scholarly journals The Impact of Prolonged Mechanical Ventilation on Overall Survival in Patients With Surgically Treated Brain Metastases

2021 ◽  
Vol 11 ◽  
Author(s):  
Patrick Schuss ◽  
Niklas Schäfer ◽  
Christian Bode ◽  
Valeri Borger ◽  
Lars Eichhorn ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Brain Metastases ◽  
Prolonged Mechanical Ventilation ◽  
Postoperative Phase ◽  
Significant Prognostic Factor ◽  
Cancer Disease ◽  
Definition Of ◽  
The Impact

ObjectiveSurgical resection represents a common treatment modality in patients with brain metastasis (BM). Postoperative prolonged mechanical ventilation (PMV) might have an enormous impact on the overall survival (OS) of these patients suffering from advanced cancer disease. We therefore have analyzed our institutional database with regard to a potential impact of PMV on OS of patients who had undergone surgery for brain metastases.Methods360 patients with surgically treated brain metastases were included. The definition of PMV consisted of postoperative mechanical ventilation lasting for more than 48 hours. Analysis of survival incorporating established prognostic factors such as age, location of BM, and preoperative physical status was performed.Results14 of 360 patients with BM (4%) suffered from postoperative PMV after surgical treatment of BM. Patients with PMV presented in a significantly more impaired neurological condition preoperatively than patients without (p<0.0001). Multivariate analysis determined PMV to be a significant prognostic factor for OS after surgical treatment in patients with BM, independent of other predictive factors (p<0.0001).ConclusionsThe present study demonstrates postoperative PMV as significantly related to poor OS in patients with surgically treated BM. Postoperative PMV is a so far underestimated prognostic predictor, but might be utilized for optimized patient management early in the postoperative phase. For this purpose, the results of the present study should encourage the initiation of further scientific efforts.

scholarly journals ACKT: A Proposal for a Novel Score to Predict Prolonged Mechanical Ventilation after Surgical Treatment of Meningioma in Geriatric Patients

Cancers ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 98
Author(s):  
Elisa Scharnböck ◽  
Leonie Weinhold ◽  
Anna-Laura Potthoff ◽  
Niklas Schäfer ◽  
Muriel Heimann ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Surgical Treatment ◽  
Geriatric Patients ◽  
Prolonged Mechanical Ventilation ◽  
Individual Risk ◽  
Clinical Aspects ◽  
Karnofsky Performance Scale ◽  
Intracranial Meningioma ◽  
Patient Counseling ◽  
The Impact

Indication for surgical treatment in patients with intracranial meningioma must include both clinical aspects and an individual risk–benefit stratification, especially in geriatric patients. Prolonged mechanical ventilation (PMV) has not been investigated for its potential effects in patients with meningioma. We therefore analyzed the impact of PMV on mortality in geriatric patients who had undergone meningioma resection. Between 2009 and 2019, 261 patients aged ≥ 70 years were surgically treated for intracranial meningioma at our institution. PMV was defined as postoperative invasive ventilation of >7 days. Postoperative PMV was present in 17 of 261 geriatric meningioma patients (7%). Twenty-five geriatric patients (10%) died within 1 year after surgery. A scoring system (“ACKT”) based on the variables of age, preoperative C-reactive protein (CRP) value, Karnofsky performance scale and tumor size supports prediction of postoperative PMV (sensitivity 73%, specificity 84%). PMV is significantly associated with increased mortality after surgical treatment of meningiomas in geriatric patients. Furthermore, we suggest a novel score (“ACKT”) to preoperatively estimate the risk of PMV occurrence, which might help to guide future risk–benefit assessment and patient counseling in the geriatric meningioma population.

