Critical care clinics
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Critical care clinics · Jan 2010
ReviewDiagnosis and management of infectious complications in critically ill patients with cancer.
Cancer and its treatments lead to profound suppression of innate and acquired immune function. In this population, bacterial infections are common and may rapidly lead to overwhelming sepsis and death. ⋯ Despite improvements in long-term survival, infections remain a common complication of cancer therapy and accounts for the majority of chemotherapy-associated deaths. By understanding the host defense impairments and likely pathogens clinicians will be better able to guide diagnosis and management of this unique population.
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Critically ill cancer patients have a higher incidence of acute kidney injury treated with renal replacement therapy than critically ill patients without cancer. Acute kidney injury may occur as a direct or indirect consequence of the cancer itself, its treatment, or associated complications. ⋯ However, these relatively good results should not be used to justify unrealistic therapeutic perseverance or to withhold palliative care in cancer patients who are in a desperate situation. Similar to that for any other critically ill patient, the decision to initiate advanced life-supportive therapy as well as its duration should be in proportion with the patient's expected long-term prognosis and quality of life.