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BACKGROUND: Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. METHODS: A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013. RESULTS: Out of the 100 patients, 30 had small cell lung cancer (SCLC) and 70 had non-small cell lung cancer. (Thirty patients had already been treated with oncologic treatments.) Mechanical ventilation (MV) was performed for 81 patients. Seventeen patients received emergency chemotherapy during their ICU stay. ICU, hospital, 3- and 6-month mortality were, respectively, 47, 60, 67 and 71%. Hospital mortality was 60% when invasive MV was used alone, 71% when MV and vasopressors were needed and 83% when MV, vasopressors and hemodialysis were required. In multivariate analysis, hospital mortality was associated with metastatic disease (OR 4.22 [1.4-12.4]; p = 0.008), need for invasive MV (OR 4.20 [1.11-16.2]; p = 0.030), while chemotherapy in ICU was associated with survival (OR 0.23, [0.07-0.81]; p = 0.020). CONCLUSION: This study shows that ICU management can be appropriate for selected newly diagnosed patients with advanced lung cancer, and chemotherapy might improve outcome for patients with SCLC admitted for cancer-related complications. Nevertheless, tumors' characteristics, numbers and types of organ dysfunction should be taken into account in the decisional process before admitting these patients in ICU.
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La quemadura grave induce estrés oxidativo severo, respuesta inflamatoria sistémica, hipermetabolismo e hipercatabolismo severo y persistente con sarcopenia secundaria, disfunción orgánica, sepsis y mayor mortalidad. El déficit energético, el balance negativo de proteínas y la deficiencia de micronutrientes antioxidantes durante la agresión térmica están asociados a malos resultados clínicos. En este contexto, una terapia nutricional personalizada, priorizando la nutrición enteral precoz, está indicada desde el inicio de la fase de resucitación. En las últimas 4 décadas se han estudiado diferentes intervenciones nutricionales y farmacológicas moduladoras de la respuesta inmune y metabólica. Dichas estrategias han demostrado ser capaces de minimizar la malnutrición aguda, modular la respuesta inmunoinflamatoria y mejorar los resultados clínicos. El propósito del presente estudio de revisión es analizar la evidencia más reciente sobre la respuesta metabólica y la terapia nutricional en el paciente quemado crítico
Major burn injury triggers severe oxidative stress, a systemic inflammatory response, and a persistent hypermetabolic and hypercatabolic state with secondary sarcopenia, multiorgan dysfunction, sepsis and an increased mortality risk. Calorie deficit, negative protein balance and antioxidant micronutrient deficiency after thermal injury have been associated to poor clinical outcomes. In this context, personalized nutrition therapy with early enteral feeding from the start of resuscitation are indicated. Over the last four decades, different nutritional and pharmacological interventions aimed at modulating the immune and metabolic responses have been evaluated. These strategies have been shown to be able to minimize acute malnutrition, as well as modulate the immunoinflammatory response, and improve relevant clinical outcomes in this patient population. The purpose of this updating review is to summarize the most current evidence on metabolic response and nutrition therapy in critically ill burn patients
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Humanos , Quemaduras/metabolismo , Quemaduras/terapia , Terapia Nutricional , Enfermedad CríticaRESUMEN
Major burn injury triggers severe oxidative stress, a systemic inflammatory response, and a persistent hypermetabolic and hypercatabolic state with secondary sarcopenia, multiorgan dysfunction, sepsis and an increased mortality risk. Calorie deficit, negative protein balance and antioxidant micronutrient deficiency after thermal injury have been associated to poor clinical outcomes. In this context, personalized nutrition therapy with early enteral feeding from the start of resuscitation are indicated. Over the last four decades, different nutritional and pharmacological interventions aimed at modulating the immune and metabolic responses have been evaluated. These strategies have been shown to be able to minimize acute malnutrition, as well as modulate the immunoinflammatory response, and improve relevant clinical outcomes in this patient population. The purpose of this updating review is to summarize the most current evidence on metabolic response and nutrition therapy in critically ill burn patients.
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Quemaduras/metabolismo , Quemaduras/terapia , Terapia Nutricional , Enfermedad Crítica , HumanosRESUMEN
BACKGROUND: Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs. PATIENTS AND METHODS: Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality. RESULTS: Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge. CONCLUSIONS: ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.
