Annals of Intensive Care最新文献

{"title":"High-dose colistin pharmacokinetics in critically ill patients receiving continuous renal replacement therapy.","authors":"Gennaro De Pascale, Lucia Lisi, Salvatore Lucio Cutuli, Carlotta Marinozzi, Altea Palladini, Elena Sancho Ferrando, Eloisa Sofia Tanzarella, Gianmarco Lombardi, Domenico Luca Grieco, Alessandro Caroli, Rikardo Xhemalaj, Laura Cascarano, Gabriella Maria Pia Ciotti, Claudio Sandroni, Maurizio Sanguinetti, Pierluigi Navarra, Massimo Antonelli","doi":"10.1186/s13613-024-01384-1","DOIUrl":"https://doi.org/10.1186/s13613-024-01384-1","url":null,"abstract":"<p><strong>Background: </strong>Colistin, administered as intravenous colistimethate (CMS), is still used in the critical care setting and current guidelines recommend high dosage CMS in patients undergoing continuous renal replacement therapy (CRRT). Due to the paucity of real-life data, we aimed to describe colistin pharmacokinetic/pharmacodynamic (PK/PD) profile in a cohort of critically ill patients with infections due to carbapenem-resistant (CR) bacteria undergoing CRRT.</p><p><strong>Results: </strong>All consecutive patients admitted to three Intensive Care Units (ICUs) of a large metropolitan University Hospital, treated with colistin for at least 48 h at the dosage of 6.75 MUI q12, after 9 MIU loading dose, and undergoing CRRT were included. After the seventh dose, patients underwent blood serial sampling during a time frame of 24 h. We included 20 patients, who had CR-Acinetobacter baumannii ventilator-associated pneumonia and were characterized by a median SAPS II and SOFA score of 41 [34.5-59.3] and 9 [6.7-11], respectively. Fifteen patients died during ICU stay and six recovered renal function. Median peak and trough colistin concentrations were 16.6 mcg/mL [14.8-20.6] and 3.9 mcg/mL [3.3-4.4], respectively. Median area under the time-concentration curve (AUC_0 - 24) and average steady-state concentration (C_{ss, avg}) were 193.9 mcg h/mL [170.6-208.6] and 8.07 mcg/mL [7.1-8.7]. Probability of target attainment of colistin pharmacodynamics according to the fAUC_0 - 24/MIC target ≥ 12 was 100% for MIC ≤ 2 mcg/mL and 85% for MIC = 4 mcg/ML, although exceeding the toxicity limit of C_{ss, avg} 3-4 mcg/mL.</p><p><strong>Conclusions: </strong>In critically ill patients with CR infections undergoing CRRT, recommended CMS dosage resulted in colistin plasmatic levels above bacterial MIC₉₀, but exceeding the safety C_{ss, avg}. limit.</p><p><strong>Trial registration: </strong>This trial was registered in ClinicalTrials.gov on 23/07/2021 with the ID NCT04995133 (https//clinicaltrials.gov/study/NCT04995133).</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"14 1","pages":"152"},"PeriodicalIF":5.7,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study.","authors":"Mariangela Pellegrini, Mayson L A Sousa, Sebastian Dubo, Luca S Menga, Vanessa Hsing, Martin Post, Laurent J Brochard","doi":"10.1186/s13613-024-01378-z","DOIUrl":"10.1186/s13613-024-01378-z","url":null,"abstract":"<p><strong>Background: </strong>Efficacy of inhaled therapy such as Nitric Oxide (iNO) during mechanical ventilation may depend on airway patency. We hypothesized that airway closure and lung collapse, countered by positive end-expiratory pressure (PEEP), influence iNO efficacy. This could support the role of an adequate PEEP titration for inhalation therapy. The main aim of this study was to assess the effect of iNO with PEEP set above or below the airway opening pressure (AOP) generated by airway closure, on hemodynamics and gas exchange in swine models of acute respiratory distress syndrome. Fourteen pigs randomly underwent either bilateral or asymmetrical two-hit model of lung injury. Airway closure and lung collapse were measured with electrical impedance tomography as well as ventilation/perfusion ratio (V/Q). After AOP detection, the effect of iNO (10ppm) was studied with PEEP set randomly above or below regional AOP. Respiratory mechanics, hemodynamics, and gas-exchange were recorded.</p><p><strong>Results: </strong>All pigs presented airway closure (AOP > 0.5cmH₂O) after injury. In bilateral injury, iNO was associated with an improved mean pulmonary pressure from 49 ± 8 to 42 ± 7mmHg; (p = 0.003), and ventilation/perfusion matching, caused by a reduction in pixels with low V/Q and shunt from 16%[IQR:13-19] to 9%[IQR:4-12] (p = 0.03) only at PEEP set above AOP. iNO had no effect on hemodynamics or gas exchange for PEEP below AOP (low V/Q 25%[IQR:16-30] to 23%[IQR:14-27]; p = 0.68). In asymmetrical injury, iNO improved pulmonary hemodynamics and ventilation/perfusion matching independently from the PEEP set. iNO was associated with improved oxygenation in all cases.