Association of chronic obstructive pulmonary disease and postresection lung cancer survival: a systematic review and meta-analysis

2016 ◽  
Vol 65 (2) ◽  
pp. 342-352 ◽  
Author(s):  
Lan-Eng Tan ◽  
Razak A M ◽  
Chor-Shen Lim
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Overall Survival ◽  
Pulmonary Disease ◽  
Prolonged Mechanical Ventilation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Bronchial Fistula ◽  
The Impact

Patients with lung cancer often have chronic obstructive pulmonary disease (COPD), but the impact of COPD on postresection survival of patients with lung cancer is unclear. This study evaluated the impact of COPD on survival of patients with lung cancer following pulmonary resection. Databases searched included PubMed, Cochrane, and Embase until March 2016. Study outcomes were overall survival and pulmonary complication rate (pneumonia, bronchial fistula, and prolonged mechanical ventilation). 6 studies with a total of 3761 patients were included. The presence of COPD was associated with lower overall survival, increased frequency of pneumonia, and prolonged mechanical ventilation (p values ≤0.001). COPD had no influence on bronchial fistula development (p=0.098). In summary, COPD was associated with poorer survival and an increased frequency of certain adverse events in patients with lung cancer following resection.

The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation

2000 ◽  
Vol 28 (2) ◽  
pp. 342-350 ◽  
Author(s):  
Michael G. Seneff ◽  
Doug Wagner ◽  
Douglas Thompson ◽  
Charlene Honeycutt ◽  
Michael R. Silver
Keyword(s):  
Mechanical Ventilation ◽  
Acute Care ◽  
Prolonged Mechanical Ventilation ◽  
Cost Of Care ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
The Impact

Palliative medicine family conferences and caregiver psychological distress during prolonged mechanical ventilation

2020 ◽  
Vol 10 (4) ◽  
pp. 443-451 ◽  
Author(s):  
Yi-Han Lee ◽  
Jiao-Syuan Wang ◽  
Randall Curtis ◽  
Sheng-Jean Huang ◽  
Shy-Shin Chang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Palliative Care ◽  
Family Caregivers ◽  
Caregiver Burden ◽  
Psychological Symptoms ◽  
Prolonged Mechanical Ventilation ◽  
Event Scale ◽  
Quality Of Dying ◽  
Care Family ◽  
The Impact

ObjectivesLittle is known about the experience of family caregivers of patients who require prolonged mechanical ventilation (PMV). We examined the perspectives of caregivers of patients who died after PMV to explore the role of palliative care and the quality of dying and death (QODD) in patients and understand the psychological symptoms of these caregivers.MethodsA longitudinal study was performed in five hospitals in Taipei, Taiwan. Routine palliative care family conferences and optional consultation with a palliative care specialist were provided, and family caregivers were asked to complete surveys.ResultsIn total, 136 family caregivers of 136 patients receiving PMV were recruited and underwent face-to-face baseline interviews in 2016–2017. By 2018, 61 (45%) of 136 patients had died. We successfully interviewed 30 caregivers of patients’ death to collect information on the QODD of patients and administer the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression (CES-D) scale to caregivers. We observed that more frequent palliative care family conferences were associated with poorer QODD in patients (coefficients: −44.04% and 95% CIs −75.65 to −12.44), and more psychological symptoms among caregivers (coefficient: 9.77% and 95% CI 1.63 to 17.90 on CES-D and coefficient: 7.67% and 95% CI 0.78 to 14.55 on HADS). A higher caregiver burden at baseline correlated with lower psychological symptoms (coefficient: −0.35% and 95% CI −0.58 to −0.11 on IES and coefficient: −0.22% and 95% CI −0.40 to −0.05 on CES-D) among caregivers following the patients’ death. Caregivers’ who accepted the concept of palliative care had fewer psychological symptoms after patients’ death (coefficient: −3.29% and 95% CI −6.32 to −0.25 on IES and coefficient: −3.22% and 95% CI −5.24 to −1.20 on CES-D).ConclusionsPalliative care conferences were more common among family members with increased distress. Higher caregiver burden and caregiver acceptance of palliative care at baseline both predicted lower levels of caregiver distress after death.

scholarly journals Postoperative Prolonged Mechanical Ventilation in Patients With Newly Diagnosed Glioblastoma—An Unrecognized Prognostic Factor

