D Mokart, Réanimation Institut Paoli-Calmettes, Marseille, France

Slides:

Advertisements

Similar presentations

The Duration of Hypotension Prior to Initiation of Effective Antimicrobial Therapy is the Critical Determinant of Survival in Human Septic Shock Anand.

Advertisements

Élie AZOULAY Hôpital Saint-Louis, Service de Réanimation Médicale Université Paris-Diderot, Sorbonne Paris-Cité Groupe de Recherche Respiratoire en Réanimation.

A Randomized Trial of Protocol-Based Care for Early Septic Shock Andrea Caballero, MD January 15, 2015 LSU Journal Club The ProCESS Investigators. N Engl.

Febrile Neutropenia Allison Ferrara, MD Princeton Baptist Medical Center Baptist Health Systems Alabama.

Early Goal Therapy in Severe Sepsis & Septic Shock

MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?

1 Severity of illness (APACHE II score ≥ 25) stratified by RIFLE category in septic shock NoneRiskInjuryFailure.

ICU Care & Communication Bundle

A Standardized Approach to Safe, Effective Prone Positioning in the SICU Sharon Dickinson, Craig Meldrum, Connie Rickelmann and the SICU staff University.

Pediatric Acute Renal Failure: CRRT/Dialysis Outcome Studies Stuart L. Goldstein, MD Assistant Professor of Pediatrics Baylor College of Medicine.

The long-term outcome after acute renal failure Presented by Ri 顏玎安.

Cost-Conscious Care Presentation Follow-up Chest X-Ray in Patients Admitted for Community Acquired Pneumonia Huy Tran, PGY-2 12/12/2013.

Laurent Brochard NIV in the ICU: Lessons learnt in the last 20 years.

Procalcitonin-Guided Antibiotic Therapy

1 VA Hospice and Palliative Care: Identifying Veterans at High Risk of Mortality Ann Hendricks PhD, Lynn Wolfsfeld MPP Health Care Financing & Economics.

Chemotherapy Audit  Audit of patients who died within three months of their last dose of chemotherapy at Airedale General Hospital  The records of 50.

SEPSIS & SEPTIC SHOCK Jaime Palomino, MD Pulmonary & Critical Care Medicine Tulane University Health Sciences Center New Orleans, Louisiana.

Determining Acceptable Waiting Times for the Surgical Treatment of Solid Organ Malignancies - A Systematic Review CIHR Grant: Toward Canadian Benchmarks.

Use the right tool for the right job!

Pancreatic Cancer. Pancreatic Cancer Case Case presentation 67 year old male Unremarkable previous medical history No family history of pancreatic cancer.

Achieving safety and quality in MCCN chemotherapy services.

Systematic review + meta-analysis: 69 (quasi-)randomised trials: N=7,863 pts with sepsis: any BL monoTx vs any combination of BL + AG: N (studies) : same.

{ Challenges in cost-utility analysis in the critical care setting Ville Pettilä MD, PhD, A/P Helsinki University Hospital VP SFAI- veckan.

นพ. ธรรมศักดิ์ ทวิช ศรี หน่วยเวชบำบัด วิกฤต ฝ่ายวิสัญญีวิทยา รพ. จุฬาลงกรณ์

Impact of a PRUDENT © Red Blood Cell Transfusion Strategy in Pediatric HSCT and Oncology Patients Results from the CHB Experience © 2009 All rights.

Haemofiltration for sepsis: burial or resurrection?

Cancer “whiteboard” presentation ●Name of cancer (what type), where can it occur? ●Function of body part that it affects ●Causes (genetic, environmental…)?

BTS/ICS Guidelines for the ventilatory management of acute hypercapnic respiratory failure in adults British Thoracic Society Intensive Care Society.

Dr Michelle Webb Renal Consultant, Associate Medical Director Patient Safety, East Kent Hospitals University NHS Foundation Trust and Co-lead for Sepsis.

PNEUMONIA Team Membership Clinical Departments: Emergency Medical Services, General Medicine Hospital Departments: 6 Northeast, 3NESW, Emergency Department,

Can We Justify ICU Refusal for Cancer Patients ? Elie AZOULAY, MD Medical ICU, Saint Louis Teaching Hospital Paris, France 14th ESICM Annual Congress Geneva,

LSU Journal Club Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia A Systematic Review and Meta-analysis Scott Hebert,

Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult ICU patients Crit Care Med 2007 ; 35 :

Pulmonary Embolism in Patients with Unexplained Exacerbation of COPD: Prevalence and Risk Factors Isabelle Tillie-Leblond, MD, PhD; Charles-Hugo Marquette,

경희대 호흡기내과 ACUTE RESPIRATORY DISTRESS SYNDROME (Update 2013) 호흡기내과 박명재.