</p><p><strong>Conclusions: </strong>In an animal model of bilateral lung injury, PEEP level relative to AOP markedly influences iNO efficacy on pulmonary hemodynamics and ventilation/perfusion match, independently of oxygenation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"14 1","pages":"149"},"PeriodicalIF":5.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis-induced coagulopathy (SIC) in the management of sepsis.","authors":"Toshiaki Iba, Julie Helms, Jerrold H Levy","doi":"10.1186/s13613-024-01380-5","DOIUrl":"https://doi.org/10.1186/s13613-024-01380-5","url":null,"abstract":"<p><p>The mortality rate of sepsis remains high and further increases when complicated by disseminated intravascular coagulation (DIC). Consequently, early detection and appropriate management of DIC will be helpful for the management of sepsis. Although overt DIC criteria are often used for diagnosing definitive DIC, it was not designed to detect early-phase DIC. The criteria and scoring system for sepsis-induced coagulopathy (SIC) were developed and introduced in 2017 to detect early-stage DIC, and they were subsequently adopted by the International Society on Thrombosis and Haemostasis in 2019. The objective of detecting SIC was not to miss the patients at high risk of developing overt DIC at an earlier time. Although anticoagulant therapies are potential options for the treatment of sepsis-associated DIC, their effectiveness has not been established, and further research is warranted. For that purpose, an international collaborative platform is required for future clinical trials, and SIC criteria have been suggested for such studies. Calculating the SIC score is straightforward and suitable for use in clinical settings. This review aims to introduce SIC criteria and its scoring system for better management of sepsis-associated DIC. We also intended to update the current knowledge regarding this novel diagnostic criterion.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"14 1","pages":"148"},"PeriodicalIF":5.7,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ crosstalk and dysfunction in sepsis","authors":"André Borges, Luís Bento","doi":"10.1186/s13613-024-01377-0","DOIUrl":"https://doi.org/10.1186/s13613-024-01377-0","url":null,"abstract":"<p>Sepsis is a dysregulated immune response to an infection that leads to organ dysfunction. Sepsis-associated organ dysfunction involves multiple inflammatory mechanisms and complex metabolic reprogramming of cellular function. These mechanisms cooperate through multiple organs and systems according to a complex set of long-distance communications mediated by cellular pathways, solutes, and neurohormonal actions. In sepsis, the concept of organ crosstalk involves the dysregulation of one system, which triggers compensatory mechanisms in other systems that can induce further damage. Despite the abundance of studies published on ​​organ crosstalk in the last decade, there is a need to formulate a more comprehensive framework involving all organs to create a more detailed picture of sepsis. In this paper, we review the literature published on organ crosstalk in the last 10 years and explore how these relationships affect the progression of organ failure in patients with septic shock. We explored these relationships in terms of the heart–kidney–lung, gut-microbiome–liver–brain, and adipose tissue–muscle–bone crosstalk in sepsis patients. A deep connection exists among these organs based on crosstalk. We also review how multiple therapeutic interventions administered in intensive care units, such as mechanical ventilation, antibiotics, anesthesia, nutrition, and proton pump inhibitors, affect these systems and must be carefully considered when managing septic patients. The progression to multiple organ dysfunction syndrome in sepsis patients is still one of the most frequent causes of death in critically ill patients. A better understanding and monitoring of the mechanics of organ crosstalk will enable the anticipation of organ damage and the development of individualized therapeutic strategies.