2020 ◽  
Vol 10 ◽  
Author(s):  
Patrick Schuss ◽  
Felix Lehmann ◽  
Niklas Schäfer ◽  
Christian Bode ◽  
Elisa Scharnböck ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
Functional Outcome ◽  
Prolonged Mechanical Ventilation ◽  
Methylation Status ◽  
Significant Prognostic Factor ◽  
Karnofsky Performance Score ◽  
Newly Diagnosed ◽  
Newly Diagnosed Glioblastoma

ObjectiveAlthough the treatment of glioblastoma patients is well established in neuro-oncological surgery, precious scarce data is available on patients with glioblastoma requiring postoperative prolonged mechanical ventilation (PMV). Therefore, the aim of the present study was to determine the influence of PMV on overall survival (OS) in patients with glioblastoma.MethodsPatients with newly diagnosed glioblastoma who had undergone surgical therapy and complete subsequent neuro-oncological treatment at the authors’ neuro-oncological center from January 2013 to December 2018 were selected and included in the further analysis. PMV was defined as mechanical ventilation for more than 24 h after surgery. Survival analyses were performed, including established prognostic factors such as age, Karnofsky performance score, MGMT-promoter methylation status and extent of resection.ResultsA total of 240 patients with newly diagnosed glioblastoma and subsequent surgical treatment were identified. 13 patients (5%) suffered from PMV during the treatment course of glioblastoma. All but one patient were successfully weaned from mechanical ventilation. Patients suffering from PMV achieved significantly less often favorable functional outcome after 3, 6, 9, and 12 months compared to patients without PMV. Multivariate analysis revealed PMV to constitute a significant prognostic factor for OS, independent of other prognostic factors (p<0.0001, OR 6.7, 95% CI 3.2–13.8).ConclusionsThe present study identifies PMV as significantly associated with impaired functional outcome and poor OS in patients suffering from newly diagnosed glioblastoma. These findings encourage further efforts to investigate/assess this prognostic factor in future studies.

Brain Metastases: Surgical Treatment and Overall Survival

2017 ◽  
Vol 97 ◽  
pp. 169-177 ◽  
Author(s):  
Giancarlo D'Andrea ◽  
Lucia Palombi ◽  
Giuseppe Minniti ◽  
Alessandro Pesce ◽  
Paolo Marchetti
Keyword(s):  
Overall Survival ◽  
Surgical Treatment ◽  
Brain Metastases

scholarly journals P.109 Increased survival when combining BRAF inhibitors and stereotactic radiosurgery in patients with melanoma brain metastases

2016 ◽  
Vol 43 (S2) ◽  
pp. S45-S46
Author(s):  
A Wolf ◽  
A Pavlick ◽  
M Wilson ◽  
J Silverman ◽  
D Kondziolka
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Systemic Disease ◽  
Braf Inhibitor ◽  
Braf Inhibitors ◽  
Actuarial Survival ◽  
Early Management ◽  
Melanoma Brain Metastases ◽  
The Impact

Background: The purpose of the study was to evaluate the impact of BRAF inhibitors on survival outcomes in patients receiving stereotactic radiosurgery (SRS) for melanoma brain metastases. Methods: We prospectively collected treatment outcomes for 80 patients with melanoma brain metastases who underwent SRS. Thirty-five patients harbored the BRAF mutation (BRAF-M) and 45 patients did not (BRAF-WT). Results: The median overall survival from first SRS procedure was 11.2 months if treated with a BRAF inhibitor and 4.5 months for BRAF-WT. Actuarial survival rates for BRAF-M patients on an inhibitor were 54% and 41% at 6 and 12 months after radiosurgery, in contrast to 28% and 19% for BRAF-WT. Overall survival was extended for patients on a BRAF inhibitor if initiated at or after the first SRS. The local control rate did not differ based on BRAF status and was over 90%. Patients with higher KPS, fewer treated metastases, controlled systemic disease, RPA class 1 and BRAF-M patients had extended overall survival. Conclusions: Patients with BRAF-M treated with both SRS and BRAF inhibitors, at or after SRS, have increased overall survival. As patients live longer due to more effective systemic and local therapies, close surveillance and early management of intracranial disease with SRS will become increasingly important.

