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Objective This consensus aims to provide evidence-based recommendations on common questions in the diagnosis and treatment of acute respiratory failure (ARF) for critically ill cancer patients.Methods We developed six clinical questions using the PICO (Population, Intervention, Comparison, and Outcome) principle in diagnosis and treatment for critical ill cancer patients with ARF. Based on literature searching and meta-analyses, recommendations were devised. The GRADE (Grading of Recommendation Assessment, Development and Evaluation) method was applied to each question to reach consensus in the expert panel. Results The panel makes strong recommendations in favor of (1) metagenomic next-generation sequencing (mNGS) tests may aid clinicians in rapid diagnosis in critically ill cancer patients suspected of pulmonary infections; (2) extracorporeal membrane oxygenation (ECMO) therapy should not be used as a routine rescue therapy for acute respiratory distress syndrome in critically ill cancer patients but may benefit highly selected patients after multi-disciplinary consultations; (3) cancer patients who have received immune checkpoint inhibitor therapy have an increased incidence of pneumonitis compared with standard chemotherapy; (4) critically ill cancer patients who are on invasive mechanical ventilation and estimated to be extubated after 14 days may benefit from early tracheotomy; and (5) high-flow nasal oxygen and noninvasive ventilation therapy can be used as a first-line oxygen strategy for critically ill cancer patients with ARFs. A weak recommendation is: (6) for critically ill cancer patients with ARF caused by tumor compression, urgent chemotherapy may be considered as a rescue therapy only in patients determined to be potentially sensitive to the anticancer therapy after multidisciplinary consultations. Conclusions The recommendations based on the available evidence can guide diagnosis and treatment in critically ill cancer patients with acute respiratory failure and improve outcomes.
Subject(s)
Humans , Consensus , Critical Illness/therapy , Neoplasms/therapy , Oxygen , Pneumonia , Respiratory Distress Syndrome, Newborn/drug therapy , Respiratory Insufficiency/therapyABSTRACT
Objective:To explore the pathology and pathogenesis of cerebellar injuries induced by methylmercury chloride(MMC) toxication in rats. Methods:Rats were given MMC(4 mg·kg-1·d-1) consecutively and sacrificed on days 11, 15, 18 and 21. Pathological changes of the cerebellum were observed by histo-immunopathology; in situ staining was performed for DNA strand breaks in cerebellar granule cells by TUNEL technique; and the ultrastructures were observed by electron microscope. Results:On day 18, sparse TUNEL positive granular cells were observed mainly in deep lamina adjacent to the white matter. On day 21, apoptotic cells markedly increased and granule cells decreased with well-preserved Purkinje cells. Immunostaining with MRF-1 and GFAP demonstrated severe microgliosis and astrocytosis. On day 18, electron microscopy demonstrated that the nuclei of MMC-treated animals were shrunken and displayed increased electron density, and some homogeneously dense nuclear chromatin with tear-drop features, which were compatible with the apoptotic changes. Conclusion:These results indicate that the pathological changes in the cerebellum in this subacute MMC intoxication model resemble human cases, and the degeneration of granule cells is apoptosis.
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Objective:To explore the pathology and pathogenesis of cerebellar injuries induced by methylmercury chloride(MMC) toxication in rats. Methods:Rats were given MMC(4 mg·kg-1·d-1) consecutively and sacrificed on days 11, 15, 18 and 21. Pathological changes of the cerebellum were observed by histo-immunopathology; in situ staining was performed for DNA strand breaks in cerebellar granule cells by TUNEL technique; and the ultrastructures were observed by electron microscope. Results:On day 18, sparse TUNEL positive granular cells were observed mainly in deep lamina adjacent to the white matter. On day 21, apoptotic cells markedly increased and granule cells decreased with well-preserved Purkinje cells. Immunostaining with MRF-1 and GFAP demonstrated severe microgliosis and astrocytosis. On day 18, electron microscopy demonstrated that the nuclei of MMC-treated animals were shrunken and displayed increased electron density, and some homogeneously dense nuclear chromatin with tear-drop features, which were compatible with the apoptotic changes. Conclusion:These results indicate that the pathological changes in the cerebellum in this subacute MMC intoxication model resemble human cases, and the degeneration of granule cells is apoptosis.
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Objective To report the first family of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy(CARASIL)in China,and to explore its clinicopathological characteristics.Methods The clinical,imaging and pathological findings of the two patients were studied, and the sequence of the exons from 2 to 6 on Notch 3 in the chromosome 19 was detected.Results Two siblings were born from consanguineous parents.The ages at onset were 25 and 20 years old,respectively. Clinically,both of the patients were characterized by alopecia,acute lumbago,progressive intellectual deterioration,ataxia,pseudobulbar palsy and pyramidal tract signs.MRI demonstrated diffuse leucoencephalopathy and multiple subcortical infarcts on both hemisphere.The sural nerve biopsy on the elder sister demonstrated concentric thickening of vascular wall,narrowing of the lumen and mild fibrous proliferation of the intima.There were no amyloid,PAS granular deposition and uhrastructural granular osmiophilic material on the vascular wall.No mutation of exons from 2 to 6 on Notch 3 in the chromosome 19 was found by direct sequence.Conclusion The clinicopathological findings of the two patients fulfill the diagnostic criteria based on Fukutake.