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

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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.