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"33 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory effects of prone position in COVID-19 acute respiratory distress syndrome differ according to the recruitment-to-inflation ratio: a prospective observational study","authors":"Christopher Lai, Rui Shi, Ludwig Jelinski, Florian Lardet, Marta Fasan, Soufia Ayed, Hugo Belotti, Nicolas Biard, Laurent Guérin, Nicolas Fage, Quentin Fossé, Thibaut Gobé, Arthur Pavot, Guillaume Roger, Alex Yhuel, Jean-Louis Teboul, Tai Pham, Xavier Monnet","doi":"10.1186/s13613-024-01375-2","DOIUrl":"https://doi.org/10.1186/s13613-024-01375-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Improvements in oxygenation and lung mechanics with prone position (PP) in patients with acute respiratory distress syndrome (ARDS) are inconstant. The objectives of the study were (i) to identify baseline variables, including the recruitment-to-inflation ratio (R/I), associated with a positive response to PP in terms of oxygenation (improvement of the ratio of arterial oxygen partial pressure over the inspired oxygen fraction (PaO₂/FiO₂) ≥ 20 mmHg) and lung mechanics; (ii) to evaluate whether the response to the previous PP session is associated with the response to the next session.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this prospective, observational, single-center study in patients who underwent PP for ARDS due to COVID-19, respiratory variables were assessed just before PP and at the end of the session. Respiratory variables included mechanical ventilation settings and respiratory mechanics variables, including R/I, an estimate of the potential for lung recruitment compared to lung overinflation.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>In 50 patients, 201 PP sessions lasting 19 ± 3 h were evaluated. Neuromuscular blockades were used in 116 (58%) sessions. The PaO₂/FiO₂ ratio increased from 109 ± 31 mmHg to 165 ± 65 mmHg, with an increase ≥ 20 mmHg in 142 (71%) sessions. In a mixed effect logistic regression, only pre-PP PaO₂/FiO₂ (OR 1.12 (95% CI [1.01–1.24])/every decrease of 10 mmHg, <i>p</i> = 0.034) in a first model and improvement in oxygenation at the previous PP session (OR 3.69 (95% CI [1.27–10.72]), <i>p</i> = 0.017) in a second model were associated with an improvement in oxygenation with PP. The R/I ratio (<i>n</i> = 156 sessions) was 0.53 (0.30–0.76), separating lower- and higher-recruiters. Whereas PaO₂/FiO₂ improved to the same level in both subgroups, driving pressure and respiratory system compliance improved only in higher-recruiters (from 14 ± 4 to 12 ± 4 cmH₂O, <i>p</i> = 0.027, and from 34 ± 11 to 38 ± 13 mL/cmH₂O, respectively, <i>p</i> = 0.014).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>A lower PaO₂/FiO₂ at baseline and a positive O₂-response at the previous PP session are associated with a PP-induced improvement in oxygenation. In higher-recruiters, lung mechanics improved along with oxygenation. Benefits of PP could thus be greater in these patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"13 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers in acute kidney injury","authors":"Marlies Ostermann, Matthieu Legrand, Melanie Meersch, Nattachai Srisawat, Alexander Zarbock, John A. Kellum","doi":"10.1186/s13613-024-01360-9","DOIUrl":"https://doi.org/10.1186/s13613-024-01360-9","url":null,"abstract":"<p>Acute kidney injury (AKI) is a multifactorial syndrome with a high risk of short- and long-term complications as well as increased health care costs. The traditional biomarkers of AKI, serum creatinine and urine output, have important limitations. The discovery of new functional and damage/stress biomarkers has enabled a more precise delineation of the aetiology, pathophysiology, site, mechanisms, and severity of injury. This has allowed earlier diagnosis, better prognostication, and the identification of AKI sub-phenotypes. In this review, we summarize the roles and challenges of these new biomarkers in clinical practice and research.