1. 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

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

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

4. 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 Nov;29(6):

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

7. 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)

8. Blood Rev Nov;29(6):

9. Septic shock

10. Prognosis of septic cancer patients has improved over time

11. The impact of the surviving sepsis campaign

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

14. 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 Jan;40(1):41-9

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

16. Acute respiratory failure

17. 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%

18. 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 Aug;40(8):

19. 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 Dec;6(1):102

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

21. Azoulay, Bone Marrow Transplantation, 2011

24. CCM 2016; 44:

25. 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 Nov;41(11):

26. Specific situations

28. 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

29. Leukostasis
Pulmonary leukemic infiltration
Acute lysis pneumopathy

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

33. 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 Sep 1. pii: ERJ doi: /

36. Blood Rev Nov;29(6):

39. 60% des patients avec une RxT Nle présentaient des lésions pulmonaires
Cancer Jun;19(6):

40. Leukostasis
Pulmonary leukemic infiltration
Acute lysis pneumopathy

45. Systematic literature review of solid cancer adult patients admitted to ICU from 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 patients.
Hospital mortality was reported in 31 (64,6%) studies across a total sample of patients.

46. 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 Jan;40(1):41-9.

47. Surgical patients

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

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

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

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