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Published in:

01-09-2012 | Original

Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units

Authors: Jae-Uk Song, Gee Young Suh, Hye Yun Park, So Yeon Lim, Seo Goo Han, Yeh Rim Kang, O. Jung Kwon, Sookyoung Woo, Kyeongman Jeon

Published in: Intensive Care Medicine | Issue 9/2012

Abstract

Purpose

To determine whether earlier intervention was associated with decreased mortality in critically ill cancer patients admitted to an intensive care unit (ICU).

Methods

A retrospective observational study was performed of 199 critically ill cancer patients admitted to the ICU from the general ward between January 2010 and December 2010. A logistic regression model was used to adjust for potential confounding factors in the association between time to intervention and in-hospital mortality.

Results

In-hospital mortality was 52 %, with a median Simplified Acute Physiology Score 3 (SAPS 3) of 80 [interquartile range (IQR) 67–93], and a median Sequential Organ Failure Assessment (SOFA) score of 8 (IQR 5–11). Median time from physiological derangement to intervention (time to intervention) prior to ICU admission was 1.5 (IQR 0.6–4.3) h. Median time to intervention was significantly shorter in survivors than in non-survivors (0.9 vs. 3.0 h; p < 0.001). Additionally, the mortality rates increased significantly with increasing quartiles of time to intervention (p < 0.001, test for trend). Other factors associated with in-hospital mortality were severity of illness, performance status, hematologic malignancy, stem-cell transplantation, presence of three or more abnormal physiological variables, time from derangement to ICU admission, presence of infection, need for mechanical ventilation and vasopressor, and low PaO₂/FiO₂ ratio. Even after adjusting for potential confounding factors, time to intervention was still significantly associated with hospital mortality (adjusted odds ratio 1.445, 95 % confidence interval 1.217–1.717).

Conclusions

Early intervention before ICU admission was independently associated with decreased in-hospital mortality in critically ill cancer patients admitted to the ICU.

Brenner H (2002) Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet 360:1131–1135PubMedCrossRef

Azoulay E, Afessa B (2006) The intensive care support of patients with malignancy: do everything that can be done. Intensive Care Med 32:3–5PubMedCrossRef

Darmon M, Azoulay E (2009) Critical care management of cancer patients: cause for optimism and need for objectivity. Curr Opin Oncol 21:318–326PubMedCrossRef

Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H (1991) The nature of adverse events in hospitalized patients. Results of the Harvard medical practice study II. N Engl J Med 324:377–384PubMedCrossRef

Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP, Anderson J (1999) Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary-care hospital. Med J Aust 171:22–25PubMed

Wilson RM, Harrison BT, Gibberd RW, Hamilton JD (1999) An analysis of the causes of adverse events from the quality in Australian health care study. Med J Aust 170:411–415PubMed

Sprung CL, Geber D, Eidelman LA, Baras M, Pizov R, Nimrod A, Oppenheim A, Epstein L, Cotev S (1999) Evaluation of triage decisions for intensive care admission. Crit Care Med 27:1073–1079PubMedCrossRef

Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23:4406–4413PubMedCrossRef

Peigne V, Rusinova K, Karlin L, Darmon M, Fermand JP, Schlemmer B, Azoulay E (2009) Continued survival gains in recent years among critically ill myeloma patients. Intensive Care Med 35:512–518PubMedCrossRef

10.

Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B (2011) Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care 1:5PubMedCrossRef

11.

Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, Auerbach A, Chen WJ, Duncan K, Kenward G, Bell M, Buist M, Chen J, Bion J, Kirby A, Lighthall G, Ovreveit J, Braithwaite RS, Gosbee J, Milbrandt E, Peberdy M, Savitz L, Young L, Harvey M, Galhotra S (2006) Findings of the first consensus conference on medical emergency teams. Crit Care Med 34:2463–2478PubMedCrossRef

12.

Lim SY, Park SY, Park HK, Kim M, Park HY, Lee B, Lee JH, Jung EJ, Jeon K, Park CM, Ko MG, Park MR, Nam JM, Won SY, Jung JH, Cho SH, Suh GY (2010) Early impact of medical emergency team implementation in a country with limited medical resources: a before-and-after study. J Crit Care 26(4):373–378PubMedCrossRef

13.

Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, Finfer S, Flabouris A (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365:2091–2097PubMedCrossRef

14.

Song JU, Suh GY, Chung MP, Kim H, Kwon OJ, Jung CW, Kang WK, Park K, Jeon K (2011) Risk factors to predict outcome in critically ill cancer patients receiving chemotherapy in the intensive care unit. Support Care Cancer 19:491–495PubMedCrossRef

15.