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"10 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term major events after hospital discharge for out-of-hospital cardiac arrest","authors":"Sofia Ortuno, Wulfran Bougouin, Sebastian Voicu, Marine Paul, Jean-Baptiste Lascarrou, Sarah Benghanem, Florence Dumas, Frankie Beganton, Nicole Karam, Eloi Marijon, Xavier Jouven, Alain Cariou, Nadia Aissaoui","doi":"10.1186/s13613-024-01371-6","DOIUrl":"https://doi.org/10.1186/s13613-024-01371-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Cardiac arrest remains a global health issue with limited data on long-term outcomes, particularly regarding recurrent cardiovascular events in patients surviving out-of-hospital cardiac arrest. (OHCA). We aimed to describe the long-term occurrence of major cardiac event defined by hospital admission for cardiovascular events or death in OHCA hospital survivors, whichever came first. Our secondary objective were to assess separately occurrence of hospital admission and death, and to identify the factors associated with major event occurrence. We hypothesized that patients surviving an OHCA has a protracted increased risk of cardiovascular events, due to both presence of the baseline conditions that lead to OHCA, and to the cardiovascular consequences of OHCA induced acute ischemia-reperfusion.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Consecutive OHCA patients from three hospitals of Sudden Death Expertise Center (SDEC) Registry, discharged alive from 2011 to 2015 were included. Long-term follow-up data were obtained using national inter-regime health insurance information system (SNIIRAM) database and the national French death registry. The primary endpoint was occurrence of a major event defined by hospital admission for cardiovascular events and death, whichever came first during the follow-up. The starting point of the time-to-event analysis was the date of hospital discharge. The follow-up was censored on the date of the first event. For patients without event, follow-up was censored on the date of December, 29th, 2016.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 306 patients (mean age 57; 77% male) were analyzed and followed over a median follow-up of 3 years for hospital admission for cardiovascular event and 6 years for survival. During this period, 38% patients presented a major event. Hospital admission for cardiovascular events mostly occurred during the first year after the OHCA whereas death occurred more linearly during the all period. A previous history of chronic heart failure and coronary artery disease were independently associated with the occurrence of major event (HR 1.75, 95%CI[1.06-2.88] and HR 1.70, 95%CI[1.11-2.61], respectively), whereas post-resuscitation myocardial dysfunction, cardiogenic shock and cardiologic cause of cardiac arrest did not.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Survivors from OHCA must to be considered at high risk of cardiovascular event occurrence whatever the etiology, mainly during the first year following the cardiac arrest and should require closed monitoring.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"20 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute respiratory distress syndrome in patients with hematological malignancies: a one-year retrospective nationwide cohort study","authors":"Pierre-Nicolas Bris, Vanessa Pauly, Véronica Orleans, Jean-Marie Forel, Pascal Auquier, Laurent Papazian, Laurent Boyer, Sami Hraiech","doi":"10.1186/s13613-024-01373-4","DOIUrl":"https://doi.org/10.1186/s13613-024-01373-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Acute respiratory distress syndrome (ARDS) occurring in patients with hematological malignancies (HM) is a life-threatening condition with specific features. Mortality rate remains high but improvement has been described over the past several years. We aimed to describe characteristics and outcomes of ARDS in HM patients admitted in French ICUs (Intensive Care Units) during a one year-period. Data for this nationwide cohort study were collected from the French national hospital database (Programme de Médicalisation des Systèmes d’Information (PMSI)). All patients (18 years or older) admitted to French ICUs in 2017 and with a diagnosis of ARDS were included. Three groups were compared according to the presence of an HM, a solid cancer or no cancer. The primary endpoint was 90-day mortality. Secondary endpoints were the description of ICU management, etiologies of ARDS and mortality risk factors.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 12 846 patients with ARDS were included. Among them, 990 had HM and 2744 had a solid cancer. The main malignancies were non-Hodgkin lymphoma (NHL) (28.5%), acute myeloid leukemia (AML) (20.4%) and multiple myeloma (19.7%). Day-90 mortality in patients with HM was higher than in patients with no cancer (64.4% vs. 46.6% <i>p</i> = 0.01) but was not different from that of patients with solid cancer (64.4% vs. 61.4%,<i>p</i> = 0.09). Intubation rate was lower in patients with HM in comparison with both groups (87.7% vs. 90.4% <i>p</i> = 0.02 for patients with solid cancer and 87.7% vs. 91.3%; <i>p</i> &lt; 0.01 with no cancer). Independent predictors of mortality for patients with HM were a diagnosis of lymphoma or acute leukemia, age, a high modified SAPS II score, a renal replacement therapy, invasive fungal infection, and a septic shock. Bacterial pneumonia, extrapulmonary infections and non-invasive ventilation were protective.