Non-invasive Ventilation for Management of Pneumonia Problem Based Lecture January 28 th, 2016 S.Noll PGY-3.

Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time? A Systematic Review Jason Phua1,2, Joan R. Badia1,3, Neill K. J. Adhikari1,4,

Preventing Sepsis in Wales

Time for first antibiotic dose is not predictive for the early clinical failure of moderate–severe community-acquired pneumonia Eur J Clin Microbial Infect.

AKI in critically ill cancer patients: do we need more studies? : No !

Critical Care Specialists of Cancer Patients:

Epimed to assist critical care research

Pr Jean-Ralph Zahar Infection Control Unit

Should empirical combination or mono antibiotic therapy be used in adult ICU patients with severe sepsis and septic shock ? Fredrik Sjövall MD PhD.

Transfusion thresholds for cancer patients

Jan 2016 Solar Lunar Data.

Velindre NHS Trust June 10th 2011

Professor Derek Bell a physicians perspective

Table 1. Baseline Characteristics of the 36,636 Study Subjects

AKI in critically ill cancer patients:

The Duration of Hypotension Prior to Initiation of Effective Antimicrobial Therapy is the Critical Determinant of Survival in Human Septic Shock Anand.

Advanced Ventilation Research

Outcome of Neutropenic Fever in Hospitalized Cancer Patients during a one-year Follow-up: a single center experience. Riwa Sakr1,2, Marcel Massoud1,2,

Value in Cancer Care Renato G Martins

Improving Outcomes for Severe Sepsis and Septic Shock: Tools for Early Identification of At-Risk Patients and Treatment Protocol Implementation Emanuel.

Principal recommendations

Epidemiology of sepsis and septic shock in critical care units: comparison between sepsis-2 and sepsis-3 populations using a national critical care database

Early diastolic dysfunction is associated with intensive care unit mortality in cancer patients presenting with septic shock M. Mourad, L. Chow-Chine,

Risk factors of Ganciclovir-related neutropenia after allogeneic stem cell transplantation: a retrospective monocentre study on 547 patients G. Venton,

Recognising sepsis and taking action

Optimizing Outcomes in Sepsis Dr. Anand Kumar

Time frames for the application of noninvasive positive-pressure ventilation in acute respiratory failure (ARF) according to the severity and end-of-life.

Activated endothelial cells

PPI prophylaxis for GI bleeding in ICU

Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients T.A. Williams, K.M. Ho, G.J. Dobb,

Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery D Mokart,

Predictive perioperative factors for developing severe sepsis after major surgery D. Mokart, M. Leone, A. Sannini, J.P. Brun, A. Tison, J.R. Delpero,

Eliane Gluckman Experimental Hematology

Timing for HCT Consultation

Number of ventilator starts (including both noninvasive ventilation [NIV] and invasive mechanical ventilation subjects) based on age and etiology of ARF.

Presentation transcript:

D Mokart, Réanimation Institut Paoli-Calmettes, Marseille, France Pourquoi la mortalité des patients d’onco-hématologie admis en réanimation diminue? D Mokart, Réanimation Institut Paoli-Calmettes, Marseille, France

CA Cancer J Clin. 2016 Jun 27. doi: 10.3322/caac.21351.

Intensive Care Med. 2014 Oct;40(10):1570-2

The development of more effective cancer therapies Advances in critical care Improvements in patient selection Changes in ICU admission policies Close collaboration with hematologists and oncologists Blood Rev. 2015 Nov;29(6):359-67.

Risk factors for hospital mortality ICU mortality 27% Hospital mortality 38% 1-year mortality 57%

Hospital mortality (CI 95% ) Cancer ICU mortality (CI 95% ) Hospital mortality (CI 95% ) Lung 40,1% (28,6 - 52,2) 46,9% (39,9 -54,0) Oesophageal 14,7% (2,5 - 34,6) 19,9% (3,6 - 44,8) Stomach 14,6% (8,8 – 78,2) 14,6% (8,8 - 78,2) Pancreatic - 6,7% (5,1 - 46,7) Colorectal 19,2% (0 - 62,3) 35,0% (13,7 - 60,2) Breast 34,2% (15,1 - 56,4) 57,7% (42,1- 72,7) Gyneacological 8,3% (4,8 - 12,7) Head neck 34,2% (24,6 - 44,6) 54,7% (24,9 - 82,8) Urological 36,6% (25,5 - 48,4) Prostate 75,5% (36,9 - 98,6) Melanoma 95,6% (67,1 - 96,4) Overall 31,2% (24,0 - 39,0) 38,2% (33,8 - 42,7)

Blood Rev. 2015 Nov;29(6):359-67.

