Patients with cancer in the intensive monitoring unit. New perspectives

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Nuevas perspectivas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2351 "Ancho" => 3007 "Tamanyo" => 259625 ] ] "descripcion" => array:1 [ "en" => "Intensive care unit decision algorithm." ] ] ] "textoCompleto" => "BackgroundFor years, the admission of patients with cancer to intensive care units (ICUs) has been very restricted, mainly because hospitalization in the ICU is associated with high mortality rates. This is most evident in patients who require invasive mechanical ventilation (IMV).In recent years, the survival of patients with oncohematologic diseases (POHD) in the ICU has improved dramatically.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Several factors have contributed to these results, including better selection of patients and overall progress in the treatment of solid and hematological neoplasms. From the intensive care point of view, the proper and early treatment of patients with sepsis (code sepsis), replacement therapies for organ failures, progress in prevention measures for nosocomial infection in critical patients, better management of sedoanalgesia and developments in ventilatory support (such as noninvasive mechanical ventilation and the optimization of “weaning”) have increased life expectancy in this group of patients.Currently, 15% of patients admitted to European ICUs are POHD, especially patients with solid neoplasms and who undergo some type of surgery.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>In the following review, we will attempt to answer the following questions that arise when POHD require critical care, and to provide a current overview of critical care for these patients in an attempt to improve its focus:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.Should we limit admission of POHD to the ICU?</li><li class="elsevierStyleListItem" id="lsti0010">2.What does mechanical ventilation provide us?</li><li class="elsevierStyleListItem" id="lsti0015">3.What prognostic markers are of use?</li><li class="elsevierStyleListItem" id="lsti0020">4.Does ICU mortality depend on the prognosis of the neoplastic disease? What is the quality of life of POHD after hospital discharge?</li><li class="elsevierStyleListItem" id="lsti0025">5.What is an ICU test? Under what circumstances should the test be applied?</li></ul>Should we limit the admission of POHD to the ICU?The prioritization model is the most frequently used system to decide whether a patient should be admitted to the ICU, defining an order starting from patients who will most benefit from admission (priority 1) to those who will not benefit in any case (priority 4) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0015">3</a> For many years, POHD have been considered as belonging to priority 3 and 4 groups within this assessment system. As we will discuss in the following article, a large portion of patients with neoplasms should be considered priority 1.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The objective of admitting patients to an ICU is to improve their life expectancy, while not taking measures that entail a significant reduction in their quality of life after their hospital discharge. This last constraint has been and is still an argument used in many centers for not admitting POHD to the ICU, despite the weak scientific evidence supporting that argument in most cases. It is therefore important that we consider the various aspects that could help us in making decisions that are always difficult.The main reason POHD might require intensive care, excluding elective surgery, is infectious complications. More than half of those admitted are hospitalized for this reason. In general, these infections occur in the context of immunosuppression due to various causes. The understanding of these infections and the appropriate antimicrobial approach are essential factors that determine patient outcomes. Acute respiratory failure and severe sepsis are present in more than 80% of patients who require hospitalization for medical reasons.The need for IMV significantly worsens the prognosis of critically ill patients, especially in the case of POHD.<a class="elsevierStyleCrossRefs" href="#bib0020">4–8</a> In any case, we should point out several issues. First, hospital mortality associated with IMV for POHD is between 60% and 80%.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> Although high, this does not change the fact that 1 of every 4 patients can benefit from admission to the ICU. Second, we should be able to individualize each case. POHD cover a heterogeneous group of diseases and evolutionary stages, which makes a universal assessment impossible. More studies are probably necessary on specific subgroups of patients with cancer, such as patients with acute myeloblastic leukemia in first-line treatment or patients with differing stages of lung cancer.Patients who undergo allogeneic hematopoietic progenitor cell transplantation (HPT) with severe graft-versus-host disease (GVHD) have a hospital mortality greater than 80%.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> The mortality of a complication that requires intensive care and IMV in the midst of severe GVHD approaches 100%.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Patients with solid tumors have better prognoses. If the cancer is not in progression, the IMV-related mortality is approximately 60%.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> For patient group with solid tumors, the prognosis worsens if the tumor originates in the lungs.<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a>Recent studies<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a> suggest that early admission to the ICU of POHD is associated with reduced hospital mortality, which highlights the importance of early diagnosis and treatment in the ICU. Similarly, a delay in admission to the ICU of POHD with acute respiratory failure is significantly associated with an increased mortality at 28 days.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>With the current evidence, there are no good reasons to not recommend ICU admission for POHD that cannot be extrapolated to other types of patients (those with cachexia, who are bedridden, have a poor vital prognosis of the underlying disease or who refuse treatment). It is recommended that criteria for action in the ICU be established, criteria that limit the therapeutic effort according to the patient's evolution during the first 3–5 days of hospitalization (ICU test), as we will see later in this article. Admission to the ICU should not be delayed and should be implemented without reducing any of the necessary measures for causal treatment and respiratory and hemodynamic stabilization.What does mechanical ventilation provide?There have been 2 notable developments in the field of mechanical ventilation. The first was the emergence of noninvasive mechanical ventilation (NIMV), and the second was the use of respiratory strategies based on low tidal volume and low pressure (protective ventilation). These events have likely played a role in the reduction of mortality in acute lung damage that requires admission to the ICU, a condition that includes POHD.Mechanical ventilation (MV) that requires endotracheal intubation (ETI) is associated with numerous complications, particularly with these patients. NIMV significantly decreases the need for ETI and IMV in patients with cancer.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a> In recent years, a significant increase has been observed in the survival of immunocompromised patients with acute respiratory failure (ARF) and who require MV with the use of NIMV. Azoulay et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> measured a 44% mortality rate for patients with cancer connected to NIMV in the ICU compared with 71% for patients who required IMV. The authors<a class="elsevierStyleCrossRef" href="#bib0100">20</a> corroborated these results in a 2004 study that revealed a mortality rate of 48% (NIMV) versus 75% (IMV). Furthermore, the authors described the need for IMV after failure of NIMV and the late failure of NIMV as variables related to mortality. Hilbert et al.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> observed a 53% hospital mortality rate for POHD and neutropenia in whom NIMV was started early compared with 93% for patients who required IMV.NIMV improves survival for POHD who do not subsequently require IMV; however, NIMV likely worsens survival<a class="elsevierStyleCrossRef" href="#bib0105">21</a> if IMV is used after the failure of NIMV. Therefore, deciding the initial type of respiratory support is especially important. Each case should be evaluated individually, avoiding generalizations and, assuming the treatment starts with NIMV, performing a careful surveillance of the technique's effectiveness parameters (respiratory frequency, arterial oxygen saturation, arterial pressure of carbon dioxide, respiratory effort, etc.) to avoid delaying IMV if it is necessary.The mechanisms that make NIMV beneficial include the effects of positive end-expiratory pressure (PEEP) in alveolar recruitment, in the treatment of microatelectasis and in the redistribution of extravascular lung water and the effects of pressure support in reducing the respiratory effort, improving the efficacy of respiratory muscles and maintaining an appropriate tidal volume.The reduced mortality observed using protective lung ventilation with low tidal volumes<a class="elsevierStyleCrossRef" href="#bib0110">22</a> in patients with acute respiratory distress syndrome (ARDS) can also be applied to POHD with the same expectation of benefit. Ventilator-induced lung damage is mainly due to the overdistension and opening–closing of alveolar units. The prevention of this damage using strategies such as low tidal volume, permissive hypercapnia and PEEP optimization represents notable progress in improving the prognosis of POHD with ARF connected to IMV.Over the last 10 years, there has been a significant reduction in mortality for patients with cancer in connection with both IMV and NIMV. This fact prompts us to indicate one or other type of ventilation in patients with cancer in the ICU. We should not ignore the fact that NIMV also has significant adverse effects, especially for patients with ARDS,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> and that several studies have shown that patients with cancer who require MV and are intubated in the first 24h of admission to the ICU have greater survival compared with those who are intubated later.<a class="elsevierStyleCrossRefs" href="#bib0045">9,20,23</a> Adda et al. found that half of POHD admitted to the ICU with ARF benefit from NIMV and do not require IMV during their stay in the ICU.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> When differentiating between these patients and those who will need IMV, the authors reported that the predictors of poor prognosis with NIMV were ARDS, multiple organ failure and high respiratory rates.High-flow oxygen therapy administered with a humidification system by nasal cannula is very well tolerated by patients, significantly decreases dyspnea and the respiratory rate and increases the arterial oxygen pressure.