Intensive care of the cancer patient:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2010
|
| Schriftenreihe: | Critical care clinics
26,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV, 237 S. Ill., graph. Darst. |
| ISBN: | 9781437718065 |
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| 650 | 4 | |a Intensive Care | |
| 650 | 4 | |a Neoplasms |x therapy | |
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Datensatz im Suchindex
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| adam_text | Titel: Intensive care of the cancer patient
Autor: Pastores, Stephen M.
Jahr: 2010
Intensive Care of the Cancer Patient
Contents
Preface
Stephen M. Pastores and Neil A. Halpern
Admission Criteria and Prognostication in Patients with Cancer Admitted
to the Intensive Care Unit 1
Brenda K. Shelton
Critical care for patients with cancer was once considered inappropriate
because of a perceived poor prognosis for their long-term survival. Three
decades of research has yielded evidence to support the use of critical
care resources for many patients with cancer. A methodical approach to
triage and evaluation of critically ill patients regardless of baseline medical
diagnosis, coupled with an appreciation for the likely prognosis of their
current cancer, is most likely to yield the fairest and most accurate appro-
priation of care. No clinical scoring system has emerged that accurately
defines the severity of illness and likelihood for survival in patients with
cancer. This article reviews the studies that have attempted to apply mor-
tality prediction scales or scoring systems to these patients. Clinical judg-
ment with incorporation of consensus opinions from the literature should
be used to develop admission or restriction criteria for intensive care of pa-
tients with cancer.
Acute Respiratory Failure in the Patient with Cancer: Diagnostic
and Management Strategies 21
Stephen M. Pastores and Louis P. Voigt
Acute respiratory failure (ARF) remains the major reason for admission to
the intensive care unit (ICU) in patients with cancer and is often associated
with high mortality, especially in those who require mechanical ventilation.
The diagnosis and management of ARF in patients who have cancer pose
unique challenges to the intensivist. This article reviews the most common
causes of ARF in patients with cancer and discusses recent advances in
the diagnostic and management approaches of these disorders. Timely di-
agnosis and treatment of reversible causes of respiratory failure, including
earlier use of noninvasive ventilation and judicious ventilator and fluid man-
agement in patients with acute lung injury, are essential to achieve an
optimal outcome. Close collaboration between oncologists and intensiv-
ists helps ensure that clear goals, including direction of treatment and
quality of life, are established for every patient with cancer who requires
mechanical ventilation for ARF.
Mechanical Ventilation in Cancer Patients: Clinical Characteristics and Outcomes 41
Marcio Soares, Pieter O. Depuydt, and Jorge I.F. Salluh
Acute respiratory failure with the need for mechanical ventilation is a severe
and frequent complication, and a leading reason for admission to the
intensive care unit (ICU) in patients with malignancies. Nevertheless,
Contents
improvements in patient survival have been observed over the last decade.
This article reviews the epidemiology of adult patients with malignancies re-
quiring ventilatory support. Criteria used to assist decisions to admit a pa-
tient to the ICU and to select the initial ventilatory strategy are discussed.
Diagnosis and Management of Infectious Complications in Critically III Patients
with Cancer 59
Raghukumar Thirumala, Madhusudanan Ramaswamy,
and Sanjay Chawla
Cancer and its treatments lead to profound suppression of innate and
acquired immune function. In this population, bacterial infections are
common and may rapidly lead to overwhelming sepsis and death. Further-
more, infections caused by viral and fungal pathogens should be consid-
ered in patients who have specific immune defects. As cancer therapies
have become more aggressive the risk for infection has increased and
many patients require intensive care support. Despite improvements in
long-term survival, infections remain a common complication of cancer
therapy and accounts for the majority of chemotherapy-associated
deaths. By understanding the host defense impairments and likely patho-
gens clinicians will be better able to guide diagnosis and management of
this unique population.
