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2.
Internist (Berl) ; 54(9): 1051-60, 2013 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-23943008

RESUMEN

The occurrence of hyperleukocytosis (leukocytes > 100.000/µl) is associated with complications such as leukostasis, tumor lysis and consumption coagulopathy in patients with acute leukemia much more often than in patients with chronic malignant hematological diseases. To manage these situations may be complex as organ failure is often imminent or manifest, infectious complications arise and indications for induction chemotherapy are usually urgent. Prophylaxis and therapy of the tumor lysis syndrome consists of hydration, lowering of uric acid and the management of electrolyte disturbances. Leukostasis requires immediate reduction of the leukocyte count by leukapheresis, administration of hydroxycarbamide and, ultimately, by causative and specific treatment of the underlying disease itself. In patients with curable diseases or favorable long-term prognosis, transfer to the intensive care unit must be evaluated early in the course of impending organ dysfunction, especially in cases of acute respiratory failure.


Asunto(s)
Cuidados Críticos/métodos , Leucocitosis/terapia , Leucostasis/etiología , Leucostasis/terapia , Síndrome de Lisis Tumoral/etiología , Síndrome de Lisis Tumoral/terapia , Humanos , Leucocitosis/diagnóstico , Leucocitosis/etiología , Leucostasis/diagnóstico , Síndrome de Lisis Tumoral/diagnóstico
3.
Med Klin Intensivmed Notfmed ; 115(8): 633-640, 2020 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-33044656

RESUMEN

Intensivists are confronted with a broad spectrum of specific clinical problems while caring for critically ill cancer patients. These include defining proper goals of intensive care treatment, managing acute respiratory failure with diverse differential considerations, treating immunologic side-effects of ever new and innovative cancer therapies, as well as numerous clinical scenarios which may exclusively arise in cancer patients. To help clinicians handle such challenges, the initiative Intensive Care in Hematologic and Oncologic Patients (iCHOP) has been dealing with these topics for several years. Supported by several Austrian and German medical societies of intensive care medicine, hematology and oncology, the first "Consensus statement for cancer patients requiring intensive care support" has only recently been released. Acute respiratory failure and its management continues to be a major focus in critically ill cancer patients due to its frequency and its prognostic impact. While noninvasive oxygenation strategies were considered the gold standard of therapy, more recent high-quality data do not show clinical benefits of such techniques including high flow nasal oxygen. On the contrary, several studies revealed an unidentified etiology of an acute respiratory failure as the only potentially modifiable risk factor for adverse outcome. Consequently, evidence-based and rigorously applied diagnostic algorithms are of utmost importance in these patients. Furthermore, intensivists are increasingly confronted with the rising incidence of various and new immunotherapy-associated toxicities and their management.


Asunto(s)
Síndrome de Dificultad Respiratoria , Tabú , Austria , Cuidados Críticos , Enfermedad Crítica , Humanos
4.
Med Klin Intensivmed Notfmed ; 115(4): 312-319, 2020 May.
Artículo en Alemán | MEDLINE | ID: mdl-31363797

RESUMEN

INTRODUCTION: Cancer is one of the leading causes of death worldwide. Due to increasing comorbidities, age and aggressive chemotherapy, care of cancer patients in intensive care units (ICUs) is more and more necessary. So far, little is known about the care structure of cancer patients in German ICUs. The aim of this work is to collect and evaluate the prevalence and care data of cancer patients on two reference dates. METHODS: German ICUs were invited to participate in a 2-day, prospective, multicenter point prevalence study in ICU cancer patients. Participation in the study was voluntary and the study was not funded. An ethics vote was obtained to conduct the study. The data were anonymously entered into an eCRF (electronic case report form) by the participating centers. Identification of the patients is therefore not possible. RESULTS: About one in four patients on the ICU/IMC ward had hematological-oncological (HO) disease (n = 316/1319, 24%). The proportion depended significantly on the number of beds in each hospital. The most frequent reasons for admission to the ICU/IMC station were postoperative monitoring (n = 83/221, 37.6%), respiratory instability (n = 79/221, 35.7%), circulatory instability (n = 52/221; 23.5%) and the severe infection with sepsis (n = 47/221; 21.3%). In all, 66.5% (n = 147/221) of the patients had a solid tumor and 21.7% (n = 48/221) had hematological cancer, 78.3% (n = 173/221) of the documented cancer patients received "full-code" intensive management, while 42.5% (n = 94/221) of the HO patients were ventilated and 40.7% (n = 90/221) required catecholamines. The median (mean; IQR) SAPS II score was 35 (37.79, IQR = 24-48) and the median (mean, IQR) TISS score was 10 (13.26, IQR = 10-15). Through the analysis and evaluation of the data available in the context of the prevalence study, it was possible for the first time to determine the Germany-wide cross-center prevalence and care situation of hematological cancer patients in intensive care and intermediate care stations. About one in four patients on German ICUs and IMC wards have a major or minor cancer diagnosis (n = 316/1319 = 24%). Care management is complex in this patient population and requires close interdisciplinary collaboration.


