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Organ Dysfunction in Critically Ill Cancer Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy FREE TO VIEW

Silvio Namendys-Silva, MS; Paulina Correa-García; Horacio López-Basave, MD; Francisco García-Guillén, MD; Julia Texcocano-Becerra, RN; Angel Herrera-Gómez, MD
Author and Funding Information

Instituto Nacional de Cancerología and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

Chest. 2013;144(4_MeetingAbstracts):548A. doi:10.1378/chest.1698399
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SESSION TITLE: Outcomes/Quality Control Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: This study was designed to describe the incidence of organ dysfunction, clinical characteristics, and intensive care unit (ICU) outcomes of critically ill cancer patients admitted to an oncological ICU in the postoperative period of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC).

METHODS: The present study was an observational and descriptive study that included 25 critically ill cancer patients admitted to the ICU of the Instituto Nacional de Cancerologia, Mexico in the postoperative period of HIPEC between January 2007 and February 2013. Categorical variables are expressed as percentages and continuous variables are expressed as the means ± standard deviation. All continuous variables were tested for normality using the Kolmogorov-Smirnoff test. Student’s t-test was used to compare continuous variables. A two-sided p value <0.05 was used to determine statistical significance.

RESULTS: The mean age of the patients was 49.2 ± 14.4 years, and 76% (19) were female. The ovary was the most common site of the primary tumor (36%). The length of surgery was 8.6 ± 1.5 hours. The mean blood loss volume during HIPEC was 870 ± 732 ml. The patients received 8.4 ± 2.6 L of crystalloid during the surgery, and then required and additional 3.7 ± 2 L on the first postoperative day. During the first 24 h after ICU admission, vasopressors were required by 6 (24%) patients for a total of 2.1 ± 1.1 days, and invasive mechanical ventilation was required by 15 patients (60%) with a mean duration of 24.6 ± 24.2 hours. The incidence of organ dysfunction was 68% (17 patients). The incidence of organ dysfunction was noted most frequently for the respiratory (60%), and hepatic systems (44%). Three (12%) patients had acute kidney injury. The lengths of the ICU and hospital stays were 2.6 ± 2 and 16.1 ± 12.4 days, respectively. The patients with ≤ 1 organ system dysfunction during their ICU stay had a significantly shorter hospital length of stay compared with the patients who had 2 or more organ system dysfunctions (12.4±10.7 vs. 24.1 ±12.8 days, p=0.025). No patient died during their hospital stay.

CONCLUSIONS: This study showed a high incidence of organ dysfunction. Organ dysfunction was associated with a longer hospital stay. This group of patients had an in-hospital mortality rate of 0%.

CLINICAL IMPLICATIONS: HIPEC plays an important role in the treatment of patients with cancer. At the end of this complex procedure, critically ill cancer patients may require organ support systems in the ICU.

DISCLOSURE: The following authors have nothing to disclose: Silvio Namendys-Silva, Paulina Correa-García, Horacio López-Basave, Francisco García-Guillén, Julia Texcocano-Becerra, Angel Herrera-Gómez

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