Critical Care Issues in Oncological Surgery Patients 93
Sanam Ahmed and John M. Oropello
As life expectancy increases and advances in cancer treatment more often
convert deadly conditions into more chronic diseases, the surgical inten-
sivist can expect to be faced with greater numbers of oncology patients
undergoing aggressive surgical treatments for curative intent, prolonging
survival, or primarily palliation by alleviating obstruction, infection, bleed-
ing, or pain. Cytoreductive surgery (CRS) and heated intraperitoneal che-
motherapy (HIPEC) are a paradigm for the emerging field of multimodal
aggressive oncological surgery. This article describes the CRS/HIPEC
technique, and discusses the most common postoperative complications
and critical care issues in these patients, including anastomotic leaks, in-
testinal perforation, abscesses, and intra-abdominal bleeding. The leading
cause of mortality is sepsis leading to multiple organ failure, and such pa-
tients are at particularly higher risk due to the extensive CRS and HIPEC.
The intensivist must be vigilant to ensure that source control is not over-
looked. This process is a very difficult one, made even more challenging
by the blunting of physiologic responses and the frequent absence of
the classic acute abdomen.
Hematological Issues in Critically III Patients with Cancer 107
Karen S. Carlson and Maria T. DeSancho
Patients with solid and hematologic malignancies presenting with major
bleeding or thrombotic complications, potentially life-ending events in
a cancer patient s clinical course, usually require admission to an intensive
care unit (ICU), making their diagnosis and management even more impor-
tant for the intensivist. Given the significant advances in the diagnosis and
Contents
treatment of almost all types of cancers in recent years, the intensivist is
likely to encounter an ever-increasing number of cancer patients in the
ICU setting with these complications. Abnormal hemostasis can occur
as a consequence of both the pathology and treatment of cancer. Because
cancer can have multiple effects on hemostatic equilibrium, treatment of
these complications can be more complex than in the general population.
This article reviews the physiology of coagulation and fibrinolysis, with
special attention to those aspects that are most frequently altered in the
setting of malignancy. The pathophysiology of bleeding and thrombotic
complications specific to critically ill cancer patients are then detailed,
and the diagnostic and therapeutic strategies are discussed. Special em-
phasis is placed on new cancer medications that have an effect on hemo-
stasis, and on novel clotting and anticoagulant agents that are available to
the intensivist for the management of these patients.
Critical Care of the Hematopoietic Stem Cell Transplant Recipient 133
Bekele Afessa and Elie Azoulay
An estimated 50,000 to 60,000 patients undergo hematopoietic stem cell
transplantation (HSCT) worldwide annually, of which 15.7% are admitted
to the intensive care unit (ICU). The most common reason for ICU admis-
sion is respiratory failure and almost all develop single or multiorgan failure.
Most HSCT recipients admitted to ICU receive invasive mechanical venti-
lation (MV). The overall short-term mortality rate of HSCT recipients admit-
ted to ICU is 65%, and 86.4% for those receiving MV. Patient outcome has
improved over time. Poor prognostic indicators include advanced age,
poor functional status, active disease at transplant, allogeneic transplant,
the severity of acute illness, and the development of multiorgan failure. fCU
resource limitations often lead to triage decisions for admission. For HSCT
recipients, the authors recommend (1) ICU admission for full support dur-
ing their pre-engraftment period and when there is no evidence of disease
recurrence; (2) no ICU admission for patients who refuse it and those who
are bedridden with disease recurrence and without treatment options ex-
cept palliation; (3) a trial ICU admission for patients with unknown status of
disease recurrence with available treatment options.
Acute Kidney Injury in Critically III Patients with Cancer 151
Dominique D. Benoit and Eric A. Hoste
Critically ill cancer patients have a higher incidence of acute kidney injury
treated with renal replacement therapy than critically ill patients without
cancer. Acute kidney injury may occur as a direct or indirect consequence
of the cancer itself, its treatment, or associated complications. Several re-
cent studies have shown that the presence of an underlying cancer alone
can no longer be considered a contraindication to initiate renal replace-
ment therapy or other advanced life-supportive measures in critically ill pa-
tients. However, these relatively good results should not be used to justify
unrealistic therapeutic perseverance or to withhold palliative care in cancer
patients who are in a desperate situation. Similar to that for any other crit-
ically ill patient, the decision to initiate advanced life-supportive therapy as
Contents
well as its duration should be in proportion with the patient s expected
long-term prognosis and quality of life.
