[A prehabilitation program for patients undergoing elective resection of a colorectal carcinoma: effects on the postoperative hospital stay and complication burden]. / Prehabilitatie bij resectie van colorectaal carcinoom.

OBJECTIVE: To investigate the effect of a prehabilitation program on the postoperative hospital stay and complication burden in patients undergoing elective resection of a colorectal carcinoma. DESIGN: Comparative retrospective cohort study. METHOD: The study population consisted of patients who had undergone elective resection of a colorectal carcinoma between 2017 and 2020 at the Elkerliek hospital in Helmond. Patients in the intervention group had surgery from May 1, 2019 and they followed a three to six-week prehabilitation program, focusing on physical condition, nutritional status and psychosocial well-being. Patients in the control group had surgery until May 1, 2019 and did not follow a prehabilitation program. The primary outcome measures were hospital stay and complication burden according to the Comprehensive Complication Index (CCI). The secondary outcome measures were the number and type of complications up to 90 days postoperatively. RESULTS: The intervention group (n=85) and control group (n=197) were almost comparable in preoperative patient and treatment characteristics. The intervention group had a shorter hospital stay (median 5 versus 6 days, p<0.001) and less often a heavy complication burden (18% versus 36%, p=0.002). The intervention group also contained fewer patients with a complication (25% versus 44%, p=0.002). Specifically, infection (4% vs 13%, p=0.018), pulmonary complication (2% vs 12%, p=0.009) and delirium (1% vs 9%, p=0.019) were less common. CONCLUSION: A prehabilitation program can shorten the postoperative hospital stay and reduce the postoperative complication burden in patients undergoing elective resection for colorectal carcinoma.

The Intensive Care Medicine research agenda on critically ill oncology and hematology patients.

Over the coming years, accelerating progress against cancer will be associated with an increased number of patients who require life-sustaining therapies for infectious or toxic chemotherapy-related events. Major changes include increased number of cancer patients admitted to the ICU with full-code status or for time-limited trials, increased survival and quality of life in ICU survivors, changing prognostic factors, early ICU admission for optimal monitoring, and use of noninvasive diagnostic and therapeutic strategies. In this review, experts in the management of critically ill cancer patients highlight recent changes in the use and the results of intensive care in patients with malignancies. They seek to put forward a standard of care for the management of these patients and highlight important updates that are required to care for them. The research agenda they suggest includes important studies to be conducted in the next few years to increase our understanding of organ dysfunction in this population and to improve our ability to appropriately use life-saving therapies or select new therapeutic approaches that are likely to improve outcomes. This review aims to provide more guidance for the daily management of patients with cancer, in whom outcomes are constantly improving, as is our global ability to fight against what is becoming the leading cause of mortality in industrialized and non-industrialized countries.

Characteristics and outcomes of patients with a haematological malignancy admitted to the intensive care unit for a neurological event.

OBJECTIVES: Patients with haematological malignancies are at risk of concomitant critical neurological events warranting intensive care unit admission. We aimed to examine the characteristics and outcomes of this patient population, as more knowledge could facilitate decision making on ICU admission and treatment. DESIGN, SETTING AND PARTICIPANTS: A retrospective cohort study of 68 patients in adult ICUs of six Dutch university hospitals between 2003 and 2011. RESULTS: The median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23 (IQR, 16-27), and 77% of patients needed mechanical ventilation within the first 24 hours of admission. Forty percent of patients had received an allogeneic stem cell transplantation, and 22% were neutropenic on admission. The most frequent underlying haematological condition was non-Hodgkin lymphoma (27%). Seizures were the most common neurological event for ICU admission (29%). The median ICU length of stay was 5 days (IQR, 1-13 days). ICU mortality (28%), hospital mortality (37%) and 3-month mortality (50%) were comparable with other studies of ICU patients with haematological malignancies. Factors associated with 3-month survival were baseline platelet count (113×10(9)/L in survivors v 39×10(9)/L in non-survivors, P<0.01) and APACHE II score (20 in survivors v 25 in non-survivors, P=0.02). CONCLUSIONS: Patients with a history of haematological malignancy presenting with a critical neurological event have comparable survival rates with other patients with a haematologic malignancy admitted to the ICU. Our findings suggest that restrictions in ICU care are not justified for this patient population.

Trends in admission prevalence, illness severity and survival of haematological patients treated in Dutch intensive care units.

