Critical care clinics
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Critical care clinics · Jul 2001
ReviewEvaluation of pulmonary infiltrates in critically ill patients with cancer and marrow transplant.
Pulmonary infiltrates in critically ill patients with cancer or marrow transplant can be evaluated by the differential diagnosis presented at the beginning of this article. The patient's quantitative immune system dysfunction, epidemiologic history and chest radiographic findings (pattern, rapidity, and time of onset) will help focus the differential diagnosis. ⋯ Early bronchoscopy to rule out infection is the focus of diagnostic testing. Surgical lung biopsy in this patient population has a low yield.
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Critical care clinics · Jul 2001
ReviewCritical care of patients with cancer. Surgical considerations.
Surgical evaluation of and therapy for the critically ill cancer patient continue to present significant challenges despite, or perhaps in part because of, an ongoing technologic refinement of therapeutic modalities within a modern ICU.
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Nutritional depletion is a common problem seen in critically ill patients with cancer and is associated with increased morbidity and mortality. Infection and injury activate a cascade of metabolic events that leads to a poor nutritional state and wasteful energy consumption. The goals of nutritional support entail minimizing starvation, preventing nutrient deficiencies, supporting or improving immune function, and facilitating tissue repair and wound healing. ⋯ The unselective use of nutritional support is not indicated in well-nourished patients with cancer undergoing surgery, chemotherapy, or radiotherapy in whom adequate oral intake is anticipated. Nutritional support remains an important adjunctive therapy in the overall management of critically ill patients. Continued clinical investigations in nutrition are necessary to identify other groups of patients who can benefit from nutritional interventions.
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Critical care clinics · Jul 2001
ReviewIntensive care, mechanical ventilation, dialysis, and cardiopulmonary resuscitation. Implications for the patient with cancer.
The broad range in mortality rates seen in the critically ill cancer population reflects the fact that cancer is a heterogeneous disease, affecting a heterogeneous population at different stages of care. Patients, families, and physicians frequently agonize about the utility of CPR and ICU care and whether this care should be offered. Understanding the goals of care, respecting autonomy, and knowing the likelihood of benefits and burdens of these interventions are critical in making these difficult decisions.
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End-of-life decisions in critically ill patients with cancer are often complex and fraught with emotion. End-of-life care involves a multidisciplinary approach that takes into account the patient and family's desires and the goals of therapy. Decisions regarding the use of life-support technology at the end of life encompass an outcomes and goal-oriented approach. Ethical, medical, legal, and economic issues should be considered in the assessment of life-support technologies and directives for their appropriate use in the ICU.