Central neurological complications in critically ill patients with malignancies
| Autor: | Elie Azoulay, Virginie Lemiale, Michael Darmon, Jean-Pierre Bedos, Stéphane Legriel, Benoit Schlemmer, Hélène Marijon |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Resuscitation medicine.medical_specialty genetic structures health care facilities manpower and services Critical Illness Critical Care and Intensive Care Medicine Spinal Puncture Brain diagnosis Intensive care Anesthesiology Neoplasms medicine Humans Meningitis Coma Intensive care medicine Hypoxia Brain Aged Critically ill business.industry Cancer Electroencephalography Middle Aged medicine.disease Respiration Artificial Hospitalization Intensive Care Units Critical illness Female Complication business |
| Zdroj: | Intensive care medicine. 36(2) |
| ISSN: | 1432-1238 |
| Popis: | To determine outcomes in critically ill patients hospitalized in the ICU for central neurological complications of cancer.A 7-year retrospective study. SUBJECT AND INTERVENTION: Observational study in 100 critically ill cancer patients with central neurological complications managed using standardized diagnostic and therapeutic strategies.There were 52 men and 48 women, aged 55 years (IQR, 40-65). Presenting manifestations were coma (56%), epilepsy (48%), focal signs (35%), encephalopathy (31%), and meningitis (7%). Cerebral imaging was abnormal in 61 patients, lumbar puncture in 17, and electroencephalography in 6. Neurosurgical biopsy was performed on four patients. The main etiologies included drug toxicity in 28, malignant brain infiltration in 21 patients, and cerebrovascular disease in 20. Mechanical ventilation was needed for 60 patients. Anticancer chemotherapy was administered during the ICU stay in 15 patients. ICU and hospital mortalities were 28 and 45%, respectively. By multivariate analysis, independent positive predictors of hospital mortality were poor performance status [odds ratio (OR) 2.94, 95% CI, 1.01-8.55, P = 0.047), focal signs at presentation (OR 3.52, 95% CI, 1.14-10.88, P = 0.029), abnormal lumbar puncture (OR 5.49, 95% CI 1.09-27.66, P = 0.038), and need for vasoactive drugs (OR 6.47, 95% CI 1.32-31.66, P = 0.021), whereas remission of the malignancy (OR 0.20, 95% CI 0.04-0.88, P = 0.033) and GCS score at admission (OR 0.81/point, 95% CI, 0.70-0.95, P = 0.009) were negative predictors of hospital mortality.In cancer patients, central neurological events are mainly related to malignant brain infiltration and drug-related toxicity. Despite advanced severity, a standardized intensive management strategy yields a 55% hospital survival rate. |
| Databáze: | OpenAIRE |
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