Hematologic Malignancy, Respiratory Insufficiency
Conditions
Keywords
Respiratory Insufficiency, Hematologic Malignancy, Intensive Care Unit
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.
Interventions
OTHERSystematic evaluation by an intensivist
implementation of a standardized procedure for patient care in ICU
Sponsors
University Hospital, Grenoble
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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 1. Respiratory : oxygen saturation \<90 % and/or O2 \>3l/min, with either a worsening of saturation or increased oxygen needs within 4h 2. 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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| delta Sepsis-related Organ Failure Assessment (SOFA) score | 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
| Measure | Time frame | Description |
|---|---|---|
| survival status at the end of the ICU stage | up to Day 45 | survival status (alive/dead) at the end of the ICU stage |
| survival status at the end of the hospitalization | up to Day 120 | survival status (alive/dead) at the end of the hospitalization |
| ICU admission | up to 72h | Delay between the start of critical care illness and ICU admission Delay is measured in minutes |
| Invasive mechanical ventilation | up to Day 45 | Number of days with mechanical ventilation |
| survival status after one year | one year after ICU admission | survival status (alive/dead) at one year after ICU admission |
| Vasopressive support | up to Day 45 | Number of days with vasopressive support |
| renal replacement therapy | up to Day 45 | Number of days with renal replacement therapy |
| hematological disease evolution | up to one year | status of hematological primary disease at death or after one year of evolution if the patient is still alive. Possible status of hematology disease : complete remission, partial remission, stability, relapsed/refractory. |
| Life quality for patients | up to one year | EQ5-D assessment of patients' quality of life one year after Intensive care unit admission |
| Non-invasive ventilation | up to Day 45 | Number of days with non-invasive ventilation |
Countries
France
Outcome results
None listed