Critical care clinics
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Although patients with cancer may derive much benefit from treatment, they are at risk for developing life-threatening complications. Hypersensitivity reactions can be severe, as in the case of anaphylaxis with L-asparaginase. Cardiac toxicities consist of arrhythmias with various drugs, hemorrhagic myocarditis with cyclophosphamide and ifosfamide, cardiomyopathy with anthracyclines, and pericardial disease. ⋯ Hemorrhagic cystitis caused by cyclophosphamide and ifosfamide can be severe and result in exsanguination if unresponsive to treatment. Disseminated intravascular coagulation and thrombotic microangiopathy can produce thrombotic or hemorrhagic complications. Gastrointestinal toxicities include significant hepatotoxicity with a variety of drugs and development of acute surgical abdomen.
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Hematopoietic stem cell transplantation is evolving into a treatment modality with expanding indications and volume and with excellent outcomes, although it carries significant risk for morbidity and mortality affecting most major organ systems and often requires ICU care. With continuing improvements in supportive care and specific therapy of complications following HCT including the open-lung strategy of mechanical ventilation, use of nitric oxide, less toxic myeloablative regimens, newer classes of antibiotics, and improved immunosuppression strategies, it is hoped that mortality in this setting will continue to decline in coming years.
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Critical care clinics · Jul 2001
ReviewBleeding and thrombotic complications in critically ill patients with cancer.
Alterations in hemostasis are common in patients with cancer admitted to the ICU. Depending on the underlying disease and specific hemostatic abnormality, the patient with cancer may develop bleeding, thrombosis, or both, such as DIC. ⋯ Advances in diagnostic imaging and the availability of newer and more potent anticoagulant agents have facilitated the care of these patients greatly. Ultimately, it is hoped that a thorough understanding of the various disturbances in hemostasis, innovative treatment approaches, and implementation of preventive strategies in patients with cancer will lead to decreased morbidity and improved survival rates of critically ill patients with cancer in the ICU.
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Critical care clinics · Jul 2001
ReviewInfectious morbidity in critically ill patients with cancer.
Infection frequently complicates the course of cancer treatment and often adversely affects the outcome. Patients have a greater tendency for acquiring infections caused by opportunistic microorganisms. Agents with low virulence potential may lead to invasive and often life-threatening infections because of altered host immune function. The immune dysfunction may be caused by the underlying malignancy, by antineoplastic chemotherapy, or by invasive procedures during supportive care.
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Patients with malignancy may present with acute circulatory compromise requiring ICU monitoring and care. The clinician must be familiar with a multiplicity of acute and chronic medical conditions common to the general population and also with conditions directly related to cancer or therapy thereof.