Systematic Evaluation by an Intensivist of Hematological Malignancy Patients Presenting With Acute Respiratory or Hemodynamic Failure: Impact on Prognosis: A Monocentric Observational Before-after Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Respiratory Insufficiency
- Sponsor
- University Hospital, Grenoble
- Enrollment
- 221
- Locations
- 2
- Primary Endpoint
- delta Sepsis-related Organ Failure Assessment (SOFA) score
- Status
- Completed
- Last Updated
- 3 years ago
Overview
Brief Summary
Over the last two decades, the number of patients with hematological malignancies (HMs) admitted to the ICU increased and their mortality has dropped sharply. Patients with HMs increasingly require admission to the intensive care unit (ICU) for life-threatening events related to the malignancy and/or treatments, with immunosuppression being a major contributor. Whether the increase in ICU admissions is related to increased referrals by hematologists and/or to increased admissions by intensivists is unknown. The criteria used for ICU referral and admission decisions have not been extensively evaluated. Finally, the links between admission policies and treatment-limitation decisions are unclear, but ICUs with broad admission policies may change the treatment goals based on the response to several days of full-code management.
The aim of this study is to evaluate the impact of a systematic evaluation by an intensivist of HMs patients presenting with acute respiratory and/or hemodynamic failure.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients hospitalized in a hematology unit
- •Patients presenting with criteria for critical respiratory and/or hemodynamic condition and worsening during the next 4 hours
- •Respiratory : oxygen saturation \<90 % and/or O2 \>3l/min, with either a worsening of saturation or increased oxygen needs within 4h
- •Hemodynamic : systolic blood pressure \< 90 mmHg and remaining \< 90 mmHg within 4h despite ≥ 1l of crystalloid administration, or becoming \< 80 mmHg no matter the quantity of fluid (even if no fluid administration).
Exclusion Criteria
- •therapeutic limitations decided hematological investigators (moribund patients, uncontrolled allogenic graft,...)
- •Do-not-reanimate directives
- •Pregnant or breastfeeding women
Outcomes
Primary Outcomes
delta Sepsis-related Organ Failure Assessment (SOFA) score
Time Frame: up to 72 hours
difference between the Sepsis-related Organ Failure Assessment score between 48h and 72h after ICU admission and the SOFA score during the first 24h. SOFA score ranges from 0 to 20 delta SOFA= SOFA day 3 - SOFA day1
Secondary Outcomes
- renal replacement therapy(up to Day 45)
- survival status after one year(one year after ICU admission)
- survival status at the end of the ICU stage(up to Day 45)
- survival status at the end of the hospitalization(up to Day 120)
- Invasive mechanical ventilation(up to Day 45)
- Vasopressive support(up to Day 45)
- ICU admission(up to 72h)
- Non-invasive ventilation(up to Day 45)
- Life quality for patients(up to one year)
- hematological disease evolution(up to one year)