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"apellidos" => "Añón" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Hematología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Oncología Médica, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (ISCIII), Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rondas multidisciplinares en oncología y hematología: ¿son superiores a los equipos de respuesta rápida?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Over the last few years, the therapeutic armamentarium for the management of neoplasms has experienced a tremendous growth. Actually, it is associated with an exponentially increasing number of patients who require advanced therapies including life support due to infections-sepsis, respiratory failure, neurological disorders and/or complications associated with chemotherapy. As a matter of fact, we should accept the fact that this is a process on the rise.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Fifteen per cent of hematological patients require admission to the intensive care unit (ICU) due to their clinical condition. Also, these admissions are associated with iso-severity criteria being the number of patients with solid tumors admitted for medical reasons relatively low compared to those admitted to recovery rooms.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Azoulay et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> confirm an increasing number of oncological and hematological patients admitted to the ICU—representative of an up to 15% occupation rate—and a higher survival rate both for the ICU (mortality rate < 30%) and the hospital (mortality rate < 40%). Regarding hematological patients, more patients admitted to the ICU are in remission and have a better quality of life compared to patients who were never admitted in the first place.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our former (2000−11) and later data (2012−16) on the implementation of daily multidisciplinary rounds in the onco-hematological unit show higher rates of admission (8%) to the ICU and lower mortality rates at the ICU setting both at the 90-day follow-up and after 90 days (44%, 54%, and 62%) compared to the pre-implementation period of these rounds (53%, 61%, and 66%).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We believe that these multidisciplinary rounds may outperform the rapid response teams including daily assessments at the hospital floor, monitorization and administration of advanced therapies (high flow, fluids, antibiotics, vasopressors…), decisions on the patient’s admission and how early it should occur, and the therapeutic targets that should be reached (non-invasive and invasive ventilation, ECMO, CVHH. However, stable and uncompromised patients who are going to receive some kind of life-threatening therapy (CAR T cell therapy: ARDS, shock…) can also be admitted to the ICU.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, the key points that should be observed in the partnerships achieved among different units are<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>: <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">Specific clinical practice guidelines for ICU admission and therapeutic protocols before and after admission should become available (actually they are already available in 79% of monographic ICUs compared to only 27% of polyvalent ICUs).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall">Daily meetings between intensivists and oncology and hematology specialists (documented in 90% of monographic centers compared to only 53% of general hospitals).</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">Accept that the traditional predictors of mortality have been losing momentum.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0040" class="elsevierStylePara elsevierViewall">Document the safety profile of the intensive therapies administered at the hospitalization floor.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">Accept that chemotherapy at the ICU setting is safe and its administration is not associated with a worse prognosis.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Optimize transition from the ICU to the palliative care setting.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">Acquire in-depth knowledge on how to manage toxicity associated with targeted therapies, immunotherapies, and biotherapies.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">Implement the QALY (quality-adjusted life years) score.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">Take into account the family’s specific needs.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">Encourage multidisciplinary cooperation.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">•</span><p id="par0075" class="elsevierStylePara elsevierViewall">Cost assessment.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">•</span><p id="par0080" class="elsevierStylePara elsevierViewall">Consider the added value of an ICU-oncological setting.</p></li></ul></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-de-Lorenzo A, Jiménez V, Feliu J, Asensio MJ, Civantos B, Añón JM. Rondas multidisciplinares en oncología y hematología: ¿son superiores a los equipos de respuesta rápida? Med Intensiva. 2021;45:127–128.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care in cancer patientsin the age of immunotherapy and molecular therapies: commitment of the SEOM-SEMICYUC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Carmona" 1 => "F. Gordo" 2 => "C. Beato" 3 => "J. Castaño" 4 => "P. Jiménez" 5 => "Virizuela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2018.01.008" "Revista" => array:7 [ "tituloSerie" => "Med Intensiva." 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"fecha" => "2018" "volumen" => "97" "paginaInicial" => "1271" "paginaFinal" => "1282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29704018" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004500000002/v1_202102260751/S2173572720302150/v1_202102260751/en/main.assets" "Apartado" => array:4 [ "identificador" => "64268" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004500000002/v1_202102260751/S2173572720302150/v1_202102260751/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572720302150?idApp=WMIE" ]
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---|---|---|---|
2024 November | 1 | 2 | 3 |
2024 October | 50 | 50 | 100 |
2024 September | 64 | 32 | 96 |
2024 August | 78 | 29 | 107 |
2024 July | 60 | 38 | 98 |
2024 June | 57 | 48 | 105 |
2024 May | 41 | 34 | 75 |
2024 April | 45 | 48 | 93 |
2024 March | 42 | 27 | 69 |
2024 February | 48 | 37 | 85 |
2024 January | 44 | 32 | 76 |
2023 December | 29 | 35 | 64 |
2023 November | 39 | 46 | 85 |
2023 October | 37 | 31 | 68 |
2023 September | 33 | 37 | 70 |
2023 August | 35 | 25 | 60 |
2023 July | 38 | 28 | 66 |
2023 June | 37 | 22 | 59 |
2023 May | 45 | 32 | 77 |
2023 April | 25 | 16 | 41 |
2023 March | 46 | 36 | 82 |
2023 February | 39 | 34 | 73 |
2023 January | 31 | 22 | 53 |
2022 December | 53 | 38 | 91 |
2022 November | 51 | 35 | 86 |
2022 October | 58 | 44 | 102 |
2022 September | 35 | 37 | 72 |
2022 August | 44 | 38 | 82 |
2022 July | 33 | 39 | 72 |
2022 June | 34 | 32 | 66 |
2022 May | 48 | 45 | 93 |
2022 April | 42 | 48 | 90 |
2022 March | 43 | 53 | 96 |
2022 February | 34 | 44 | 78 |
2022 January | 38 | 38 | 76 |
2021 December | 36 | 45 | 81 |
2021 November | 39 | 44 | 83 |
2021 October | 58 | 79 | 137 |
2021 September | 34 | 44 | 78 |
2021 August | 39 | 42 | 81 |
2021 July | 36 | 35 | 71 |
2021 June | 37 | 50 | 87 |
2021 March | 1 | 2 | 3 |
2021 February | 0 | 2 | 2 |