICU. The aim of our study was to examine the survival of patients who have a hematologic malignancy
and multiple organ failure admitted to the ICU.
Design: This retrospective cohort study, part of the HEMA-ICU
study group, was designed to study the survival of patients with a
hematologic malignancy and organ failure after admission to the
ICU. Patients were followed for at least 1 year.
Setting: Five university hospitals in the Netherlands.
Patients: One-thousand ninety-seven patients with a hematologic
malignancy who were admitted at the ICU.
Interventions: None.
Measurements and Main Results: Primary outcome was 1-year
survival. Organ failure was categorized as acute kidney injury,
respiratory failure, hepatic failure, and hemodynamic failure; multiple organ failure was defined as failure of two or more organs.
The World Health Organization performance score measured 3
months after discharge from the ICU was used as a measure of
functional outcome. The 1-year survival rate among these patients
was 38%. Multiple organ failure was inversely associated with
long-term survival, and an absence of respiratory failure was the
strongest predictor of 1-year survival. The survival rate among
patients with 2, 3, and 4 failing organs was 27%, 22%, and 8%,
respectively. Among all surviving patients for which World Health Organization scores were available, 39% had a World Health
Organization performance score of 0–1 3 months after ICU discharge. Functional outcome was not associated with the number
of failing organs.
Conclusions: Our results suggest that multiple organ failure
should not be used as a criterion for excluding a patient with a
hematologic malignancy from admission to the ICU
The management of critically ill patients with haematological malignancies
Item does not contain fulltextThe management of critically ill patients with haematological malignancy (HM) still shows inter- and intra-regional differences. Our objective in this updated review was to address the evidence supporting the potential treatment options, based on multidisciplinary processes, of critically ill patients with HM. A stepwise approach to the critical care pathway of this patient population from the triage to ICU admission to ICU discharge was chosen to emphasise certain key findings. Our main focus relied on significant issues of decision-making in daily clinical routine. The plethora of studies shifted the pragmatic treatment policy into an evidence-based approach. The transfer of a patient with HM from the haematology ward to the ICU and vice versa should be based on a well-defined clinical care process in which the haematologists and intensivists are in close collaboration and direct communication. A protocolised clinical approach to treat a critically ill patient with HM seems helpful to optimise patient-oriented care and patient safety