Septic shock

Prognosis of septic cancer patients has improved over time

The impact of the surviving sepsis campaign

Intensive Care Med. 2014 Aug;40(8):1173-4

Hospital mortality = 43,5% (131/289 patients) Mokart D, Slehofer G, Lambert J, Sannini A, Chow-Chine L, Brun JP, Berger P, Duran S, Faucher M, Blache JL, Saillard C, Vey N, Leone M. Intensive Care Med. 2014 Jan;40(1):41-9

Eur J Haematol. 2016 Sep;97(3):271-7

Acute respiratory failure

Acute Respiratory Failure in Cancer Patients Acute respiratory failure (ARF) is a frequent event Solid tumour: 5% Hematology patients: 15% Neutropenic: 30% Hematology patients at ICU admission: 62% Hospital mortality: ARF: 43% NIV: 46% IMV: 61%

Acute respiratory distress syndrome in patients with malignancies. Azoulay E, Lemiale V, Mokart D, Pène F, Kouatchet A, Perez P, Vincent F, Mayaux J, Benoit D, Bruneel F, Meert AP, Nyunga M, Rabbat A, Darmon M. Intensive Care Med. 2014 Aug;40(8):1106-14.

Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology: a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study. Contejean A, Lemiale V, Resche-Rigon M, Mokart D, Pène F, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Hamidfar R, Darmon M, Jourdain M, Renault A, Schlemmer B, Azoulay E. Ann Intensive Care. 2016 Dec;6(1):102

Bone Marrow Transplant. 2015 Jun;50(6):840-5.

Azoulay, Bone Marrow Transplantation, 2011

CCM 2016; 44:282-290

Intensive Care Med. 2015 Nov;41(11):2008-10 Mokart D, Geay C, Chow-Chine L, Brun JP, Faucher M, Blache JL, Bisbal M, Sannini A Intensive Care Med. 2015 Nov;41(11):2008-10

Specific situations

Patients with advanced lung cancer harboring oncogenic mutations should be admitted to intensive care units. Toffart AC, Dhalluin X, Girard N, Chouaid C, Audigier-Valette C, Duruisseaux M, Mennecier B, Parrot A, Fournel P, Moro-Sibilot D, Timsit JF

Leukostasis Pulmonary leukemic infiltration Acute lysis pneumopathy

Leuk Lymphoma. 2010 Feb;51(2):221-7.

Saillard C, Bisbal M, Sannini A, Chow-Chine L, Brun JP, Harbi S, Furst S, Blaise D, Paciencia M, Secq V, Mokart D. Eur Respir J. 2016 Sep 1. pii: ERJ-01130-2016. doi: 10.1183/13993003.01130-2016.

Blood Rev. 2015 Nov;29(6):359-67.

60% des patients avec une RxT Nle présentaient des lésions pulmonaires Cancer. 1966 Jun;19(6):781-93.

Leukostasis Pulmonary leukemic infiltration Acute lysis pneumopathy

Systematic literature review of solid cancer adult patients admitted to ICU from 2000 to April 2014 on wards using EMBASE and MEDLINE electronic databases. 48 papers identified that reported survival in ICU patients with solid cancers. ICU mortality was reported in 35 (73%) studies comprising a total sample of 25339 patients. Hospital mortality was reported in 31 (64,6%) studies across a total sample of 74061 patients.

Intensive Care Med. 2014 Jan;40(1):41-9. Cumulative incidence of de-escalation = 44% Associated factors Adequation of the empirical antimicrobial treatment used in ICU [OR = 10.8 (95 % CI 1.20–96) ] for adequate documented treatment versus appropriate empirical treatment Compliance with guidelines regarding the empirical anti-pseudomonal betalactam used in ICU [OR = 10.8 (95 % CI 1.3–89.5)] Intensive Care Med. 2014 Jan;40(1):41-9.

Surgical patients

J Crit Care. 2016 Feb;31(1):48-53

Evidence for a causal link between sepsis and long-term mortality: a systematic review of epidemiologic studies

Factors associated with hospital mortality : Poorer physiological score, Invasive mechanical ventilation Poor functional status (PS >3) Oncological characteristics were not associated with mortality

Reasons for ICU admission Severe sepsis/ Septic shock Acute respiratory failure Surgical patients Specific oncological situations J Clin Oncol. 2013 Aug 1;31(22):2810-8.