<a class="elsevierStyleCrossRefs" href="#bib0125">25,26</a> Although there are no controlled studies that show that this therapy reduces the use of ETI and connections to IMV, high-flow oxygen therapy is comfortable for the patient, decreases the respiratory effort and has encouraging results, especially for POHD.What prognostic markers are of use?The classical prognostic scores for mortality in POHD should be applied with caution given their tendency to underestimate the actual mortality of these patients.Neutropenia has for years been considered an indication of poor prognosis for critically ill patients, especially those connected to MV. Furthermore, prolonged neutropenia is considered to have an ominous prognosis. However, various studies have questioned its credibility. Kress et al.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> assessed the prognoses of 348 POHD who required admission to the ICU and found no relationship between neutropenia and mortality in any of the analyzed subgroups. Darmon et al.,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> in a retrospective study of 102 patients with neutropenia admitted to the ICU, found no relationship between the duration of the neutropenia and mortality at 30 days from admission. Azoulay et al.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> also found no relationship between neutropenia and the prognosis of patients with solid tumors admitted to the ICU.In studies specifically performed on patients with cancer who require a stay in the ICU, the predictors of mortality described were, in most cases, similar to those of patients without cancer: multiple-organ failure,<a class="elsevierStyleCrossRefs" href="#bib0035">7,8,10,27,28</a> mechanical ventilation,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> the need for vasoactive support<a class="elsevierStyleCrossRef" href="#bib0140">28</a> or renal replacement techniques,<a class="elsevierStyleCrossRef" href="#bib0200">40</a> functional state prior to admission and being elderly.<a class="elsevierStyleCrossRefs" href="#bib0050">10,27</a> Other predictors, in contrast, are specific to this type of patient: progression or recurrence of the oncologic disease,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> allogeneic HPT<a class="elsevierStyleCrossRefs" href="#bib0040">8,29</a> and lung or tracheal disorder of tumoral origin.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>In general, the mortality of POHD in the ICU is associated with the number of dysfunctional organs (especially if there are more than 3), the need for INMV and the need for renal replacement techniques. Although these factors coincide with those of the general population, the associated mortality is significantly greater. These factors should therefore be especially considered when making decisions related to limiting the therapeutic effort.Does ICU mortality depend on the prognosis of the neoplastic disease? What is the quality of life of POHD after hospital discharge?There is an open debate on the indication for admitting POHD to the ICU with poor prognoses for their underlying disease. Although various clinical criteria have been used to differentiate between those who can and those who cannot benefit from their admission to the ICU,<a class="elsevierStyleCrossRefs" href="#bib0150">30,31</a> there are no tested guidelines, and the cancer prognosis has not been reliably correlated to ICU morbidity and mortality.Massion et al.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> found no relationship between the prognosis of hematologic disease and ICU and hospital mortality. The short-term prognosis of these patients is correlated to the degree of multiple organ failure during the first 5 days of stay in the ICU. Azoulay et al.,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> in a study performed on patients with solid tumors who required a stay in the ICU, did not consider the presence of metastases or the degree of progression of the oncologic disease to be determinants in the prognosis. However, the authors did argue that the need for vasopressor treatment and the degree of multiple organ failure were determinants in the prognosis. Staudinger et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> also found no relationship between the underlying disease and the prognosis in the ICU, although the patients with HPT had a significantly higher mortality.The tumor origin and histological type are also not related to the prognosis in the ICU. In some cases, as with lung cancer and especially in advanced stages (IIIb–IV)<a class="elsevierStyleCrossRefs" href="#bib0165">33,34</a> or for allogeneic HPT and severe GVHD, the need for IMV is associated with a mortality rate above 90%.Overall, we should consider the prognosis of POHD in the ICU regardless of the origin and extent of their cancer.Despite the nonassociation between the tumor prognosis and the ICU prognosis, patients with cancer and especially those with hematologic malignancies have a poorer ICU prognosis than those patients with no cancer but similar severity scores. This is mainly due to the functional and nutritional state prior to admission<a class="elsevierStyleCrossRefs" href="#bib0170">34,35</a> and to the immunosuppression associated with the disease and its treatment. In the case of solid tumors, the short-term prognoses could be superimposed on those of patients without cancer.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Neither neutropenia nor the underlying cancer predicts the ICU prognosis of POHD. These conditions should therefore not be taken into account as admission criteria or as factors for limiting the therapeutic effort.<a class="elsevierStyleCrossRef" href="#bib0205">41</a>After the hospital discharge, the quality of life of patients with cancer is significantly poorer than that of the general population, both at 3 months and at 12 months of the hospital discharge,<a class="elsevierStyleCrossRef" href="#bib0175">35</a> a situation that is especially evident in POHD. Advanced age, a poor functional state prior to ICU admission and a greater degree of multiple organ failure during the ICU stay are other independent predictors of a worse quality of life.What is an ICU test? Under what circumstances should the test be applied?A large POHD group can raise questions when determining their need for ICU admission, even more so when the available data are insufficient to guide even a short-term prognosis. Lecuyer et al.,<a class="elsevierStyleCrossRef" href="#bib0150">30</a> in a study that excluded patients with allogeneic HPT, found no statistically significant variable for ICU admission that differentiated survivors and nonsurvivors. After the first 72h of treatment in the ICU without restrictions, patients who ultimately did not survive had significantly greater multiple organ dysfunction than the survivors.We recommend establishing an individual strategy for selecting patients with cancer for ICU admission to avoid suboptimal treatments and nonbeneficial admissions. Bedridden patients, those in palliative treatment and those with short life expectancies (less than 6 months) are not recommended for admission, while recently diagnosed patients, those in first-line treatment, those with tumor lysis syndrome or hypercalcemia should not have restrictions in their management.For the broad group of patients who raise questions in terms of the approach to take (allogeneic HPT with GVHD, advanced stages, second or third-line treatments, etc.), it is advisable to perform an ICU test, by which we mean ICU admission without therapeutic restrictions, for at least 72hours, with continuous assessment of organ failure (e.g., sepsis related organ failure assessment). If, after this time, the patient presents failure of 3 or more organs or worsening of prior multiple organ failure, then the life expectancy is minimal. Measures to restrict the therapeutic effort should then be implemented. If however the patient shows improvement in terms of organ failure, treatment in the ICU should continue without limitations. A number of POHD subgroups, such as those with advanced stages of lung cancer,<a class="elsevierStyleCrossRefs" href="#bib0160">32,42</a> those with allogeneic HPT with severe GVHD<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> or elderly patients,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> have very poor prognoses, in the event IMV is required. It is therefore recommended that this support measure be excluded from the ICU test, as proposed in our decision algorithm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Conclusions<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030">1.We should not deny admission to the ICU for POHD due to the type and prognosis of the cancer (except in extreme in cases), that is, those with a survival prognosis of less than 6 months. This would also be a limiting factor for numerous other diseases.</li><li class="elsevierStyleListItem" id="lsti0035">2.The early implementation of resuscitation measures and life support, including NIMV, is associated with a significant reduction in mortality. Time is precious, especially for POHD who have a lower or greater degree of immunosuppression.</li><li class="elsevierStyleListItem" id="lsti0040">3.The main predictor of mortality is the degree of multiple organ failure and, especially, its evolution during the first days of admission to the ICU.</li><li class="elsevierStyleListItem" id="lsti0045">4.In general, the cancer prognosis is independent of the ICU prognosis and should therefore be a secondary determinant in the assessment of a large portion of patients. Although the prognosis for POHD in ICU (except for elective surgery) is not good, it is comparable or better than for other diseases that require ICU admission and are not subject to so much debate.<a class="elsevierStyleCrossRefs" href="#bib0180">36–39</a></li><li class="elsevierStyleListItem" id="lsti0050">5.In cases where there are questions, it is recommended that an ICU test be performed for 3–6 days and that the decision to continue with the adopted support measures be made following the evolution of the multiple organ failure, the prognostic factor that has been shown to be a better determinant of ICU mortality for POHD.</li></ul>Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres373111" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec352191" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres373112" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec352192" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Should we limit the admission of POHD to the ICU?" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "What does mechanical ventilation provide?" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "What prognostic markers are of use?" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Does ICU mortality depend on the prognosis of the neoplastic disease? What is the quality of life of POHD after hospital discharge?" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "What is an ICU test? Under what circumstances should the test be applied?" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-28" "fechaAceptado" => "2014-03-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec352191" "palabras" => array:5 [ 0 => "Cancer" 1 => "Mechanical ventilation" 2 => "Intensive care units test" 3 => "Organ failure" 4 => "Neutropenia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec352192" "palabras" => array:5 [ 0 => "Cáncer" 1 => "Ventilación mecánica" 2 => "Test de Unidad de Cuidados Intensivos" 3 => "Fallo orgánico" 4 => "Neutropenia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "In recent years, there has been a significant improvement in the survival of patients with cancer in intensive care units (ICUs). Advances in medical and surgical treatments and better selection of patients have helped improve the life expectancy of such type of patients. An appropriate and early resuscitation in the ICU, without initial limitations on the life support techniques, has been shown to also decrease the mortality of patients with cancer. At present, we should not deny admission to the ICU based only on the underlying neoplastic disease. However, the mortality rate for patients with cancer in the ICU, especially those with hematologic disease, remains high. In some cases, an ICU admission test (ICU test) is required for at least 3 days to identify patients who can benefit from intensive treatment. We would like to propose a decision algorithm for ICU admission that will help in making decisions in an often complex situation." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Durante los últimos años, se ha evidenciado una mejoría significativa en la supervivencia de los pacientes con cáncer en las unidades de cuidados intensivos (UCI). Tanto el avance en el tratamiento médico y quirúrgico, como una mejor selección de pacientes, han influido en la mejoría de las expectativas vitales de estos enfermos. En la UCI una resucitación adecuada y precoz, sin limitaciones iniciales a técnicas de soporte vital, ha demostrado disminuir también la mortalidad en los pacientes con cáncer. Actualmente, no debemos denegar el ingreso en UCI solo por la enfermedad neoplásica de base. Aun así, la mortalidad del paciente con cáncer en la UCI, especialmente el hematológico, sigue siendo alta y en algunos casos es necesario realizar una prueba de ingreso en UCI (test de UCI) de, al menos, 3 días para diferenciar a los pacientes que se estén beneficiando de un tratamiento intensivo. Proponemos un algoritmo de decisión al ingreso en la UCI que nos ayude en una situación, a veces, compleja." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Prieto del Portillo I, Polo Zarzuela M, Pujol Varela I. El paciente con cáncer en la unidad de vigilancia intensiva.Rev Clin Esp. 2014;214:403–409." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2351 "Ancho" => 3007 "Tamanyo" => 259625 ] ] "descripcion" => array:1 [ "en" => "Intensive care unit decision algorithm." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Priority 1: Patients who are gravely ill, unstable, who require monitoring and treatment that cannot be provided outside of the ICU. There are no initial limits on the duration or type of therapy they require. This category can include patients with septic shock with no prior disease. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Priority 2: Patients who require surveillance and monitoring measures specific to the ICU and who might require immediate intervention. This category includes, for example, patients with respiratory failure who might require mechanical ventilation. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Priority 3: Patients who, due to their underlying disease or acute disease, have little chance of recovery. Although treatment is initiated in the ICU, measures can be established to restrict the therapeutic effort over the course of their evolution. Patients with chronic exacerbated respiratory diseases and limited quality of life are an example of this category. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Priority 4: Patients for whom ICU admission is considered inappropriate, either due to end-stage or irreversible diseases (too ill to benefit from the ICU) or for not requiring any of the measures intrinsic to the ICU (too healthy to benefit from the ICU). \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab564181.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Levels of prioritization." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:42 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Critical care management of cancer patients: cause for optimism and need for objectivity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Darmon" 1 => "E. Azoulay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCO.0b013e32832b68b6" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Oncol" "fecha" => "2009" "volumen" => "21" "paginaInicial" => "318" "paginaFinal" => "326" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19436200" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and outcomes of cancer patients in European ICUs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.S. Taccone" 1 => "A.A. Artigas" 2 => "C.L. Sprung" 3 => "R. Moreno" 4 => "Y. Sakr" 5 => "J.L. Vincent" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc7713" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2009" "volumen" => "13" "paginaInicial" => "R15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19200368" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for intensive care unit admission, discharge and triage" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Task Force of the American College of Critical Care Medicine. Society of Critical Care Medicine" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "1999" "volumen" => "27" "paginaInicial" => "633" "paginaFinal" => "638" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10199547" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Darmon" 1 => "G. Thiery" 2 => "M. Ciroldi" 3 => "S. de Miranda" 4 => "L. Galicier" 5 => "E. Raffoux" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Crit Care Med" "fecha" => "2005" "volumen" => "248" "paginaInicial" => "8" "paginaFinal" => "93" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Staudinger" 1 => "B. Stoiser" 2 => "M. Müllner" 3 => "G.J. Locker" 4 => "K. Laczika" 5 => "S. Knapp" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2000" "volumen" => "28" "paginaInicial" => "1322" "paginaFinal" => "1328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10834673" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of short-term mortality in critically ill patients with solid malignancies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Azoulay" 1 => "D. Moreau" 2 => "C. Alberti" 3 => "G. Leleu" 4 => "C. Adrie" 5 => "M. Barboteau" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2000" "volumen" => "26" "paginaInicial" => "1817" "paginaFinal" => "1823" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11271090" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome and prognostic factors of hematopoietic stem cell transplantation recipients admitted to a medical ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.O. Soubani" 1 => "E. Kseibi" 2 => "J.J. Bander" 3 => "J.L. Klein" 4 => "G. Khanchandani" 5 => "H.P. Ahmed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.126.5.1604" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2004" "volumen" => "126" "paginaInicial" => "1604" "paginaFinal" => "1611" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15539734" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of critically ill cancer patients in a university hospital setting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.P. Kress" 1 => "J. Christenson" 2 => "A.S. Pohlman" 3 => "D.R. Linkin" 4 => "J.B. Hall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.160.6.9812055" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1999" "volumen" => "160" "paginaInicial" => "1957" "paginaFinal" => "1961" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10588613" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome for cancer patients requiring mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Groeger" 1 => "P. White Jr." 2 => "D.M. Nierman" 3 => "J. Glassman" 4 => "W. Shi" 5 => "D. Horak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/jco.1999.17.3.991" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "1999" "volumen" => "17" "paginaInicial" => "991" "paginaFinal" => "997" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10071294" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24hrs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Soares" 1 => "J.I. Salluh" 2 => "N. Spector" 3 => "J.R. Rocco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2005" "volumen" => "33" "paginaInicial" => "520" "paginaFinal" => "526" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15753742" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Pene" 1 => "C. Aubron" 2 => "E. Azoulay" 3 => "F. Blot" 4 => "G. Thiery" 5 => "B. Raynard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Oncol Pract" "fecha" => "2006" "volumen" => "24" "paginaInicial" => "643" "paginaFinal" => "649" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of bone marrow transplantation patients requiring mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. Huaringa" 1 => "F.J. Leyva" 2 => "S.A. Giralt" 3 => "J. Blanco" 4 => "J. Signes-Costa" 5 => "H. Velarde" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2000" "volumen" => "28" "paginaInicial" => "1014" "paginaFinal" => "1017" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10809275" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognosis of lung cancer patients with life-threatening complications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Soares" 1 => "M. Darmon" 2 => "J.I. Salluh" 3 => "C.G. Ferreira" 4 => "G. Thiery" 5 => "B. Schlemmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.06-2244" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2007" "volumen" => "131" "paginaInicial" => "840" "paginaFinal" => "846" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17356101" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome and code status of lung cancer patients admitted to the medical ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.A. Reichner" 1 => "J.A. Thompson" 2 => "S. O’Brien" 3 => "T. Kuru" 4 => "E.D. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.130.3.719" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2006" "volumen" => "130" "paginaInicial" => "719" "paginaFinal" => "723" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16963668" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.U. Song" 1 => "G.Y. Suh" 2 => "H.Y. Park" 3 => "S.Y. Lim" 4 => "S.G. Han" 5 => "Y.R. Kang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-012-2594-0" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "1505" "paginaFinal" => "1513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22592633" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continued survival gains in recent years among critically ill myeloma patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Peigne" 1 => "K. Rusinová" 2 => "L. Karlin" 3 => "M. Darmon" 4 => "J.P. Fermand" 5 => "B. Schlemmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-008-1320-4" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2009" "volumen" => "35" "paginaInicial" => "512" "paginaFinal" => "516" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18853139" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Mokart" 1 => "J. Lambert" 2 => "D. Schnell" 3 => "L. Fouché" 4 => "A. Rabbat" 5 => "A. Kouatchet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/10428194.2012.753446" "Revista" => array:6 [ "tituloSerie" => "Leuk Lymphoma" "fecha" => "2013" "volumen" => "54" "paginaInicial" => "1724" "paginaFinal" => "1729" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23185988" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Azoulay" 1 => "C. Alberti" 2 => "C. Bornstain" 3 => "G. Leleu" 4 => "D. Moreau" 5 => "C. Recher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2001" "volumen" => "29" "paginaInicial" => "519" "paginaFinal" => "525" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11373414" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Hilbert" 1 => "D. Gruson" 2 => "F. Vargas" 3 => "R. Valentino" 4 => "G. Gbikpi-Benissan" 5 => "M. Dupon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200102153440703" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2001" "volumen" => "344" "paginaInicial" => "481" "paginaFinal" => "487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172189" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prognosis of acute respiratory failure in critically ill cancer patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Azoulay" 1 => "G. Thiery" 2 => "S. Chevret" 3 => "D. Moreau" 4 => "M. Darmon" 5 => "A. Bergeron" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "2004" "volumen" => "83" "paginaInicial" => "360" "paginaFinal" => "370" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Invasive mechanical ventilation in cancer patients. Prior non invasive ventilation is a poor prognostic factor" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.P. Meert" 1 => "T. Berghmans" 2 => "E. Markiewicz" 3 => "M. Hardy" 4 => "N. Nayer" 5 => "M. Paesmans" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Buon" "fecha" => "2011" "volumen" => "16" "paginaInicial" => "160" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21674869" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "The Acute Respiratory Distress Syndrome Network: ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome" ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200005043421801" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2000" "volumen" => "342" "paginaInicial" => "1301" "paginaFinal" => "1308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10793162" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome in noninvasively ventilated patients with acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.O. Depuydt" 1 => "D.D. Benoit" 2 => "K.H. Vanderwoude" 3 => "J.M. Decruyenaere" 4 => "F.A. Colardyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.126.4.1299" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2004" "volumen" => "126" "paginaInicial" => "1299" "paginaFinal" => "1306" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15486396" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Adda" 1 => "I. Coquet" 2 => "M. Darmon" 3 => "G. Thiery" 4 => "B. Schlemmer" 5 => "E. Azoulay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e31818699f6" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2008" "volumen" => "36" "paginaInicial" => "2766" "paginaFinal" => "2772" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18766110" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Sztrymf" 1 => "J. Messika" 2 => "F. Bertrand" 3 => "D. Hurel" 4 => "R. Leon" 5 => "D. Dreyfuss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-011-2354-6" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1780" "paginaFinal" => "1786" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21946925" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Humidified high-flow nasal oxygen utilization in patients with cancer at Memorial Sloan-Kettering Cancer Center" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.S. Epstein" 1 => "S.K. Hartridge-Lambert" 2 => "J.S. Ramaker" 3 => "L.P. Voigt" 4 => "C.S. Portlock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/jpm.2011.0005" "Revista" => array:6 [ "tituloSerie" => "J Palliat Med" "fecha" => "2011" "volumen" => "14" "paginaInicial" => "835" "paginaFinal" => "839" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21599530" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Darmon" 1 => "E. Azoulay" 2 => "C. Alberti" 3 => "F. Fieux" 4 => "D. Moreau" 5 => "J.R. Le Gall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-002-1528-7" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "1775" "paginaFinal" => "1780" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12447522" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.Y. Khassawneh" 1 => "P. White Jr." 2 => "A.J. Anaissie" 3 => "B. Barlogie" 4 => "F.C. Hiller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "121" "paginaInicial" => "185" "paginaFinal" => "188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11796449" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting hospital mortality in critically ill cancer patients according to acute kidney injury severity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.B. Libório" 1 => "K.L. Abreu" 2 => "G.B. Silva Jr." 3 => "R.S. Lima" 4 => "A.G. Barreto" 5 => "O.A. Barbosa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000329042" "Revista" => array:6 [ "tituloSerie" => "Oncology" "fecha" => "2011" "volumen" => "80" "paginaInicial" => "160" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21677465" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care unit support and Acute Physiology and Chronic Health Evaluation III performance in hematopoietic stem cell transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Afessa" 1 => "A. Tefferi" 2 => "W.F. Dunn" 3 => "M.R. Litzow" 4 => "S.G. Peters" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000065761.51367.2D" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2003" "volumen" => "31" "paginaInicial" => "1715" "paginaFinal" => "1721" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12794410" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The ICU Trial: a new admission policy for cancer patients requiring mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Lecuyer" 1 => "S. Chevret" 2 => "G. Thiery" 3 => "M. Darmon" 4 => "B. Schlemmer" 5 => "E. Azoulay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000256846.27192.7A" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2007" "volumen" => "35" "paginaInicial" => "808" "paginaFinal" => "814" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17235261" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severity-of-illness scores for neutropenic patients in an intensive care unit: which is the best predictor? Do multiple assessment times improve the predictive value?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Guiguet" 1 => "F. Blot" 2 => "B. Escudier" 3 => "S. Antoun" 4 => "B. Leclerq" 5 => "G. Niteberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "1998" "volumen" => "26" "paginaInicial" => "488" "paginaFinal" => "493" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9504577" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognosis of hematologic malignancies does not predict intensive care unit mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.B. Massion" 1 => "A.M. Dive" 2 => "C. Doyen" 3 => "P. Bulpa" 4 => "J. Jamart" 5 => "A. Bosly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000030456.11264.EF" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2002" "volumen" => "30" "paginaInicial" => "2260" "paginaFinal" => "2270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12394954" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Six-month prognosis of patients with lung cancer admitted to the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Roques" 1 => "A. Parrot" 2 => "A. Lavole" 3 => "P.Y. Ancel" 4 => "V. Gounant" 5 => "M. Djibre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-009-1625-y" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2009" "volumen" => "35" "paginaInicial" => "2044" "paginaFinal" => "2050" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19768453" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care outcomes among patients with lung cancer in the surveillance: epidemiology, and end results-medicare registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.G. Slatore" 1 => "L.M. Cecere" 2 => "J.L. Letourneau" 3 => "M.E. O’Neil" 4 => "J.P. Duckart" 5 => "R.S. Wiener" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2011.40.0846" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "1686" "paginaFinal" => "1691" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22473159" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term outcomes and quality of life in critically patients with haematological or solid malignancies: a single center study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.G. Oeyen" 1 => "D.D. Benoit" 2 => "L. Annemans" 3 => "P.O. Depuydt" 4 => "S.J. Van Belle" 5 => "R.I. Troisi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-012-2791-x" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2013" "volumen" => "39" "paginaInicial" => "889" "paginaFinal" => "898" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23248039" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Soares" 1 => "P. Caruso" 2 => "E. Silva" 3 => "J.M. Teles" 4 => "S.M. Lobo" 5 => "G. Friedman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3181c0349e" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2010" "volumen" => "38" "paginaInicial" => "9" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19829101" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome and predictors of mortality in patients requiring invasive mechanical ventilation due to acute respiratory failure while undergoing ambulatory chemotherapy for solid cancers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.Y. Park" 1 => "S.Y. Lim" 2 => "S.W. Um" 3 => "W.J. Koh" 4 => "M.P. Chung" 5 => "H. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00520-012-1709-z" "Revista" => array:6 [ "tituloSerie" => "Support Care Cancer" "fecha" => "2013" "volumen" => "21" "paginaInicial" => "1647" "paginaFinal" => "1653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23314602" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of acute respiratory distress syndrome (ARDS) in elderly patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.R. Eachempati" 1 => "L.J. Hydo" 2 => "J. Shou" 3 => "P.S. Barie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0b013e3180eea5a1" "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "2007" "volumen" => "63" "paginaInicial" => "344" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17693834" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Decreasing frequency but worsening mortality of acute respiratory failure secondary to AIDS-related Pneumocystis carinii pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.H. Hawley" 1 => "J.J. Ronco" 2 => "S.A. Guillemi" 3 => "J. Quieffin" 4 => "J.A. Russell" 5 => "L.M. Lawson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1994" "volumen" => "106" "paginaInicial" => "1456" "paginaFinal" => "1459" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7956401" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of older patients receiving mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Esteban" 1 => "A. Anzueto" 2 => "F. Frutos-Vivar" 3 => "I. Alia" 4 => "E.W. Ely" 5 => "L. 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Special article

Patients with cancer in the intensive monitoring unit. New perspectives

El paciente con cáncer en la unidad de vigilancia intensiva. Nuevas perspectivas

I. Prieto del Portilloa,

Corresponding author

iprieto.hrc@salud.madrid.org

Corresponding author.

