F Galas

Severe novel influenza A (H1N1) infection in cancer patients

Background: The natural history and consequences of severe H1N1 influenza infection among cancer patients are not yet fully characterized. We describe eight cases of H1N1 infection in cancer patients admitted to the intensive care unit of a referral cancer center. Patients and methods: Clinical data from all patients admitted with acute respiratory failure due to novel viral H1N1 infection were reviewed. Lung tissue was submitted for viral and bacteriological analyses by real-time RT-PCR, and autopsy was conducted on all patients who died. Results: Eight patients were admitted, with ages ranging from 55 to 65 years old. There were five patients with solid organ tumors (62.5%) and three with hematological malignancies (37.5%). Five patients required mechanical ventilation and all died. Four patients had bacterial bronchopneumonia. All deaths occurred due to multiple organ failure. A milder form of lung disease was present in the three cases who survived. Lung tissue analysis was performed in all patients and showed diffuse alveolar damage in most patients. Other lung findings were necrotizing bronchiolitis or extensive hemorrhage. Conclusions: H1N1 viral infection in patients with cancer can cause severe illness, resulting in acute respiratory distress syndrome and death. More data are needed to identify predictors of unfavorable evolution in these patients.

Impact of positive fluid balance on survival in critically ill cancer patients

Fluid overload has recently been linked to adverse outcomes in critically ill patients, but its impact on the outcomes of cancer patients admitted to intensive care units (ICUs) has not been previously described.

Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial

Background Major abdominal oncology surgery is associated with substantial postoperative loss of functional capacity, and exercise may be an effective intervention to improve outcomes. The aim of this study was to assess efficacy, feasibility and safety of a supervised postoperative exercise programme. Methods We performed a single-blind, parallel-arm, randomized trial in patients who underwent major abdominal oncology surgery in a tertiary university hospital. Patients were randomized to an early mobilization postoperative programme based on supervised aerobic exercise, resistance and flexibility training or to standard rehabilitation care. The primary outcome was inability to walk without human assistance at postoperative day 5 or hospital discharge. Results A total of 108 patients were enrolled, 54 into the early mobilization programme group and 54 into the standard rehabilitation care group. The incidence of the primary outcome was nine (16.7%) and 21 (38.9%), respectively (P=0.01), with an absolute risk reduction of 22.2% [95% confidence interval (CI) 5.9-38.6] and a number needed to treat of 5 (95% CI 3-17). All patients in the intervention group were able to follow at least partially the exercise programme, although the performance among them was rather heterogeneous. There were no differences between groups regarding clinical outcomes or complications related to the exercises. Conclusions An early postoperative mobilization programme based on supervised exercises seems to be safe and feasible and improves functional capacity in patients undergoing major elective abdominal oncology surgery. However, its impact on clinical outcomes is still unclear. Clinical trial registration NCT01693172.

Outcomes of 3,400 patients with cancer admitted to intensive care unit: a Brazilian prospective study

ICU admission of critically ill cancer patients was controversial until recently. In the past years, advances in the management of malignancies and organ failures have improved outcomes of patients, resulting in higher rates of survival in the ICU. The aim of this study is to prospectively evaluate the characteristics, short-term and mid-term outcomes of cancer patients requiring intensive care.

Effects of inhaled nitric oxide combined to mechanic ventilation on the patients with acute respiratory dysfunction in postoperative heart surgery: comparative study among pressure controlled ventilation and volume controlled ventilation

Pressure-controlled ventilation (PCV), is related to a better distribution of the inhaling flow and lower pressure peaks, when compared to volume-controlled ventilation (VCV). Nitric oxide (NO) promotes redistribution of blood flow to the ventilated areas and decreases the pulmonary shunt effect improving oxygenation.

Red blood cell transfusion is an independent risk factor for cardiovascular complications in adult patients undergoing cardiac surgery: a propensity score-matched analysis

Red blood cell (RBC) transfusion is associated with a higher occurrence of clinical complications after cardiac surgery. However, the cause-effect relationship is confounded by other risk factors for worse outcomes as advanced age, valve or combined procedure, high EuroSCORE, redo surgery, longer bypass time and previous anemia. The objective of this study was to evaluate the effect of RBC transfusion in a propensity score-matched case-control analysis.

Prognostic factors for acute kidney injury development in critically ill cancer patients

Acute kidney injury (AKI) in cancer patients is a complication that causes substantial morbidity and mortality.

Perioperative Cardiac Risk Stratification

Cardiovascular events are considered the main cause of death in the perioperative period. The most important events are acute myocardial infarction (MI), unstable angina, cardiac failure, severe arrhythmias, nonfatal cardiac arrest, and death. Patients experiencing an MI after noncardiac surgery have a hospital mortality rate of 15–25% [1, 2], and nonfatal perioperative MI is an independent risk factor for cardiovascular death and nonfatal MI during the 6 months following surgery. Patients who have a cardiac arrest after noncardiac surgery have a hospital mortality rate of 65%, and nonfatal perioperative cardiac arrest is a risk factor for cardiac death during the 5 years following surgery [3, 4]. The objectives of preoperative evaluation are: (a) performing an evaluation of the patient’s current medical status; (b) making recommendations concerning the evaluation, management, and risk of cardiac problems over the entire perioperative period; and (c) providing a clinical risk profile that the patient, primary physician, anesthesiologist, and surgeon can use in making treatment decisions that may influence short- and long-term outcomes. No test should be performed unless it is likely to influence patient treatment [5]. The cost of risk stratification cannot be ignored. Accurate estimation of a patient’s risk for postoperative cardiac events (MI, unstable angina, ventricular tachycardia, pulmonary edema, and death) after surgery can guide allocation of clinical resources, use of preventive therapies, and priorities for future research.