Darmon M, Thiery G, Ciroldi M, de Miranda S, Galicier L, Raffoux E, Le Gall JR, Schlemmer B, Azoulay E (2005) Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 33:2488–2493PubMedCrossRef

16.

Benoit DD, Depuydt PO, Vandewoude KH, Offner FC, Boterberg T, De Cock CA, Noens LA, Janssens AM, Decruyenaere JM (2006) Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit. Intensive Care Med 32:93–99PubMedCrossRef

17.

Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, Iapichino G, Edbrooke D, Capuzzo M, Le Gall JR (2005) SAPS 3—from evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 31:1345–1355PubMedCrossRef

18.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 22:707–710PubMedCrossRef

19.

Shelton BK (2010) Admission criteria and prognostication in patients with cancer admitted to the intensive care unit. Crit Care Clin 26:1–20PubMedCrossRef

20.

McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, Nielsen M, Barrett D, Smith G, Collins CH (1998) Confidential inquiry into quality of care before admission to intensive care. Br Med J 316:1853–1858CrossRef

21.

McGloin H, Adam SK, Singer M (1999) Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable? J R Coll Physicians Lond 33:255–259PubMed

22.

Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, Silvester W, Doolan L, Gutteridge G (2003) A prospective before-and-after trial of a medical emergency team. Med J Aust 179:283–287PubMed

23.

Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, Silvester W, Doolan L, Gutteridge G (2004) Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med 32:916–921PubMedCrossRef

24.

Sebat F, Musthafa AA, Johnson D, Kramer AA, Shoffner D, Eliason M, Henry K, Spurlock B (2007) Effect of a rapid response system for patients in shock on time to treatment and mortality during 5 years. Crit Care Med 35:2568–2575PubMedCrossRef

25.

Buist M, Harrison J, Abaloz E, Van Dyke S (2007) Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital. Br Med J 335:1210–1212CrossRef

26.

Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, Opdam H, Gutteridge G (2005) Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care 9:R808–R815PubMedCrossRef

27.

Konrad D, Jaderling G, Bell M, Granath F, Ekbom A, Martling CR (2010) Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team. Intensive Care Med 36:100–106PubMedCrossRef

28.

McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M (2007) Outreach and early warning systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 18(3):CD005529

29.

Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C (2010) Rapid response teams: a systematic review and meta-analysis. Arch Intern Med 170:18–26PubMedCrossRef

30.

Edelson DP (2010) A weak link in the rapid response system. Arch Intern Med 170:12–13PubMedCrossRef

31.

Calzavacca P, Licari E, Tee A, Egi M, Haase M, Haase-Fielitz A, Bellomo R (2008) A prospective study of factors influencing the outcome of patients after a medical emergency team review. Intensive Care Med 34:2112–2116PubMedCrossRef

32.

Downey AW, Quach JL, Haase M, Haase-Fielitz A, Jones D, Bellomo R (2008) Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias. Crit Care Med 36:477–481PubMedCrossRef

33.

Quach JL, Downey AW, Haase M, Haase-Fielitz A, Jones D, Bellomo R (2008) Characteristics and outcomes of patients receiving a medical emergency team review for respiratory distress or hypotension. J Crit Care 23:325–331PubMedCrossRef

34.

Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL (2009) Characteristics and outcomes of cancer patients in European ICUs. Crit Care 13:R15PubMedCrossRef

35.

Vandijck DM, Benoit DD, Depuydt PO, Offner FC, Blot SI, Van Tilborgh AK, Nollet J, Steel E, Noens LA, Decruyenaere JM (2008) Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med 34:847–855PubMedCrossRef

36.

Vandijck DM, Depuydt PO, Offner FC, Nollet J, Peleman RA, Steel E, Noens LA, Decruyenaere JM, Benoit DD (2010) Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies. Intensive Care Med 36:1744–1750PubMedCrossRef

37.

Calzavacca P, Licari E, Tee A, Egi M, Downey A, Quach J, Haase-Fielitz A, Haase M, Bellomo R (2010) The impact of rapid response system on delayed emergency team activation patient characteristics and outcomes–a follow-up study. Resuscitation 81:31–35PubMedCrossRef

38.

Jones DA, DeVita MA, Bellomo R (2011) Rapid-response teams. N Engl J Med 365:139–146PubMedCrossRef

Title: Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units
Authors: Jae-Uk Song
Gee Young Suh
Hye Yun Park
So Yeon Lim
Seo Goo Han
Yeh Rim Kang
O. Jung Kwon
Sookyoung Woo
Kyeongman Jeon
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 9/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2594-0

At a glance: The STEP trials

Springer Medicine

Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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