PURPOSE: To explore trends over time in admission prevalence and (risk-adjusted) mortality of critically ill haematological patients and compare these trends to those of several subgroups of patients admitted to the medical intensive care unit (medical ICU patients). METHODS: A total of 1,741 haematological and 60,954 non-haematological patients admitted to the medical ICU were analysed. Trends over time and differences between two subgroups of haematological medical ICU patients and four subgroups of non-haematological medical ICU patients were assessed, as well as the influence of leukocytopenia. RESULTS: The proportion of haematological patients among all medical ICU patients increased over time [odds ratio (OR) 1.06; 95 % confidence interval (CI) 1.03-1.10 per year; p < 0.001]. Risk-adjusted mortality was significantly higher for haematological patients admitted to the ICU with white blood cell (WBC) counts of <1.0 × 10(9)/L (47 %; 95 % CI 41-54 %) and ≥1.0 × 10(9)/L (45 %; 95 % CI 42-49 %), respectively, than for patients admitted with chronic heart failure (27 %; 95 % CI 26-28 %) and with chronic liver cirrhosis (38 %; 95 % CI 35-42 %), but was not significantly different from patients admitted with solid tumours (40 %; 95 % CI 36-45 %). Over the years, the risk-adjusted hospital mortality rate significantly decreased in both the haematological and non-haematological group with an OR of 0.93 (95 % CI 0.92-0.95) per year. After correction for case-mix using the APACHE-II score (with WBC omitted), a WBC <1.0 × 10(9)/L was not a predictor of mortality in haematological patients (OR 0.86; 95 % CI 0.46-1.64; p = 0.65). We found no case-volume effect on mortality for haematological ICU patients. CONCLUSIONS: An increasing number of haematological patients are being admitted to Dutch ICUs. While mortality is significantly higher in this group of medical ICU patients than in subgroups of non-haematological ones, the former show a similar decrease in raw and risk-adjusted mortality rate over time, while leukocytopenia is not a predictor of mortality. These results suggest that haematological ICU patients have benefitted from improved intensive care support during the last decade.

Long-term health related quality of life following intensive care during treatment for haematological malignancies.

OBJECTIVE: Long-term health-related quality of life (HRQoL) was determined for patients admitted to the haematology ward who needed intensive care treatment (H-IC+) and compared with those who did not (H-IC-) as well as with that for patients admitted to the general ICU (nH-IC+). METHODS: A cross-sectional study was carried out median 18 months after admission by employing the short form-36, checklist for individual strength, cognitive failure questionnaire and hospital anxiety and depression scale. RESULTS: 27 (79%) of the 34 H-IC+ patients approached, and 93 (85%) of the 109 H-IC- patients approached replied. Data were adjusted for relevant covariates and matched with those of 149 patients in the general ICU. Apart from the lower role-physical functioning score for H-IC+ (P = 0.04) no other differences were found between H-IC+ and H-IC-. Groups H-IC+ and nH-IC+ evaluated their HRQoL on SF-36 similarly, except for the lower aggregated physical component summary (PCS) for H-IC+ (P<0.0001). After adjusting for PCS, no significant differences in CIS, CFQ and HADS were observed between the groups. CONCLUSIONS: Eighteen months after admission, patients treated for haematological malignancies reported similar HRQoL, whether or not they had received intensive care treatment, but reported a lower PCS than those of patients in the general ICU. Hence, there is no reason to assume that admission to the ICU has a negative impact on long-term HRQoL, so this should not affect the decision whether or not to transfer patients with haematological malignancies to the ICU.

Continuous non-invasive monitoring of the skin temperature of HSCT recipients.

GOALS OF WORK: Empirical antibiotic therapy usually started in patients who are neutropenic following treatment with cytostatic chemotherapy for a haematological malignancy as soon as fever develops to forestall fulminant sepsis. Hence, accurate and timely detection of fever is crucial to the successful management of infectious complications in these patients. We report an investigation of the feasibility and validity of continuous non-invasive body temperature measurement. PATIENTS AND METHODS: The feasibility of non-invasive continuous measurement of the skin temperature was investigated using the Propaq(R) device in a cohort of 33 patients receiving an allogeneic HSCT who were all at risk of developing a febrile episode. Non-invasive continuous measurement of the skin temperature (CST) was compared with a standard episodic axillary temperature measurement (EAT) five times daily using a Terumo(R) device. The study period entailed monitoring during the 10 or 12 days that profound neutropenia was expected to be present. MAIN RESULTS: Measuring the skin temperature continuously and accurately by using the Propaq(R) was feasible. The CST correlated well with the EAT measurements (Pearson r = 0.782). Compared to EAT, the start of empirical therapy could be started 2.5 h earlier when relying on continuous measurements than was possible with EAT. CONCLUSION: Continuous skin temperature measurements are feasible and valid compared to the conventional temperature measurement and may improve the management of infections by earlier detection of fever in neutropenic patients.