Intensive care of the cancer patient: recent achievements and remaining challenges.
Intensive care of the cancer patient: recent achievements and remaining challenges.
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DOI：
10.1186/2110-5820-1-5
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发表时间：
2011-03-23
影响因子：
8.1
通讯作者：
Afessa B
中科院分区：
文献类型：
--
作者：
Azoulay E;Soares M;Darmon M;Benoit D;Pastores S;Afessa B
自从重症监护病房（ICU）床位可用于癌症重症患者以来，已经过去了几十年。虽然最初的报告显示预后不佳，但最近的数据表明，越来越多的实体和血液恶性肿瘤患者受益于重症监护支持，死亡率大幅下降。基础恶性肿瘤管理和器官功能障碍支持方面的进展已导致恶性肿瘤本身危及生命的并发症以及与肿瘤治疗相关的感染和毒性不良反应患者的生存率提高。在这篇综述中，我们将评估预后因素，并讨论与癌症危重患者的管理相关的整体前景。某些因素的预后意义随着时间的推移而改变。例如，中性粒细胞减少症或自体骨髓移植（BMT）对预后的不良影响比二十年前要小。同样，由于血液科医生和肿瘤科医生根据恶性肿瘤的特征选择ICU入院的患者，因此潜在的恶性肿瘤很少影响ICU入院后的短期生存。由于最近的数据并不清楚地支持ICU支持对重症异基因骨髓移植受者的益处，因此需要在该亚组中进行更多的结局研究。由于癌症重症患者的总体生存率有所提高，我们概述了一个易于使用和循证的ICU入院分诊标准，这可能有助于避免剥夺可以受益的癌症患者的生命支持。最后，我们提出了一个研究议程，以解决悬而未决的问题。
A few decades have passed since intensive care unit (ICU) beds have been available for critically ill patients with cancer. Although the initial reports showed dismal prognosis, recent data suggest that an increased number of patients with solid and hematological malignancies benefit from intensive care support, with dramatically decreased mortality rates. Advances in the management of the underlying malignancies and support of organ dysfunctions have led to survival gains in patients with life-threatening complications from the malignancy itself, as well as infectious and toxic adverse effects related to the oncological treatments. In this review, we will appraise the prognostic factors and discuss the overall perspective related to the management of critically ill patients with cancer. The prognostic significance of certain factors has changed over time. For example, neutropenia or autologous bone marrow transplantation (BMT) have less adverse prognostic implications than two decades ago. Similarly, because hematologists and oncologists select patients for ICU admission based on the characteristics of the malignancy, the underlying malignancy rarely influences short-term survival after ICU admission. Since the recent data do not clearly support the benefit of ICU support to unselected critically ill allogeneic BMT recipients, more outcome research is needed in this subgroup. Because of the overall increased survival that has been reported in critically ill patients with cancer, we outline an easy-to-use and evidence-based ICU admission triage criteria that may help avoid depriving life support to patients with cancer who can benefit. Lastly, we propose a research agenda to address unanswered questions.
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影响因子：
8.8
作者：
Azoulay, E;Alberti, C;Schlemmer, B
通讯作者：
Schlemmer, B
DOI：
10.1164/rccm.200206-554oc
发表时间：
2003-05-15
影响因子：
24.7
作者：
Azoulay, É;Fieux, F;Schlemmer, B
通讯作者：
Schlemmer, B
影响因子：
38.9
作者：
Benoit, DD;Depuydt, PO;Decruyenaere, JM
通讯作者：
Decruyenaere, JM
影响因子：
8.8
作者：
Benoit, DD;Vandewoude, KH;Colardyn, FA
通讯作者：
Colardyn, FA
影响因子：
6.1
作者：
Benoit, DD;Hoste, EA;Decruyenaere, JM
通讯作者：
Decruyenaere, JM