, M. Polo Zarzuelab, I. Pujol Varelac

a Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, Spain

b Servicio de Hematología, Hospital Clínico San Carlos, Madrid, Spain

c Servicio de Medicina Intensiva, Hospital MD Anderson, Madrid, Spain

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From the intensive care point of view&#44; the proper and early treatment of patients with sepsis &#40;code sepsis&#41;&#44; replacement therapies for organ failures&#44; progress in prevention measures for nosocomial infection in critical patients&#44; better management of sedoanalgesia and developments in ventilatory support &#40;such as noninvasive mechanical ventilation and the optimization of &#8220;weaning&#8221;&#41; have increased life expectancy in this group of patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Currently&#44; 15&#37; of patients admitted to European ICUs are POHD&#44; especially patients with solid neoplasms and who undergo some type of surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the following review&#44; we will attempt to answer the following questions that arise when POHD require critical care&#44; and to provide a current overview of critical care for these patients in an attempt to improve its focus&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Should we limit admission of POHD to the ICU&#63;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0030" class="elsevierStylePara elsevierViewall">What does mechanical ventilation provide us&#63;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">What prognostic markers are of use&#63;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Does ICU mortality depend on the prognosis of the neoplastic disease&#63; What is the quality of life of POHD after hospital discharge&#63;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">What is an ICU test&#63; Under what circumstances should the test be applied&#63;</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Should we limit the admission of POHD to the ICU&#63;</span><p id="par0050" class="elsevierStylePara elsevierViewall">The prioritization model is the most frequently used system to decide whether a patient should be admitted to the ICU&#44; defining an order starting from patients who will most benefit from admission &#40;priority 1&#41; to those who will not benefit in any case &#40;priority 4&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> For many years&#44; POHD have been considered as belonging to priority 3 and 4 groups within this assessment system&#46; As we will discuss in the following article&#44; a large portion of patients with neoplasms should be considered priority 1&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The objective of admitting patients to an ICU is to improve their life expectancy&#44; while not taking measures that entail a significant reduction in their quality of life after their hospital discharge&#46; This last constraint has been and is still an argument used in many centers for not admitting POHD to the ICU&#44; despite the weak scientific evidence supporting that argument in most cases&#46; It is therefore important that we consider the various aspects that could help us in making decisions that are always difficult&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The main reason POHD might require intensive care&#44; excluding elective surgery&#44; is infectious complications&#46; More than half of those admitted are hospitalized for this reason&#46; In general&#44; these infections occur in the context of immunosuppression due to various causes&#46; The understanding of these infections and the appropriate antimicrobial approach are essential factors that determine patient outcomes&#46; Acute respiratory failure and severe sepsis are present in more than 80&#37; of patients who require hospitalization for medical reasons&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The need for IMV significantly worsens the prognosis of critically ill patients&#44; especially in the case of POHD&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;8</span></a> In any case&#44; we should point out several issues&#46; First&#44; hospital mortality associated with IMV for POHD is between 60&#37; and 80&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> Although high&#44; this does not change the fact that 1 of every 4 patients can benefit from admission to the ICU&#46; Second&#44; we should be able to individualize each case&#46; POHD cover a heterogeneous group of diseases and evolutionary stages&#44; which makes a universal assessment impossible&#46; More studies are probably necessary on specific subgroups of patients with cancer&#44; such as patients with acute myeloblastic leukemia in first-line treatment or patients with differing stages of lung cancer&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Patients who undergo allogeneic hematopoietic progenitor cell transplantation &#40;HPT&#41; with severe graft-versus-host disease &#40;GVHD&#41; have a hospital mortality greater than 80&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> The mortality of a complication that requires intensive care and IMV in the midst of severe GVHD approaches 100&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Patients with solid tumors have better prognoses&#46; If the cancer is not in progression&#44; the IMV-related mortality is approximately 60&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> For patient group with solid tumors&#44; the prognosis worsens if the tumor originates in the lungs&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Recent studies<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> suggest that early admission to the ICU of POHD is associated with reduced hospital mortality&#44; which highlights the importance of early diagnosis and treatment in the ICU&#46; Similarly&#44; a delay in admission to the ICU of POHD with acute respiratory failure is significantly associated with an increased mortality at 28 days&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">With the current evidence&#44; there are no good reasons to not recommend ICU admission for POHD that cannot be extrapolated to other types of patients &#40;those with cachexia&#44; who are bedridden&#44; have a poor vital prognosis of the underlying disease or who refuse treatment&#41;&#46; It is recommended that criteria for action in the ICU be established&#44; criteria that limit the therapeutic effort according to the patient&#39;s evolution during the first 3&#8211;5 days of hospitalization &#40;ICU test&#41;&#44; as we will see later in this article&#46; Admission to the ICU should not be delayed and should be implemented without reducing any of the necessary measures for causal treatment and respiratory and hemodynamic stabilization&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">What does mechanical ventilation provide&#63;</span><p id="par0085" class="elsevierStylePara elsevierViewall">There have been 2 notable developments in the field of mechanical ventilation&#46; The first was the emergence of noninvasive mechanical ventilation &#40;NIMV&#41;&#44; and the second was the use of respiratory strategies based on low tidal volume and low pressure &#40;protective ventilation&#41;&#46; These events have likely played a role in the reduction of mortality in acute lung damage that requires admission to the ICU&#44; a condition that includes POHD&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Mechanical ventilation &#40;MV&#41; that requires endotracheal intubation &#40;ETI&#41; is associated with numerous complications&#44; particularly with these patients&#46; NIMV significantly decreases the need for ETI and IMV in patients with cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> In recent years&#44; a significant increase has been observed in the survival of immunocompromised patients with acute respiratory failure &#40;ARF&#41; and who require MV with the use of NIMV&#46; Azoulay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> measured a 44&#37; mortality rate for patients with cancer connected to NIMV in the ICU compared with 71&#37; for patients who required IMV&#46; The authors<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> corroborated these results in a 2004 study that revealed a mortality rate of 48&#37; &#40;NIMV&#41; versus 75&#37; &#40;IMV&#41;&#46; Furthermore&#44; the authors described the need for IMV after failure of NIMV and the late failure of NIMV as variables related to mortality&#46; Hilbert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> observed a 53&#37; hospital mortality rate for POHD and neutropenia in whom NIMV was started early compared with 93&#37; for patients who required IMV&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">NIMV improves survival for POHD who do not subsequently require IMV&#59; however&#44; NIMV likely worsens survival<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> if IMV is used after the failure of NIMV&#46; Therefore&#44; deciding the initial type of respiratory support is especially important&#46; Each case should be evaluated individually&#44; avoiding generalizations and&#44; assuming the treatment starts with NIMV&#44; performing a careful surveillance of the technique&#39;s effectiveness parameters &#40;respiratory frequency&#44; arterial oxygen saturation&#44; arterial pressure of carbon dioxide&#44; respiratory effort&#44; etc&#46;&#41; to avoid delaying IMV if it is necessary&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The mechanisms that make NIMV beneficial include the effects of positive end-expiratory pressure &#40;PEEP&#41; in alveolar recruitment&#44; in the treatment of microatelectasis and in the redistribution of extravascular lung water and the effects of pressure support in reducing the respiratory effort&#44; improving the efficacy of respiratory muscles and maintaining an appropriate tidal volume&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The reduced mortality observed using protective lung ventilation with low tidal volumes<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> in patients with acute respiratory distress syndrome &#40;ARDS&#41; can also be applied to POHD with the same expectation of benefit&#46; Ventilator-induced lung damage is mainly due to the overdistension and opening&#8211;closing of alveolar units&#46; The prevention of this damage using strategies such as low tidal volume&#44; permissive hypercapnia and PEEP optimization represents notable progress in improving the prognosis of POHD with ARF connected to IMV&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Over the last 10 years&#44; there has been a significant reduction in mortality for patients with cancer in connection with both IMV and NIMV&#46; This fact prompts us to indicate one or other type of ventilation in patients with cancer in the ICU&#46; We should not ignore the fact that NIMV also has significant adverse effects&#44; especially for patients with ARDS&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> and that several studies have shown that patients with cancer who require MV and are intubated in the first 24<span class="elsevierStyleHsp" style=""></span>h of admission to the ICU have greater survival compared with those who are intubated later&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;20&#44;23</span></a> Adda et al&#46; found that half of POHD admitted to the ICU with ARF benefit from NIMV and do not require IMV during their stay in the ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> When differentiating between these patients and those who will need IMV&#44; the authors reported that the predictors of poor prognosis with NIMV were ARDS&#44; multiple organ failure and high respiratory rates&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">High-flow oxygen therapy administered with a humidification system by nasal cannula is very well tolerated by patients&#44; significantly decreases dyspnea and the respiratory rate and increases the arterial oxygen pressure&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> Although there are no controlled studies that show that this therapy reduces the use of ETI and connections to IMV&#44; high-flow oxygen therapy is comfortable for the patient&#44; decreases the respiratory effort and has encouraging results&#44; especially for POHD&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">What