Asunto(s)
Unidades de Cuidados Intensivos , Sepsis , Alemania , Humanos , Prevalencia , Estudios Prospectivos
5.
J Crit Care ; 47: 198-203, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30015290

RESUMEN

Invasive pulmonary aspergillosis (IPA) is an emerging and life-threatening infectious disease in patients admitted to the intensive care unit (ICU). Most diagnostic studies are conducted in hematological patients and results cannot readily be transferred to ICU patients lacking classical host factors. In a multicenter, prospective clinical trial including 44 ICU patients, hematological (n = 14) and non-hematological patients (n = 30), concurrent serum and bronchoalveolar lavage (BAL) samples were analyzed by conventional culture, galactomannan (GM), 1-3-beta-D-glucan (BDG) as well as an Aspergillus specific nested polymerase chain reaction (PCR). Nine patients (20%) had putative IPA according to AspICU classification. GM and PCR showed superior performance in BAL with sensitivity/specificity of 56%/94% and 44%/94% compared to 33%/97% and 11%/94% in serum. Despite better sensitivity of 89%, BDG showed poor specificity of only 31% (BAL) and 26% (serum). Combination of GM and PCR (BAL) with BDG (serum) resulted in 100% sensitivity, but also reduced specificity to 23%. Whereas mean GM levels were significantly higher in hematological patients BDG and PCR did not differ between hematological and non-hematological patients. Under present clinical conditions test combinations integrating both BAL and blood samples are advantageous. BDG might best serve as possible indicator for ruling out IPA. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01695499. First posted: September 28, 2012, last update posted: May 8, 2017.


Asunto(s)
Aspergillus/aislamiento & purificación , Líquido del Lavado Bronquioalveolar/microbiología , Enfermedad Crítica , Aspergilosis Pulmonar Invasiva/microbiología , Reacción en Cadena de la Polimerasa , Adulto , Anciano , Anciano de 80 o más Años , Pruebas Diagnósticas de Rutina , Galactosa/análogos & derivados , Humanos , Masculino , Mananos/análisis , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Adulto Joven , beta-Glucanos/análisis
6.
Med Klin Intensivmed Notfmed ; 109(3): 200-4, 2014 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-24615144

RESUMEN

A patient suffering from severe cutaneous graft versus host disease (GvHD) developed generalized epidermolysis and refractory hypothermia. Due to the insufficient effect of traditional rewarming methods, an endovascular temperature catheter was placed via the femoral vein to achieve and maintain normothermia over a period of 31 days. This case shows that an endovascular temperature modulation device primarily made for short-term use may be safe and effective even over weeks and may offer an alternative to other rewarming methods in patients with severe epidermolysis and burns.


Asunto(s)
Regulación de la Temperatura Corporal , Catéteres de Permanencia , Epidermólisis Ampollosa Adquirida/terapia , Enfermedad Injerto contra Huésped/terapia , Hipotermia/terapia , Unidades de Cuidados Intensivos , Recalentamiento/instrumentación , Femenino , Vena Femoral , Trasplante de Células Madre Hematopoyéticas , Humanos , Cuidados a Largo Plazo , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adulto Joven
7.
Med Klin Intensivmed Notfmed ; 108(3): 203-8, 2013 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-23512138

RESUMEN

Providing critical care to cancer patients requires a high degree of practical multidisciplinary teamwork between intensivists and cancer specialists. Intensivists should have a solid basic knowledge of malignant diseases as well as of the typical complications of the underlying illness and its therapies. Hemato-oncologists should evaluate the transfer of these patients to the intensive care unit early in the course of emerging organ dysfunctions. Both parties should have a realistic impression of the short-term intensive care and long-term oncologic options and perspectives of the respective patient. Good cooperation between intensivists and cancer specialists is the basis for meaningful decisions on admission, planning of individual therapeutic aims, successful patient management, and tailored therapy, with a smooth transition into a palliative care setting whenever appropriate.