scholarly journals Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery

2017 ◽  
Vol 24 (3) ◽  
pp. 153-158
Author(s):  
Gabrielius Jakutis ◽  
Ieva Norkienė ◽  
Donata Ringaitienė ◽  
Tomas Jovaiša
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Prolonged Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Research Database ◽  
Elective Cardiac Surgery ◽  
The Impact

Background. Hyperoxia has long been perceived as a desirable or at least an inevitable part of cardiopulmonary bypass. Recent evidence suggest that it might have multiple detrimental effects on patient homeostasis. The aim of the study was to identify the determinants of supra-physiological values of partial oxygen pressure during on-pump cardiac surgery and to assess the impact of hyperoxia on clinical outcomes. Materials and methods. Retrospective data analysis of the institutional research database was performed to evaluate the effects of hyperoxia in patients undergoing elective cardiac surgery with cardiopulmonary bypass, 246 patients were included in the final analysis. Patients were divided in three groups: mild hyperoxia (MHO, PaO2 100–199 mmHg), moderate hyperoxia (MdHO, PaO2 200–299 mmHg), and severe hyperoxia (SHO, PaO2 >300 mmHg). Postoperative complications and outcomes were defined according to standardised criteria of the Society of Thoracic Surgeons. Results. The extent of hyperoxia was more immense in patients with a lower body mass index (p = 0.001) and of female sex (p = 0.005). A significant link between severe hyperoxia and a higher incidence of infectious complications (p – 0.044), an increased length of hospital stay (p – 0.044) and extended duration of mechanical ventilation (p < 0.001) was confirmed. Conclusions. Severe hyperoxia is associated with an increased incidence of postoperative infectious complications, prolonged mechanical ventilation, and increased hospital stay.

scholarly journals Circulating Tumor Cells and Bevacizumab Pharmacokinetics during Neoadjuvant Treatment Combining Chemotherapy and Bevacizumab for Early Breast Cancer: Ancillary Analysis of the AVASTEM Trial

Cancers ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 140
Author(s):  
Renaud Sabatier ◽  
Jean-Yves Pierga ◽  
Hervé Curé ◽  
Rakan Abulnaja ◽  
Eric Lambaudie ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Neoadjuvant Treatment ◽  
Complete Response ◽  
Rank Test ◽  
Significant Prognostic Factor ◽  
Log Rank Test ◽  
The Impact

The phase II AVASTEM trial explored the impact of chemotherapy-bevacizumab combination on breast cancer stem cells in the neoadjuvant setting. We aimed to identify biological features associated with preoperative chemotherapy efficacy and prognosis by analyses of circulating tumor cells (CTCs) and bevacizumab pharmacokinetics (PK). The main objective was to assess the prognostic (relapse-free survival and overall survival) and predictive (pathological complete response, pCR) values of CTCs (CellSearch technology) and bevacizumab PK (ELISA). Seventy-five patients were included. Out of them 50 received bevacizumab-chemotherapy and 25 received chemotherapy alone. CTC results were available for 60 patients and PK data for 29 patients in the experimental arm. The absence of CTC at inclusion was correlated to better outcome. Five-years overall survival (OS) was 91% for CTC-negative patients vs. 54% for CTC-positive cases (HR = 6.21; 95%CI (1.75–22.06), p = 0.001, log-rank test). Similar results were observed for RFS with 5 y-RFS of 78% vs. 44% (HR = 3.51; 95%CI (1.17–10.52), p = 0.017, log-rank test). However, CTC status at baseline was not predictive of pCR (p = 0.74). CTC status after one cycle was not a significant prognostic factor (HR = 1.56; 95%CI (0.19–12.67); p = 0.68 for OS and HR = 2.76; 95%CI (0.60–12.61); p = 0.17 for RFS, log-rank test). Bevacizumab serum levels could not predict pCR and survival. PK values were not associated with treatment-related toxicities. In conclusion, CTCs detection at baseline is a prognostic marker for breast cancer receiving a neoadjuvant chemotherapy-bevacizumab combination independently of tumor response.

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