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Intensive Care Medicine

, Volume 38, Issue 9, pp 1505–1513 | Cite as

Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units

  • Jae-Uk Song
  • Gee Young Suh
  • Hye Yun Park
  • So Yeon Lim
  • Seo Goo Han
  • Yeh Rim Kang
  • O. Jung Kwon
  • Sookyoung Woo
  • Kyeongman JeonEmail author
Original

Abstract

Purpose

To determine whether earlier intervention was associated with decreased mortality in critically ill cancer patients admitted to an intensive care unit (ICU).

Methods

A retrospective observational study was performed of 199 critically ill cancer patients admitted to the ICU from the general ward between January 2010 and December 2010. A logistic regression model was used to adjust for potential confounding factors in the association between time to intervention and in-hospital mortality.

Results

In-hospital mortality was 52 %, with a median Simplified Acute Physiology Score 3 (SAPS 3) of 80 [interquartile range (IQR) 67–93], and a median Sequential Organ Failure Assessment (SOFA) score of 8 (IQR 5–11). Median time from physiological derangement to intervention (time to intervention) prior to ICU admission was 1.5 (IQR 0.6–4.3) h. Median time to intervention was significantly shorter in survivors than in non-survivors (0.9 vs. 3.0 h; p < 0.001). Additionally, the mortality rates increased significantly with increasing quartiles of time to intervention (p < 0.001, test for trend). Other factors associated with in-hospital mortality were severity of illness, performance status, hematologic malignancy, stem-cell transplantation, presence of three or more abnormal physiological variables, time from derangement to ICU admission, presence of infection, need for mechanical ventilation and vasopressor, and low PaO2/FiO2 ratio. Even after adjusting for potential confounding factors, time to intervention was still significantly associated with hospital mortality (adjusted odds ratio 1.445, 95 % confidence interval 1.217–1.717).

Conclusions

Early intervention before ICU admission was independently associated with decreased in-hospital mortality in critically ill cancer patients admitted to the ICU.

Keywords

Critical illness Early intervention Cancer hospital Mortality 

Notes

Acknowledgments

The authors thank the Samsung Medical Alarm Response Team (SMART) and the staff of the medical oncology intensive care unit for their enthusiasm and commitment to patient care.

