Systematic Evaluation by an Intensivist of Hematological Malignancy Patients Presenting With Acute Respiratory or Hemodynamic Failure

University Hospital, Grenoble221 enrolled

Overview

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.

Study Type

OBSERVATIONAL

Enrollment

221

Conditions

Respiratory Insufficiency Hematologic Malignancy

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

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

Locations (2)

Hematologic unit - Hospital Grenoble Alpes

Grenoble, France

Intensive Care Unit - Hospital Grenoble-Alpes

Grenoble, France

Outcomes

Primary Outcomes

delta Sepsis-related Organ Failure Assessment (SOFA) score

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

Time frame: up to 72 hours

Secondary Outcomes

survival status after one year

survival status (alive/dead) at one year after ICU admission

Time frame: one year after ICU admission

survival status at the end of the ICU stage

survival status (alive/dead) at the end of the ICU stage

Time frame: up to Day 45

survival status at the end of the hospitalization

survival status (alive/dead) at the end of the hospitalization

Time frame: up to Day 120

ICU admission

Delay between the start of critical care illness and ICU admission Delay is measured in minutes

Time frame: up to 72h

Invasive mechanical ventilation

Number of days with mechanical ventilation

Time frame: up to Day 45

Non-invasive ventilation

Number of days with non-invasive ventilation

Time frame: up to Day 45

Vasopressive support

Number of days with vasopressive support

Time frame: up to Day 45

renal replacement therapy

Number of days with renal replacement therapy

Time frame: up to Day 45

hematological disease evolution

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.

Time frame: up to one year

Life quality for patients

EQ5-D assessment of patients' quality of life one year after Intensive care unit admission

Time frame: up to one year