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Carcinoma de Pulmón de Células no Pequeñas/terapia , Cuidados Críticos , Neoplasias Pulmonares/terapia , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Estudios de Cohortes , Femenino , Humanos , Pulmón/patología , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
El síndrome de lisis tumoral (SLT) es una complicación potencialmente letal provocada por la liberación masiva de ácidos nucleicos, potasio y fosfato hacia la circulación sistémica. Este cuadro es el resultado de la lisis celular de neoplasias, con frecuencia hematológicas, las cuales se caracterizan por una rápida capacidad de proliferación y alta sensibilidad a fármacos. Por otra parte, el SLT se puede observar por muerte celular espontánea previo al inicio del tratamiento citoreductor, agravándose luego de iniciada la quimioterapia. El SLT presenta una alta mortalidad, por lo que su prevención continúa siendo la medida terapéutica más importante. En la unidad de cuidados intensivos los médicos deben conocer su cuadro clínico, el cual se caracteriza por la existencia de graves trastornos del metabolismo hidroelectrolítico, en particular hiperpotasemia, hiperfosfatemia e hipocalcemia y por la aparición de una lesión renal aguda. Una adecuada intervención terapéutica implica la rápida admisión a unidad de cuidados intensivos, hidratación intravenosa y aporte de la enzima urato-oxidasa como las medidas más importantes. El objetivo de la presente revisión es proporcionar herramientas diagnósticas y terapéuticas que le permiten al médico intensivista reconocer la población en riesgo de desarrollar este síndrome, así como establecer una adecuada estrategia terapéutica y profiláctica (AU)
The tumor lysis syndrome (TLS) is a life-threatening complication caused by the massiverelease of nucleic acids, potassium and phosphate into the blood. This complication is theresult of tumor cell lysis, which may occur due to treatment of drug sensitive and is characterizedby rapid capacity of proliferation, that is often hematological origin. Moreover, the TLScan be observed before starting the treatment due to spontaneous tumor cell death, and frequentlyworsens when chemotherapy is initiated. TLS has high mortality, so that its prevention continues to be the most important therapeutic measure. In the intensive care unit (ICU), physicians should be aware of the clinical characteristics of TLS, which results in severe electrolytemetabolism disorders, especially hyperkalemia, hyperphosphatemia and hypocalcemia,and acute kidney injury which is a major cause of ICU mortality. An adequate strategy for themanagement of the TLS, combining hydration, urate oxidase, and an early admission to ICU can control this complication in most patients. The aim of this review is to provide diagnostic toolsthat allow to the ICU physician to recognize the population at high risk for developing the TLS,and outline a proper strategy for treating and preventing this serious complication (AU)
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Humanos , Síndrome de Lisis Tumoral/diagnóstico , Síndrome de Lisis Tumoral/terapia , Cuidados Críticos , Índice de Severidad de la Enfermedad , Factores de Riesgo , IncidenciaRESUMEN
The tumor lysis syndrome (TLS) is a life-threatening complication caused by the massive release of nucleic acids, potassium and phosphate into the blood. This complication is the result of tumor cell lysis, which may occur due to treatment of drug sensitive and is characterized by rapid capacity of proliferation, that is often hematological origin. Moreover, the TLS can be observed before starting the treatment due to spontaneous tumor cell death, and frequently worsens when chemotherapy is initiated. TLS has high mortality, so that its prevention continues to be the most important therapeutic measure. In the intensive care unit (ICU), physicians should be aware of the clinical characteristics of TLS, which results in severe electrolyte metabolism disorders, especially hyperkalemia, hyperphosphatemia and hypocalcemia, and acute kidney injury which is a major cause of ICU mortality. An adequate strategy for the management of the TLS, combining hydration, urate oxidase, and an early admission to ICU can control this complication in most patients. The aim of this review is to provide diagnostic tools that allow to the ICU physician to recognize the population at high risk for developing the TLS, and outline a proper strategy for treating and preventing this serious complication.
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Cuidados Críticos/métodos , Síndrome de Lisis Tumoral/diagnóstico , Síndrome de Lisis Tumoral/terapia , Lesión Renal Aguda/etiología , Lesión Renal Aguda/prevención & control , Lesión Renal Aguda/terapia , Alopurinol/uso terapéutico , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Arritmias Cardíacas/tratamiento farmacológico , Arritmias Cardíacas/etiología , Arritmias Cardíacas/prevención & control , Terapia por Quelación , Ensayos Clínicos como Asunto , Terapia Combinada , Fluidoterapia , Humanos , Hiperpotasemia/tratamiento farmacológico , Hiperpotasemia/etiología , Hiperfosfatemia/tratamiento farmacológico , Hiperfosfatemia/etiología , Hipocalcemia/tratamiento farmacológico , Hipocalcemia/etiología , Incidencia , Estudios Multicéntricos como Asunto , Pronóstico , Terapia de Reemplazo Renal , Factores de Riesgo , Índice de Severidad de la Enfermedad , Síndrome de Lisis Tumoral/sangre , Síndrome de Lisis Tumoral/epidemiología , Síndrome de Lisis Tumoral/prevención & control , Urato Oxidasa/uso terapéuticoRESUMEN
La aspergilosis invasiva es una entidad frecuente en los pacientes hematooncológicos. La sintomatología es sumamente inespecífica, por lo que es necesario conocer las herramientas diagnósticas para alcanzar diagnósticos precoces. Esta revisión intenta poner en claro la actual evidencia en los siguientes aspectos: la presentación clínica, los métodos de estudio y el tratamiento de esta entidad en pacientes hematooncológicos críticos (AU)
Invasive aspergillosis is a common condition in patients with hematologic malignancies. Symptoms are extremely non-specific, and therefore it is necessary to be familiar with the diagnostic tests for early diagnosis. This review has attempted to clarify the current evidence regarding the following areas: clinical presentation, methods of study and treatment of this condition in hemato-oncological critical patients (AU)
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Humanos , Aspergilosis Pulmonar Invasiva/epidemiología , Neoplasias Hematológicas/complicaciones , Unidades de Cuidados Intensivos/estadística & datos numéricos , Antifúngicos/uso terapéutico , Trasplante de Médula Ósea/efectos adversos , Insuficiencia Respiratoria/etiologíaRESUMEN
Invasive aspergillosis is a common condition in patients with hematologic malignancies. Symptoms are extremely non-specific, and therefore it is necessary to be familiar with the diagnostic tests for early diagnosis. This review has attempted to clarify the current evidence regarding the following areas: clinical presentation, methods of study and treatment of this condition in hemato-oncological critical patients.