prognostic markers are of use&#63;</span><p id="par0120" class="elsevierStylePara elsevierViewall">The classical prognostic scores for mortality in POHD should be applied with caution given their tendency to underestimate the actual mortality of these patients&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Neutropenia has for years been considered an indication of poor prognosis for critically ill patients&#44; especially those connected to MV&#46; Furthermore&#44; prolonged neutropenia is considered to have an ominous prognosis&#46; However&#44; various studies have questioned its credibility&#46; Kress et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> assessed the prognoses of 348 POHD who required admission to the ICU and found no relationship between neutropenia and mortality in any of the analyzed subgroups&#46; Darmon et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> in a retrospective study of 102 patients with neutropenia admitted to the ICU&#44; found no relationship between the duration of the neutropenia and mortality at 30 days from admission&#46; Azoulay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> also found no relationship between neutropenia and the prognosis of patients with solid tumors admitted to the ICU&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In studies specifically performed on patients with cancer who require a stay in the ICU&#44; the predictors of mortality described were&#44; in most cases&#44; similar to those of patients without cancer&#58; multiple-organ failure&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8&#44;10&#44;27&#44;28</span></a> mechanical ventilation&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> the need for vasoactive support<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> or renal replacement techniques&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> functional state prior to admission and being elderly&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;27</span></a> Other predictors&#44; in contrast&#44; are specific to this type of patient&#58; progression or recurrence of the oncologic disease&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> allogeneic HPT<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;29</span></a> and lung or tracheal disorder of tumoral origin&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In general&#44; the mortality of POHD in the ICU is associated with the number of dysfunctional organs &#40;especially if there are more than 3&#41;&#44; the need for INMV and the need for renal replacement techniques&#46; Although these factors coincide with those of the general population&#44; the associated mortality is significantly greater&#46; These factors should therefore be especially considered when making decisions related to limiting the therapeutic effort&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Does ICU mortality depend on the prognosis of the neoplastic disease&#63; What is the quality of life of POHD after hospital discharge&#63;</span><p id="par0140" class="elsevierStylePara elsevierViewall">There is an open debate on the indication for admitting POHD to the ICU with poor prognoses for their underlying disease&#46; Although various clinical criteria have been used to differentiate between those who can and those who cannot benefit from their admission to the ICU&#44;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a> there are no tested guidelines&#44; and the cancer prognosis has not been reliably correlated to ICU morbidity and mortality&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Massion et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> found no relationship between the prognosis of hematologic disease and ICU and hospital mortality&#46; The short-term prognosis of these patients is correlated to the degree of multiple organ failure during the first 5 days of stay in the ICU&#46; Azoulay et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in a study performed on patients with solid tumors who required a stay in the ICU&#44; did not consider the presence of metastases or the degree of progression of the oncologic disease to be determinants in the prognosis&#46; However&#44; the authors did argue that the need for vasopressor treatment and the degree of multiple organ failure were determinants in the prognosis&#46; Staudinger et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> also found no relationship between the underlying disease and the prognosis in the ICU&#44; although the patients with HPT had a significantly higher mortality&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The tumor origin and histological type are also not related to the prognosis in the ICU&#46; In some cases&#44; as with lung cancer and especially in advanced stages &#40;IIIb&#8211;IV&#41;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;34</span></a> or for allogeneic HPT and severe GVHD&#44; the need for IMV is associated with a mortality rate above 90&#37;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Overall&#44; we should consider the prognosis of POHD in the ICU regardless of the origin and extent of their cancer&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Despite the nonassociation between the tumor prognosis and the ICU prognosis&#44; patients with cancer and especially those with hematologic malignancies have a poorer ICU prognosis than those patients with no cancer but similar severity scores&#46; This is mainly due to the functional and nutritional state prior to admission<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;35</span></a> and to the immunosuppression associated with the disease and its treatment&#46; In the case of solid tumors&#44; the short-term prognoses could be superimposed on those of patients without cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Neither neutropenia nor the underlying cancer predicts the ICU prognosis of POHD&#46; These conditions should therefore not be taken into account as admission criteria or as factors for limiting the therapeutic effort&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">After the hospital discharge&#44; the quality of life of patients with cancer is significantly poorer than that of the general population&#44; both at 3 months and at 12 months of the hospital discharge&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> a situation that is especially evident in POHD&#46; Advanced age&#44; a poor functional state prior to ICU admission and a greater degree of multiple organ failure during the ICU stay are other independent predictors of a worse quality of life&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">What is an ICU test&#63; Under what circumstances should the test be applied&#63;</span><p id="par0175" class="elsevierStylePara elsevierViewall">A large POHD group can raise questions when determining their need for ICU admission&#44; even more so when the available data are insufficient to guide even a short-term prognosis&#46; Lecuyer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> in a study that excluded patients with allogeneic HPT&#44; found no statistically significant variable for ICU admission that differentiated survivors and nonsurvivors&#46; After the first 72<span class="elsevierStyleHsp" style=""></span>h of treatment in the ICU without restrictions&#44; patients who ultimately did not survive had significantly greater multiple organ dysfunction than the survivors&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">We recommend establishing an individual strategy for selecting patients with cancer for ICU admission to avoid suboptimal treatments and nonbeneficial admissions&#46; Bedridden patients&#44; those in palliative treatment and those with short life expectancies &#40;less than 6 months&#41; are not recommended for admission&#44; while recently diagnosed patients&#44; those in first-line treatment&#44; those with tumor lysis syndrome or hypercalcemia should not have restrictions in their management&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">For the broad group of patients who raise questions in terms of the approach to take &#40;allogeneic HPT with GVHD&#44; advanced stages&#44; second or third-line treatments&#44; etc&#46;&#41;&#44; it is advisable to perform an ICU test&#44; by which we mean ICU admission without therapeutic restrictions&#44; for at least 72<span class="elsevierStyleHsp" style=""></span>hours&#44; with continuous assessment of organ failure &#40;e&#46;g&#46;&#44; sepsis related organ failure assessment&#41;&#46; If&#44; after this time&#44; the patient presents failure of 3 or more organs or worsening of prior multiple organ failure&#44; then the life expectancy is minimal&#46; Measures to restrict the therapeutic effort should then be implemented&#46; If however the patient shows improvement in terms of organ failure&#44; treatment in the ICU should continue without limitations&#46; A number of POHD subgroups&#44; such as those with advanced stages of lung cancer&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;42</span></a> those with allogeneic HPT with severe GVHD<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> or elderly patients&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> have very poor prognoses&#44; in the event IMV is required&#46; It is therefore recommended that this support measure be excluded from the ICU test&#44; as proposed in our decision algorithm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">1&#46;</span><p id="par0195" class="elsevierStylePara elsevierViewall">We should not deny admission to the ICU for POHD due to the type and prognosis of the cancer &#40;except in extreme in cases&#41;&#44; that is&#44; those with a survival prognosis of less than 6 months&#46; This would also be a limiting factor for numerous other diseases&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">2&#46;</span><p id="par0200" class="elsevierStylePara elsevierViewall">The early implementation of resuscitation measures and life support&#44; including NIMV&#44; is associated with a significant reduction in mortality&#46; Time is precious&#44; especially for POHD who have a lower or greater degree of immunosuppression&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">3&#46;</span><p id="par0205" class="elsevierStylePara elsevierViewall">The main predictor of mortality is the degree of multiple organ failure and&#44; especially&#44; its evolution during the first days of admission to the ICU&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">4&#46;</span><p id="par0210" class="elsevierStylePara elsevierViewall">In general&#44; the cancer prognosis is independent of the ICU prognosis and should therefore be a secondary determinant in the assessment of a large portion of patients&#46; Although the prognosis for POHD in ICU &#40;except for elective surgery&#41; is not good&#44; it is comparable or better than for other diseases that require ICU admission and are not subject to so much debate&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#8211;39</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">5&#46;</span><p id="par0215" class="elsevierStylePara elsevierViewall">In cases where there are questions&#44; it is recommended that an ICU test be performed for 3&#8211;6 days and that the decision to continue with the adopted support measures be made following the evolution of the multiple organ failure&#44; the prognostic factor that has been shown to be a better determinant of ICU mortality for POHD&#46;</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Should we limit the admission of POHD to the ICU&#63;"
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          "titulo" => "What does mechanical ventilation provide&#63;"
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          "titulo" => "What prognostic markers are of use&#63;"
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          "titulo" => "Does ICU mortality depend on the prognosis of the neoplastic disease&#63; What is the quality of life of POHD after hospital discharge&#63;"
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          "titulo" => "What is an ICU test&#63; Under what circumstances should the test be applied&#63;"
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          "titulo" => "Conclusions"
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    "fechaRecibido" => "2013-10-28"