Oncologic Emergencies 181
Deepti Behl, Andrea Wahner Hendrickson, and Timothy J. Moynihan
Oncologic emergencies represent a wide variety of conditions that can oc-
cur at any time during the course of a malignancy, from an initial presenting
manifestation in someone with an undiagnosed cancer, to end-stage in-
curable metastatic disease. Emergent conditions can also arise after a ma-
lignancy has been in remission for many years, even decades, so clinicians
must be aware of any prior history of cancer in patients. Oncologic emer-
gencies include conditions caused by the cancer itself or side effects
of therapy. Emergent conditions include metabolic, cardiac, neurologic,
or infectious disorders. Many of these emergencies are imminently life-
threatening, and can occur in patients with curable disease (such as
lymphomas or leukemias); however, many also present in patients with
incurable advanced disease. Prompt recognition and treatment of these
conditions can lead to markedly improved quality and quantity of life.
Acute Care Nurse Practitioners in Oncologic Critical Care: The Memorial
Sloan-Kettering Cancer Center Experience 207
Rhonda D Agostino and Neil A. Halpern
Nurse practitioners (NPs) are increasingly being used to fill the physician-
staffing void in intensive care units. This article describes the initiation and
role development of our collaborative physician-NP critical care medicine
(CCM) program at the Memorial Sloan-Kettering Cancer Center. The chal-
lenges that our program encountered with recruiting, training, transition-
ing, collaborating, communicating, and addressing end-of-life issues are
detailed in this article. Finally, we delve into the emotional impact NPs
have on this new role and propose future directions to strengthen the
CCM NP model. We hope that this descriptive article of the development
of our CCM NP group will allow others who are seeking to cultivate their
own CCM NP teams to benefit from our experience.
End-of-Life Issues in Critically III Cancer Patients 219
Susan Gaeta and Kristen J. Price
This article discusses end-of-life issues in critically ill cancer patients.
Since the majority of deaths will occur after limiting or withdrawing life sup-
port, focus should be given to ensuring that multidisciplinary family meet-
ings are convened to discuss end-of-life decision making. Throughout the
process of transitioning from cure to comfort care, it is essential to support
the patient and the patient s family cultural beliefs and spiritual values, and
to ensure good pain and symptom management. The use of protocols fa-
cilitates a smooth transition and potentially reduces variability between
health care providers. Integrating measures into the ICU routine that will
help health care providers cope with the care of a dying patient is recom-
mended to avoid moral distress or emotional burnout.
Index 229
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| spelling | Intensive care of the cancer patient guest eds. Stephen M. Pastores ... Philadelphia [u.a.] Saunders 2010 XIV, 237 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Critical care clinics 26,1 Cancer Complications Treatment Cancer Palliative treatment Intensive Care Neoplasms therapy Intensivmedizin (DE-588)4027263-1 gnd rswk-swf Krebskranker (DE-588)4032913-6 gnd rswk-swf Krebskranker (DE-588)4032913-6 s Intensivmedizin (DE-588)4027263-1 s DE-604 Pastores, Stephen M. Sonstige (DE-588)140240500 oth Critical care clinics 26,1 (DE-604)BV000019838 26,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=018857225&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Intensive care of the cancer patient Critical care clinics Cancer Complications Treatment Cancer Palliative treatment Intensive Care Neoplasms therapy Intensivmedizin (DE-588)4027263-1 gnd Krebskranker (DE-588)4032913-6 gnd |
| subject_GND | (DE-588)4027263-1 (DE-588)4032913-6 |
| title | Intensive care of the cancer patient |
| title_auth | Intensive care of the cancer patient |
| title_exact_search | Intensive care of the cancer patient |
| title_full | Intensive care of the cancer patient guest eds. Stephen M. Pastores ... |
| title_fullStr | Intensive care of the cancer patient guest eds. Stephen M. Pastores ... |
| title_full_unstemmed | Intensive care of the cancer patient guest eds. Stephen M. Pastores ... |
| title_short | Intensive care of the cancer patient |
| title_sort | intensive care of the cancer patient |
| topic | Cancer Complications Treatment Cancer Palliative treatment Intensive Care Neoplasms therapy Intensivmedizin (DE-588)4027263-1 gnd Krebskranker (DE-588)4032913-6 gnd |
| topic_facet | Cancer Complications Treatment Cancer Palliative treatment Intensive Care Neoplasms therapy Intensivmedizin Krebskranker |
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