L Hajjar

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.

Clinical recommendations for postoperative care after heart transplantation in children: 21 years of a single-center experience

Heart transplantation is an option for children with complex congenital heart disease and cardiomyopathies. A patients quality of life and long-term survival depend on successful management of the surgical complications and adverse side effects of immunosuppression. The purpose of this review was to summarize the practical management of postoperative care in this patient population and to make recommendations for the future.

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.

Steroids and Survival in Critically Ill Adult Patients: A Meta-analysis of 135 Randomized Trials

OBJECTIVEnCorticosteroids have important effects on intermediate outcomes in critically ill patients, but their effect on survival is unknown. The objective of this meta-analysis was to analyze the effect on mortality of corticosteroids in critical and perioperative settings.nnnDESIGNnA meta-analysis of randomized trials.nnnSETTINGnPubMed, Embase, BioMed Central, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched to February 1, 2018, for randomized trials comparing corticosteroids with placebo or standard care.nnnPARTICIPANTSnCritically ill or surgical adult patients.nnnINTERVENTIONSnCorticosteroids compared with placebo or standard care.nnnMEASUREMENTS AND MAIN RESULTSnA total of 44,553 patients from 135 studies were included. Overall, mortality in the corticosteroid group and in the control group were similar (16% v 16%; p = 0.9). Subanalyses identified a beneficial effect of corticosteroids on survival in patients with respiratory system diseases (9% v 13%; p < 0.001) and bacterial meningitis (28% v 32%; p= 0.04), and a detrimental effect on survival in patients with traumatic brain injury (22% v 19%; p < 0.001). No differences in mortality were found in patients with cardiac diseases (7% v 6%; p = 0.7), in patients undergoing cardiac surgery (2.8% v 3.2% p = 0.14), and when treatment duration or patient age were considered.nnnCONCLUSIONSnThis meta-analysis documents the safety of corticosteroids in the overall critically ill population with the notable exception of brain injury patients, a setting where the authors confirmed their detrimental effect on survival. A possible beneficial effect of corticosteroids on survival was found among patients with respiratory diseases and in patients with bacterial meningitis.

Vasopressin Versus Norepinephrine in Patients With Vasoplegic Shock After Cardiac Surgery: The VANCS Randomized Controlled Trial

<zdoi;10.1097/ALN.0000000000001434> Anesthesiology, V 126 • No 1 85 January 2017 V asoplegic syndrome, characterized by low arterial pressure with normal or elevated cardiac output and reduced systemic vascular resistance,1 occurs in 5 to 25% of patients undergoing cardiac surgery. patients who develop vasoplegic shock after cardiac surgery are at higher risk of organ failure and have increased mortality and longer hospital length of stay.2,3 administration of norepinephrine is currently considered the standard treatment for vasoplegic shock, but all catecholamines have adverse effects, including arrhythmias and myocardial ischemia.4 Furthermore, in severe vasoplegic states, What We Already Know about This Topic

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.