    "fechaAceptado" => "2014-03-10"
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            0 => "Cancer"
            1 => "Mechanical ventilation"
            2 => "Intensive care units test"
            3 => "Organ failure"
            4 => "Neutropenia"
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            0 => "C&#225;ncer"
            1 => "Ventilaci&#243;n mec&#225;nica"
            2 => "Test de Unidad de Cuidados Intensivos"
            3 => "Fallo org&#225;nico"
            4 => "Neutropenia"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In recent years&#44; there has been a significant improvement in the survival of patients with cancer in intensive care units &#40;ICUs&#41;&#46; Advances in medical and surgical treatments and better selection of patients have helped improve the life expectancy of such type of patients&#46; An appropriate and early resuscitation in the ICU&#44; without initial limitations on the life support techniques&#44; has been shown to also decrease the mortality of patients with cancer&#46; At present&#44; we should not deny admission to the ICU based only on the underlying neoplastic disease&#46; However&#44; the mortality rate for patients with cancer in the ICU&#44; especially those with hematologic disease&#44; remains high&#46; In some cases&#44; an ICU admission test &#40;ICU test&#41; is required for at least 3 days to identify patients who can benefit from intensive treatment&#46; We would like to propose a decision algorithm for ICU admission that will help in making decisions in an often complex situation&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Durante los &#250;ltimos a&#241;os&#44; se ha evidenciado una mejor&#237;a significativa en la supervivencia de los pacientes con c&#225;ncer en las unidades de cuidados intensivos &#40;UCI&#41;&#46; Tanto el avance en el tratamiento m&#233;dico y quir&#250;rgico&#44; como una mejor selecci&#243;n de pacientes&#44; han influido en la mejor&#237;a de las expectativas vitales de estos enfermos&#46; En la UCI una resucitaci&#243;n adecuada y precoz&#44; sin limitaciones iniciales a t&#233;cnicas de soporte vital&#44; ha demostrado disminuir tambi&#233;n la mortalidad en los pacientes con c&#225;ncer&#46; Actualmente&#44; no debemos denegar el ingreso en UCI solo por la enfermedad neopl&#225;sica de base&#46; Aun as&#237;&#44; la mortalidad del paciente con c&#225;ncer en la UCI&#44; especialmente el hematol&#243;gico&#44; sigue siendo alta y en algunos casos es necesario realizar una prueba de ingreso en UCI &#40;test de UCI&#41; de&#44; al menos&#44; 3 d&#237;as para diferenciar a los pacientes que se est&#233;n beneficiando de un tratamiento intensivo&#46; Proponemos un algoritmo de decisi&#243;n al ingreso en la UCI que nos ayude en una situaci&#243;n&#44; a veces&#44; compleja&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Prieto del Portillo I&#44; Polo Zarzuela M&#44; Pujol Varela I&#46; El paciente con c&#225;ncer en la unidad de vigilancia intensiva&#46;Rev Clin Esp&#46; 2014&#59;214&#58;403&#8211;409&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intensive care unit decision algorithm&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleBold">Priority 1&#58;</span> Patients who are gravely ill&#44; unstable&#44; who require monitoring and treatment that cannot be provided outside of the ICU&#46; There are no initial limits on the duration or type of therapy they require&#46; This category can include patients with septic shock with no prior disease&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Priority 2&#58;</span> Patients who require surveillance and monitoring measures specific to the ICU and who might require immediate intervention&#46; This category includes&#44; for example&#44; patients with respiratory failure who might require mechanical ventilation&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Priority 3&#58;</span> Patients who&#44; due to their underlying disease or acute disease&#44; have little chance of recovery&#46; Although treatment is initiated in the ICU&#44; measures can be established to restrict the therapeutic effort over the course of their evolution&#46; Patients with chronic exacerbated respiratory diseases and limited quality of life are an example of this category&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Priority 4&#58;</span> Patients for whom ICU admission is considered inappropriate&#44; either due to end-stage or irreversible diseases &#40;too ill to benefit from the ICU&#41; or for not requiring any of the measures intrinsic to the ICU &#40;too healthy to benefit from the ICU&#41;&#46;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Levels of prioritization&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Critical care management of cancer patients&#58; cause for optimism and need for objectivity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Darmon"
                            1 => "E&#46; Azoulay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCO.0b013e32832b68b6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Oncol"
                        "fecha" => "2009"
                        "volumen" => "21"
                        "paginaInicial" => "318"
                        "paginaFinal" => "326"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19436200"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics and outcomes of cancer patients in European ICUs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46;S&#46; Taccone"
                            1 => "A&#46;A&#46; Artigas"
                            2 => "C&#46;L&#46; Sprung"
                            3 => "R&#46; Moreno"
                            4 => "Y&#46; Sakr"
                            5 => "J&#46;L&#46; Vincent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc7713"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2009"
                        "volumen" => "13"
                        "paginaInicial" => "R15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19200368"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for intensive care unit admission&#44; discharge and triage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Task Force of the American College of Critical Care Medicine&#46; Society of Critical Care Medicine"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "27"
                        "paginaInicial" => "633"
                        "paginaFinal" => "638"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10199547"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Darmon"
                            1 => "G&#46; Thiery"
                            2 => "M&#46; Ciroldi"
                            3 => "S&#46; de Miranda"
                            4 => "L&#46; Galicier"
                            5 => "E&#46; Raffoux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "248"
                        "paginaInicial" => "8"
                        "paginaFinal" => "93"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Staudinger"
                            1 => "B&#46; Stoiser"
                            2 => "M&#46; M&#252;llner"
                            3 => "G&#46;J&#46; Locker"
                            4 => "K&#46; Laczika"
                            5 => "S&#46; Knapp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "28"
                        "paginaInicial" => "1322"
                        "paginaFinal" => "1328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10834673"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of short-term mortality in critically ill patients with solid malignancies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Azoulay"
                            1 => "D&#46; Moreau"
                            2 => "C&#46; Alberti"
                            3 => "G&#46; Leleu"
                            4 => "C&#46; Adrie"
                            5 => "M&#46; Barboteau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2000"
                        "volumen" => "26"
                        "paginaInicial" => "1817"
                        "paginaFinal" => "1823"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11271090"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome and prognostic factors of hematopoietic stem cell transplantation recipients admitted to a medical ICU"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;O&#46; Soubani"
                            1 => "E&#46; Kseibi"
                            2 => "J&#46;J&#46; Bander"
                            3 => "J&#46;L&#46; Klein"
                            4 => "G&#46; Khanchandani"
                            5 => "H&#46;P&#46; Ahmed"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.126.5.1604"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2004"
                        "volumen" => "126"
                        "paginaInicial" => "1604"
                        "paginaFinal" => "1611"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15539734"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of critically ill cancer patients in a university hospital setting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;P&#46; Kress"
                            1 => "J&#46; Christenson"
                            2 => "A&#46;S&#46; Pohlman"
                            3 => "D&#46;R&#46; Linkin"
                            4 => "J&#46;B&#46; Hall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.160.6.9812055"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "160"
                        "paginaInicial" => "1957"
                        "paginaFinal" => "1961"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10588613"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome for cancer patients requiring mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Groeger"
                            1 => "P&#46; White Jr&#46;"
                            2 => "D&#46;M&#46; Nierman"
                            3 => "J&#46; Glassman"
                            4 => "W&#46; Shi"
                            5 => "D&#46; Horak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/jco.1999.17.3.991"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "1999"
                        "volumen" => "17"
                        "paginaInicial" => "991"
                        "paginaFinal" => "997"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10071294"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for &#62;24<span class="elsevierStyleHsp" style=""></span>hrs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Soares"
                            1 => "J&#46;I&#46; Salluh"
                            2 => "N&#46; Spector"
                            3 => "J&#46;R&#46; Rocco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "33"
                        "paginaInicial" => "520"
                        "paginaFinal" => "526"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15753742"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients&#58; a reappraisal of indications for organ failure supports"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Pene"
                            1 => "C&#46; Aubron"
                            2 => "E&#46; Azoulay"
                            3 => "F&#46; Blot"
                            4 => "G&#46; Thiery"
                            5 => "B&#46; Raynard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Oncol Pract"
                        "fecha" => "2006"
                        "volumen" => "24"
                        "paginaInicial" => "643"
                        "paginaFinal" => "649"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome of bone marrow transplantation patients requiring mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Huaringa"
                            1 => "F&#46;J&#46; Leyva"
                            2 => "S&#46;A&#46; Giralt"
                            3 => "J&#46; Blanco"
                            4 => "J&#46; Signes-Costa"
                            5 => "H&#46; Velarde"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "28"
                        "paginaInicial" => "1014"
                        "paginaFinal" => "1017"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10809275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis of lung cancer patients with life-threatening complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Soares"
