cancer Archives - Critical Care Science (CCS)
Abstract
Rev Bras Ter Intensiva. 2008;20(1):82-87
DOI 10.1590/S0103-507X2008000100013
BACKGROUND AND OBJECTIVES: Until the end of the previous century it remained controversial to admit cancer patients to the ICU for advanced-life-supporting therapy. However, over the past few years several centres over the world have shown that it is possible to achieve a meaningful survival in these patients. The aim of this review is to focus on the improvement in outcome that has been achieved over the past two decades in critically ill cancer patients. CONTENTS: We performed a MEDLINE search (period of 1980 to November 2007) to identify full-text English language publications on critically ill patients with solid tumors or hematological malignancies with particular interest for the outcome and treatment. Major MESH search terms included; cancer, solid tumor, hematologic or hematological malignancies, immunosupression, ICU, ventilation, organ failure, sepsis and infection. Additional studies were identified through a manual search of citations from retrieved articles. CONCLUSIONS: In this review, we first focus on the grim prognosis in the past, subsequently we discuss the improvements in outcome over the past few years across subgroups of cancer patients with increasing degree of severity of illness, and finally, we focus on the value of non-invasive ventilation since it is considered the initial ventilatory strategy in these patients.
Abstract
Rev Bras Ter Intensiva. 2008;20(1):82-87
DOI 10.1590/S0103-507X2008000100013
BACKGROUND AND OBJECTIVES: Until the end of the previous century it remained controversial to admit cancer patients to the ICU for advanced-life-supporting therapy. However, over the past few years several centres over the world have shown that it is possible to achieve a meaningful survival in these patients. The aim of this review is to focus on the improvement in outcome that has been achieved over the past two decades in critically ill cancer patients. CONTENTS: We performed a MEDLINE search (period of 1980 to November 2007) to identify full-text English language publications on critically ill patients with solid tumors or hematological malignancies with particular interest for the outcome and treatment. Major MESH search terms included; cancer, solid tumor, hematologic or hematological malignancies, immunosupression, ICU, ventilation, organ failure, sepsis and infection. Additional studies were identified through a manual search of citations from retrieved articles. CONCLUSIONS: In this review, we first focus on the grim prognosis in the past, subsequently we discuss the improvements in outcome over the past few years across subgroups of cancer patients with increasing degree of severity of illness, and finally, we focus on the value of non-invasive ventilation since it is considered the initial ventilatory strategy in these patients.
Abstract
Rev Bras Ter Intensiva. 2007;19(4):463-468
DOI 10.1590/S0103-507X2007000400010
BACKGROUND AND OBJECTIVES: Disseminated strongyloidiasis is a clinical form of presentation associated with states of severe immunosuppression, as in AIDS, hematological malignancies and in treatment for immunosuppression (especially with high doses of corticosteroids). It usually mimics severe sepsis and still brings a significant challenge related to the diagnosis and treatment. Therefore exceedingly high mortality rates remain unchanged in the past decades. Initially, the diagnosis depends on the clinical suspicion and on the identification of the larva in an organic fluids or tissues. The cutaneous involvement, albeit rare, is typical and can provide an important clue for the diagnostic hypothesis. The emergence of ivermectin for oral use changed significantly the treatment for strongyloidiasis; however, there are still shortcomings for the utilization in critically ill patients. Shock, ileus and hypoperfusion states are associated with difficulties in the absorption that result in erratic systemic levels. Reports of good results with parenteral administration of ivermectin raised the prospect that this therapeutic modality be more effective. However, questions about dosage and safety remain unanswered. The aim of the present article is to review the medical literature on the clinical aspects of disseminated strongyloidiasis. CONTENTS: A systematic review of the literature was performed by searching the PubMed database within the last 30 years. Search terms were: disseminated strongyloidiasis, strongyloides and hyperinfection e ivermectin. CONCLUSIONS: The article highlights the diagnostic and therapeutic aspects emphasizing the importance of the clinical suspicion for the institution of appropriated therapy.
Abstract
Rev Bras Ter Intensiva. 2007;19(4):463-468
DOI 10.1590/S0103-507X2007000400010
BACKGROUND AND OBJECTIVES: Disseminated strongyloidiasis is a clinical form of presentation associated with states of severe immunosuppression, as in AIDS, hematological malignancies and in treatment for immunosuppression (especially with high doses of corticosteroids). It usually mimics severe sepsis and still brings a significant challenge related to the diagnosis and treatment. Therefore exceedingly high mortality rates remain unchanged in the past decades. Initially, the diagnosis depends on the clinical suspicion and on the identification of the larva in an organic fluids or tissues. The cutaneous involvement, albeit rare, is typical and can provide an important clue for the diagnostic hypothesis. The emergence of ivermectin for oral use changed significantly the treatment for strongyloidiasis; however, there are still shortcomings for the utilization in critically ill patients. Shock, ileus and hypoperfusion states are associated with difficulties in the absorption that result in erratic systemic levels. Reports of good results with parenteral administration of ivermectin raised the prospect that this therapeutic modality be more effective. However, questions about dosage and safety remain unanswered. The aim of the present article is to review the medical literature on the clinical aspects of disseminated strongyloidiasis. CONTENTS: A systematic review of the literature was performed by searching the PubMed database within the last 30 years. Search terms were: disseminated strongyloidiasis, strongyloides and hyperinfection e ivermectin. CONCLUSIONS: The article highlights the diagnostic and therapeutic aspects emphasizing the importance of the clinical suspicion for the institution of appropriated therapy.
