Kochanek M, Shimabukuro-Vornhagen A, Rüß K, Beutel G, Lueck C, Kiehl M, Schneider R, Kroschinsky F, Liebregts T, Kluge S, Schellongowski P, von Bergwelt-Baildon M, Böll B
Klinik I für Innere Medizin, Klinikum der Universität zu Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
"Intensive Care in Hematologic and Oncologic Patients (iCHOP)", .
Med Klin Intensivmed Notfmed. 2020 May;115(4):312-319. doi: 10.1007/s00063-019-0594-3. Epub 2019 Jul 30.
Cancer is one of the leading causes of death worldwide. Due to increasing comorbidities, age and aggressive chemotherapy, care of cancer patients in intensive care units (ICUs) is more and more necessary. So far, little is known about the care structure of cancer patients in German ICUs. The aim of this work is to collect and evaluate the prevalence and care data of cancer patients on two reference dates.
German ICUs were invited to participate in a 2-day, prospective, multicenter point prevalence study in ICU cancer patients. Participation in the study was voluntary and the study was not funded. An ethics vote was obtained to conduct the study. The data were anonymously entered into an eCRF (electronic case report form) by the participating centers. Identification of the patients is therefore not possible.
About one in four patients on the ICU/IMC ward had hematological-oncological (HO) disease (n = 316/1319, 24%). The proportion depended significantly on the number of beds in each hospital. The most frequent reasons for admission to the ICU/IMC station were postoperative monitoring (n = 83/221, 37.6%), respiratory instability (n = 79/221, 35.7%), circulatory instability (n = 52/221; 23.5%) and the severe infection with sepsis (n = 47/221; 21.3%). In all, 66.5% (n = 147/221) of the patients had a solid tumor and 21.7% (n = 48/221) had hematological cancer, 78.3% (n = 173/221) of the documented cancer patients received "full-code" intensive management, while 42.5% (n = 94/221) of the HO patients were ventilated and 40.7% (n = 90/221) required catecholamines. The median (mean; IQR) SAPS II score was 35 (37.79, IQR = 24-48) and the median (mean, IQR) TISS score was 10 (13.26, IQR = 10-15). Through the analysis and evaluation of the data available in the context of the prevalence study, it was possible for the first time to determine the Germany-wide cross-center prevalence and care situation of hematological cancer patients in intensive care and intermediate care stations. About one in four patients on German ICUs and IMC wards have a major or minor cancer diagnosis (n = 316/1319 = 24%). Care management is complex in this patient population and requires close interdisciplinary collaboration.
癌症是全球主要死因之一。由于合并症增加、患者年龄增大以及化疗手段激进,重症监护病房(ICU)对癌症患者的护理愈发必要。到目前为止,德国ICU中癌症患者的护理结构鲜为人知。本研究的目的是收集并评估两个参考日期癌症患者的患病率及护理数据。
邀请德国的ICU参与一项针对ICU癌症患者的为期2天的前瞻性多中心现况研究。参与研究是自愿的,且该研究没有资金支持。已获得伦理投票以开展本研究。参与中心将数据匿名录入电子病例报告表(eCRF)。因此无法识别患者身份。
ICU/IMC病房约四分之一的患者患有血液肿瘤(HO)疾病(n = 316/1319,24%)。这一比例很大程度上取决于各医院的床位数量。入住ICU/IMC病房最常见的原因是术后监测(n = 83/221,37.6%)、呼吸不稳定(n = 79/221,35.7%)、循环不稳定(n = 52/221;23.5%)以及严重感染伴败血症(n = 47/221;21.3%)。总体而言,66.5%(n = 147/221)的患者患有实体瘤,21.7%(n = 48/221)患有血液癌症,78.3%(n = 173/221)的已记录癌症患者接受了“完全复苏”重症管理,而42.5%(n = 94/221)的HO患者需要通气,40.7%(n = 90/221)需要使用儿茶酚胺。急性生理与慢性健康状况评分系统II(SAPS II)的中位数(均值;四分位间距)为35(37.79,四分位间距 = 24 - 48),治疗干预评分系统(TISS)的中位数(均值,四分位间距)为10(13.26,四分位间距 = 10 - 15)。通过对现况研究中可用数据的分析和评估,首次确定了德国范围内重症监护和中级护理病房中血液癌症患者的跨中心患病率及护理情况。德国ICU和IMC病房约四分之一的患者有重大或轻微癌症诊断(n = 316/1319 = 24%)。这一患者群体的护理管理很复杂,需要密切的多学科协作。