References

  1. 1.
    Brenner H (2002) Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet 360:1131–1135PubMedCrossRefGoogle Scholar
  2. 2.
    Azoulay E, Afessa B (2006) The intensive care support of patients with malignancy: do everything that can be done. Intensive Care Med 32:3–5PubMedCrossRefGoogle Scholar
  3. 3.
    Darmon M, Azoulay E (2009) Critical care management of cancer patients: cause for optimism and need for objectivity. Curr Opin Oncol 21:318–326PubMedCrossRefGoogle Scholar
  4. 4.
    Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H (1991) The nature of adverse events in hospitalized patients. Results of the Harvard medical practice study II. N Engl J Med 324:377–384PubMedCrossRefGoogle Scholar
  5. 5.
    Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP, Anderson J (1999) Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary-care hospital. Med J Aust 171:22–25PubMedGoogle Scholar
  6. 6.
    Wilson RM, Harrison BT, Gibberd RW, Hamilton JD (1999) An analysis of the causes of adverse events from the quality in Australian health care study. Med J Aust 170:411–415PubMedGoogle Scholar
  7. 7.
    Sprung CL, Geber D, Eidelman LA, Baras M, Pizov R, Nimrod A, Oppenheim A, Epstein L, Cotev S (1999) Evaluation of triage decisions for intensive care admission. Crit Care Med 27:1073–1079PubMedCrossRefGoogle Scholar
  8. 8.
    Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23:4406–4413PubMedCrossRefGoogle Scholar
  9. 9.
    Peigne V, Rusinova K, Karlin L, Darmon M, Fermand JP, Schlemmer B, Azoulay E (2009) Continued survival gains in recent years among critically ill myeloma patients. Intensive Care Med 35:512–518PubMedCrossRefGoogle Scholar
  10. 10.
    Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B (2011) Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care 1:5PubMedCrossRefGoogle Scholar
  11. 11.
    Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, Auerbach A, Chen WJ, Duncan K, Kenward G, Bell M, Buist M, Chen J, Bion J, Kirby A, Lighthall G, Ovreveit J, Braithwaite RS, Gosbee J, Milbrandt E, Peberdy M, Savitz L, Young L, Harvey M, Galhotra S (2006) Findings of the first consensus conference on medical emergency teams. Crit Care Med 34:2463–2478PubMedCrossRefGoogle Scholar
  12. 12.
    Lim SY, Park SY, Park HK, Kim M, Park HY, Lee B, Lee JH, Jung EJ, Jeon K, Park CM, Ko MG, Park MR, Nam JM, Won SY, Jung JH, Cho SH, Suh GY (2010) Early impact of medical emergency team implementation in a country with limited medical resources: a before-and-after study. J Crit Care 26(4):373–378PubMedCrossRefGoogle Scholar
  13. 13.
    Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, Finfer S, Flabouris A (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365:2091–2097PubMedCrossRefGoogle Scholar
  14. 14.
    Song JU, Suh GY, Chung MP, Kim H, Kwon OJ, Jung CW, Kang WK, Park K, Jeon K (2011) Risk factors to predict outcome in critically ill cancer patients receiving chemotherapy in the intensive care unit. Support Care Cancer 19:491–495PubMedCrossRefGoogle Scholar
  15. 15.
    Darmon M, Thiery G, Ciroldi M, de Miranda S, Galicier L, Raffoux E, Le Gall JR, Schlemmer B, Azoulay E (2005) Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 33:2488–2493PubMedCrossRefGoogle Scholar
  16. 16.
    Benoit DD, Depuydt PO, Vandewoude KH, Offner FC, Boterberg T, De Cock CA, Noens LA, Janssens AM, Decruyenaere JM (2006) Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit. Intensive Care Med 32:93–99PubMedCrossRefGoogle Scholar
  17. 17.
    Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, Iapichino G, Edbrooke D, Capuzzo M, Le Gall JR (2005) SAPS 3—from evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 31:1345–1355PubMedCrossRefGoogle Scholar
  18. 18.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
  19. 19.
    Shelton BK (2010) Admission criteria and prognostication in patients with cancer admitted to the intensive care unit. Crit Care Clin 26:1–20PubMedCrossRefGoogle Scholar
  20. 20.
    McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, Nielsen M, Barrett D, Smith G, Collins CH (1998) Confidential inquiry into quality of care before admission to intensive care. Br Med J 316:1853–1858CrossRefGoogle Scholar
  21. 21.
    McGloin H, Adam SK, Singer M (1999) Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable? J R Coll Physicians Lond 33:255–259PubMedGoogle Scholar
  22. 22.
    Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, Silvester W, Doolan L, Gutteridge G (2003) A prospective before-and-after trial of a medical emergency team. Med J Aust 179:283–287PubMedGoogle Scholar
  23. 23.
    Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, Silvester W, Doolan L, Gutteridge G (2004) Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med 32:916–921PubMedCrossRefGoogle Scholar
  24. 24.
    Sebat F, Musthafa AA, Johnson D, Kramer AA, Shoffner D, Eliason M, Henry K, Spurlock B (2007) Effect of a rapid response system for patients in shock on time to treatment and mortality during 5 years. Crit Care Med 35:2568–2575PubMedCrossRefGoogle Scholar
  25. 25.
    Buist M, Harrison J, Abaloz E, Van Dyke S (2007) Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital. Br Med J 335:1210–1212CrossRefGoogle Scholar
  26. 26.
    Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, Opdam H, Gutteridge G (2005) Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care 9:R808–R815PubMedCrossRefGoogle Scholar
  27. 27.
    Konrad D, Jaderling G, Bell M, Granath F, Ekbom A, Martling CR (2010) Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team. Intensive Care Med 36:100–106PubMedCrossRefGoogle Scholar
  28. 28.
    McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M (2007) Outreach and early warning systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 18(3):CD005529Google Scholar
  29. 29.
    Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C (2010) Rapid response teams: a systematic review and meta-analysis. Arch Intern Med 170:18–26PubMedCrossRefGoogle Scholar
  30. 30.
    Edelson DP (2010) A weak link in the rapid response system. Arch Intern Med 170:12–13PubMedCrossRefGoogle Scholar
  31. 31.
    Calzavacca P, Licari E, Tee A, Egi M, Haase M, Haase-Fielitz A, Bellomo R (2008) A prospective study of factors influencing the outcome of patients after a medical emergency team review. Intensive Care Med 34:2112–2116PubMedCrossRefGoogle Scholar
  32. 32.
    Downey AW, Quach JL, Haase M, Haase-Fielitz A, Jones D, Bellomo R (2008) Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias. Crit Care Med 36:477–481PubMedCrossRefGoogle Scholar
  33. 33.
    Quach JL, Downey AW, Haase M, Haase-Fielitz A, Jones D, Bellomo R (2008) Characteristics and outcomes of patients receiving a medical emergency team review for respiratory distress or hypotension. J Crit Care 23:325–331PubMedCrossRefGoogle Scholar
  34. 34.
    Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL (2009) Characteristics and outcomes of cancer patients in European ICUs. Crit Care 13:R15PubMedCrossRefGoogle Scholar
  35. 35.
    Vandijck DM, Benoit DD, Depuydt PO, Offner FC, Blot SI, Van Tilborgh AK, Nollet J, Steel E, Noens LA, Decruyenaere JM (2008) Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med 34:847–855PubMedCrossRefGoogle Scholar
  36. 36.
    Vandijck DM, Depuydt PO, Offner FC, Nollet J, Peleman RA, Steel E, Noens LA, Decruyenaere JM, Benoit DD (2010) Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies. Intensive Care Med 36:1744–1750PubMedCrossRefGoogle Scholar
  37. 37.
    Calzavacca P, Licari E, Tee A, Egi M, Downey A, Quach J, Haase-Fielitz A, Haase M, Bellomo R (2010) The impact of rapid response system on delayed emergency team activation patient characteristics and outcomes–a follow-up study. Resuscitation 81:31–35PubMedCrossRefGoogle Scholar
  38. 38.
    Jones DA, DeVita MA, Bellomo R (2011) Rapid-response teams. N Engl J Med 365:139–146PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Jae-Uk Song
    • 1
    • 2
  • Gee Young Suh
    • 1
  • Hye Yun Park
    • 1
  • So Yeon Lim
    • 1
  • Seo Goo Han
    • 1
  • Yeh Rim Kang
    • 1
  • O. Jung Kwon
    • 1
  • Sookyoung Woo
    • 3
  • Kyeongman Jeon
    • 1
    Email author
  1. 1.Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of MedicineGangnam-gu, SeoulRepublic of Korea
  2. 2.Division of Pulmonary and Critical Care Medicine, Department of MedicineKangbuk Samsung Hospital, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Biostatistics TeamSamsung Biomedical Research InstituteSeoulRepublic of Korea

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