Asunto(s)
Cuidados Críticos/ética , Cuidados Críticos/métodos , Ética Médica , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/terapia , Unidades de Cuidados Intensivos/ética , Neoplasias/complicaciones , Neoplasias/terapia , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Conducta Cooperativa , Neoplasias Hematológicas/mortalidad , Humanos , Comunicación Interdisciplinaria , Neoplasias/mortalidad , Transferencia de Pacientes/ética , Pronóstico , Respiración Artificial/ética , Respiración Artificial/mortalidad , Tasa de Supervivencia
8.
Med Klin Intensivmed Notfmed ; 108(4): 295-302, 2013 May.
Artículo en Alemán | MEDLINE | ID: mdl-23443518

RESUMEN

Many factors contribute to making critically ill patients with underlying hematological or oncological diseases into a special collective on intensive care units, such as an often incurable or at least doubtfully curable underlying disease, therapy associated complications and a commonly present immunosuppression. The prognosis of these patients has clearly improved in recent years so that a general reluctance in deciding to treat these patients in intensive care units can no longer be justified. Comprehensive infection diagnostics and a guideline oriented causal and supportive treatment can improve the prognosis of sepsis even in hematology/oncology patients. In the therapy of respiratory failure non-invasive ventilation is of great importance for a reduction in mortality if used early and contraindications, such as termination criteria are considered. Considerations on long-term prognosis, quality of life and palliative care are increasingly becoming topics in intensive care medicine.


Asunto(s)
Cuidados Críticos/métodos , Enfermedades Hematológicas/terapia , Neoplasias Hematológicas/terapia , Neoplasias/terapia , Conducta Cooperativa , Alemania , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/mortalidad , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/mortalidad , Trasplante de Células Madre Hematopoyéticas , Humanos , Comunicación Interdisciplinaria , Neoplasias/complicaciones , Neoplasias/mortalidad , Infecciones Oportunistas/etiología , Infecciones Oportunistas/mortalidad , Infecciones Oportunistas/terapia , Terapia por Inhalación de Oxígeno , Cuidados Paliativos , Admisión del Paciente , Grupo de Atención al Paciente , Pronóstico , Calidad de Vida , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/terapia , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/terapia , Sepsis/etiología , Sepsis/mortalidad , Sepsis/terapia , Análisis de Supervivencia
9.
Med Klin Intensivmed Notfmed ; 107(5): 386-90, 2012 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-22689258

RESUMEN

The life expectancy and prevalence of malignant diseases is continuously on the rise, which inevitably leads to an increase of critically ill cancer patients. This article explains why the prognosis of cancer patients in the intensive care unit has markedly improved over the last decades, what the reasons for admission are and which risk factors affect mortality. Furthermore, the importance of correct patient selection and other specific topics will be discussed. Accordingly, acute respiratory failure for example is the most common organ dysfunction in these patients and has specific prognostic, diagnostic and therapeutic characteristics. The successful management of cancer patients in the intensive care unit requires specific knowledge of the intensive care physician and an excellent cooperation with the treating hematologist and oncologist.


Asunto(s)
Cuidados Críticos/métodos , Neoplasias Hematológicas/terapia , Causas de Muerte , Conducta Cooperativa , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/mortalidad , Infección Hospitalaria/terapia , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/mortalidad , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Comunicación Interdisciplinaria , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/mortalidad , Infecciones Oportunistas/terapia , Cuidados Paliativos , Pronóstico , Respiración Artificial , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/terapia , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/terapia , Factores de Riesgo , Sepsis/diagnóstico , Sepsis/mortalidad , Sepsis/terapia
10.
Artículo en Alemán | MEDLINE | ID: mdl-12101510

RESUMEN

Difficult intubation can unexpectedly occur in clinical practice and emergencies. Oxygenation must be maintained with resumed artificial ventilation. Besides tracheal intubation with an ETT as the "gold standard" of airway management, the esophageal-tracheal Combitube(R) (ETC; Tyco-Healthcare, Neustadt/Donau, Germany; www.combitube.org) is another interesting device that has been used satisfactorily in a variety of circumstances, specially for management of the difficult airway. The ETC has been used during prehospital and hospital emergencies. Now, anesthesiologists have managed the ETC successfully in clinical practice also. The anesthesiological management does not differ from the management in other difficult airway situations. The use of the Combitube needs an appropriate teaching and continuous clinical practice.


Asunto(s)
Anestesia por Inhalación , Servicios Médicos de Urgencia , Intubación Gastrointestinal/instrumentación , Intubación Intratraqueal/instrumentación , Humanos
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