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Mortality remains high in patients with HM admitted in ICU with ARDS in comparison with patients without cancer. Mortality predictors for this population were a diagnosis of lymphoma or acute leukemia, age, a high modified SAPS II score, a renal replacement therapy, invasive fungal infection and a septic shock.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"21 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Impact of intensive prone position therapy on outcomes in intubated patients with ARDS related to COVID-19.","authors":"Christophe Le Terrier, Thaïs Walter, Said Lebbah, David Hajage, Florian Sigaud, Claude Guérin, Luc Desmedt, Steve Primmaz, Vincent Joussellin, Chiara Della Badia, Jean Damien Ricard, Jérôme Pugin, Nicolas Terzi","doi":"10.1186/s13613-024-01374-3","DOIUrl":"https://doi.org/10.1186/s13613-024-01374-3","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"14 1","pages":"142"},"PeriodicalIF":5.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of critical illness on continuation of anticancer treatment and prognosis of patients with aggressive hematological malignancies","authors":"Swann Bredin, Justine Decroocq, Clément Devautour, Julien Charpentier, Clara Vigneron, Frédéric Pène","doi":"10.1186/s13613-024-01372-5","DOIUrl":"https://doi.org/10.1186/s13613-024-01372-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Maintaining the dose-intensity of cancer treatment is an important prognostic factor of aggressive hematological malignancies. The objective of this study was to assess the long-term outcomes of intensive care unit (ICU) survivors with acute myeloid leukemia (AML) or aggressive B-cell non-Hodgkin lymphoma (B-NHL) with emphasis on the resumption of the intended optimal regimen of cancer treatment.</p><h3 data-test=\"abstract-sub-heading\">Patients and methods</h3><p>We conducted a retrospective (2013–2021) single-center observational study where we included patients with AML and B-NHL discharged alive from the ICU after an unplanned admission. The primary endpoint was the change in the intended optimal cancer treatment following ICU discharge. Secondary endpoints were 1-year progression-free survival and overall survival rates. Determinants associated with modifications in cancer treatment were assessed through multivariate logistic regression.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Over the study period, 366 patients with AML or B-NHL were admitted to the ICU, of whom 170 survivors with AML (<i>n</i> = 92) and B-NHL (<i>n</i> = 78) formed the cohort of interest. The hematological malignancy was recently diagnosed in 68% of patients. The admission Sequential Organ Failure Assessment (SOFA) score was 5 (interquartile range 4–8). During the ICU stay, 30 patients (17.6%) required invasive mechanical ventilation, 29 (17.0%) vasopressor support, and 16 (9.4%) renal replacement therapy. The one-year survival rate following ICU discharge was 59.5%. Further modifications in hematologic treatment regimens were required in 72 patients (42%). In multivariate analysis, age &gt; 65 years (odds ratio (OR) 3.54 [95%-confidence interval 1.67–7.50], <i>p</i> &lt; 0.001), ICU-discharge hyperbilirubinemia &gt; 20 µmol/L (OR 3.01 [1.10–8.15], <i>p</i> = 0.031), and therapeutic limitations (OR 16.5 [1.83–149.7], <i>p</i> = 0.012) were independently associated with modifications in cancer treatment. Post-ICU modifications of cancer treatment had significant impact on in-hospital, 1-year overall survival and progression-free survival.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The intended cancer treatment could be resumed in 58% of ICU survivors with aggressive hematological malignancies. At the time of ICU discharge, advanced age, persistent liver dysfunction and decisions to limit further life-support therapies were independent determinants of cancer treatment modifications. These modifications were associated with worsened one-year outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"21 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}