                            1 => "M&#46; Darmon"
                            2 => "J&#46;I&#46; Salluh"
                            3 => "C&#46;G&#46; Ferreira"
                            4 => "G&#46; Thiery"
                            5 => "B&#46; Schlemmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.06-2244"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2007"
                        "volumen" => "131"
                        "paginaInicial" => "840"
                        "paginaFinal" => "846"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17356101"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome and code status of lung cancer patients admitted to the medical ICU"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;A&#46; Reichner"
                            1 => "J&#46;A&#46; Thompson"
                            2 => "S&#46; O&#8217;Brien"
                            3 => "T&#46; Kuru"
                            4 => "E&#46;D&#46; Anderson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.130.3.719"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2006"
                        "volumen" => "130"
                        "paginaInicial" => "719"
                        "paginaFinal" => "723"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16963668"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;U&#46; Song"
                            1 => "G&#46;Y&#46; Suh"
                            2 => "H&#46;Y&#46; Park"
                            3 => "S&#46;Y&#46; Lim"
                            4 => "S&#46;G&#46; Han"
                            5 => "Y&#46;R&#46; Kang"
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                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2594-0"
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                        "tituloSerie" => "Intensive Care Med"
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                        "paginaFinal" => "1513"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22592633"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Continued survival gains in recent years among critically ill myeloma patients"
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                          "autores" => array:6 [
                            0 => "V&#46; Peigne"
                            1 => "K&#46; Rusinov&#225;"
                            2 => "L&#46; Karlin"
                            3 => "M&#46; Darmon"
                            4 => "J&#46;P&#46; Fermand"
                            5 => "B&#46; Schlemmer"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-008-1320-4"
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                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2009"
                        "volumen" => "35"
                        "paginaInicial" => "512"
                        "paginaFinal" => "516"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18853139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Mokart"
                            1 => "J&#46; Lambert"
                            2 => "D&#46; Schnell"
                            3 => "L&#46; Fouch&#233;"
                            4 => "A&#46; Rabbat"
                            5 => "A&#46; Kouatchet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/10428194.2012.753446"
                      "Revista" => array:6 [
                        "tituloSerie" => "Leuk Lymphoma"
                        "fecha" => "2013"
                        "volumen" => "54"
                        "paginaInicial" => "1724"
                        "paginaFinal" => "1729"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23185988"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved survival in cancer patients requiring mechanical ventilatory support&#58; impact of noninvasive mechanical ventilatory support"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Azoulay"
                            1 => "C&#46; Alberti"
                            2 => "C&#46; Bornstain"
                            3 => "G&#46; Leleu"
                            4 => "D&#46; Moreau"
                            5 => "C&#46; Recher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2001"
                        "volumen" => "29"
                        "paginaInicial" => "519"
                        "paginaFinal" => "525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11373414"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates&#44; fever&#44; and acute respiratory failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Hilbert"
                            1 => "D&#46; Gruson"
                            2 => "F&#46; Vargas"
                            3 => "R&#46; Valentino"
                            4 => "G&#46; Gbikpi-Benissan"
                            5 => "M&#46; Dupon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200102153440703"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2001"
                        "volumen" => "344"
                        "paginaInicial" => "481"
                        "paginaFinal" => "487"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172189"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prognosis of acute respiratory failure in critically ill cancer patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Azoulay"
                            1 => "G&#46; Thiery"
                            2 => "S&#46; Chevret"
                            3 => "D&#46; Moreau"
                            4 => "M&#46; Darmon"
                            5 => "A&#46; Bergeron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Medicine &#40;Baltimore&#41;"
                        "fecha" => "2004"
                        "volumen" => "83"
                        "paginaInicial" => "360"
                        "paginaFinal" => "370"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Invasive mechanical ventilation in cancer patients&#46; Prior non invasive ventilation is a poor prognostic factor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;P&#46; Meert"
                            1 => "T&#46; Berghmans"
                            2 => "E&#46; Markiewicz"
                            3 => "M&#46; Hardy"
                            4 => "N&#46; Nayer"
                            5 => "M&#46; Paesmans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Buon"
                        "fecha" => "2011"
                        "volumen" => "16"
                        "paginaInicial" => "160"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21674869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "The Acute Respiratory Distress Syndrome Network&#58; ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome"
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200005043421801"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2000"
                        "volumen" => "342"
                        "paginaInicial" => "1301"
                        "paginaFinal" => "1308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10793162"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome in noninvasively ventilated patients with acute respiratory failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;O&#46; Depuydt"
                            1 => "D&#46;D&#46; Benoit"
                            2 => "K&#46;H&#46; Vanderwoude"
                            3 => "J&#46;M&#46; Decruyenaere"
                            4 => "F&#46;A&#46; Colardyn"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.126.4.1299"
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                        "tituloSerie" => "Chest"
                        "fecha" => "2004"
                        "volumen" => "126"
                        "paginaInicial" => "1299"
                        "paginaFinal" => "1306"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15486396"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0120"
              "etiqueta" => "24"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "M&#46; Adda"
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                            3 => "G&#46; Thiery"
                            4 => "B&#46; Schlemmer"
                            5 => "E&#46; Azoulay"
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                      "doi" => "10.1097/CCM.0b013e31818699f6"
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                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "36"
                        "paginaInicial" => "2766"
                        "paginaFinal" => "2772"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18766110"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0125"
              "etiqueta" => "25"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beneficial effects of humidified high flow nasal oxygen in critical care patients&#58; a prospective pilot study"
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                            2 => "F&#46; Bertrand"
                            3 => "D&#46; Hurel"
                            4 => "R&#46; Leon"
                            5 => "D&#46; Dreyfuss"
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                    0 => array:2 [
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                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1780"
                        "paginaFinal" => "1786"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21946925"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0130"
              "etiqueta" => "26"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Humidified high-flow nasal oxygen utilization in patients with cancer at Memorial Sloan-Kettering Cancer Center"
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                        0 => array:2 [
                          "etal" => false
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                            1 => "S&#46;K&#46; Hartridge-Lambert"
                            2 => "J&#46;S&#46; Ramaker"
                            3 => "L&#46;P&#46; Voigt"
                            4 => "C&#46;S&#46; Portlock"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "J Palliat Med"
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                        "volumen" => "14"
                        "paginaInicial" => "835"
                        "paginaFinal" => "839"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21599530"
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients"
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                          "etal" => true
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                            5 => "J&#46;R&#46; Le Gall"
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                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "1775"
                        "paginaFinal" => "1780"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12447522"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
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              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            4 => "F&#46;C&#46; Hiller"
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Chest"
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                        "volumen" => "121"
                        "paginaInicial" => "185"
                        "paginaFinal" => "188"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11796449"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0145"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting hospital mortality in critically ill cancer patients according to acute kidney injury severity"
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                            3 => "R&#46;S&#46; Lima"
                            4 => "A&#46;G&#46; Barreto"
                            5 => "O&#46;A&#46; Barbosa"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Oncology"
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                        "volumen" => "80"
                        "paginaInicial" => "160"
                        "paginaFinal" => "166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21677465"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive care unit support and Acute Physiology and Chronic Health Evaluation III performance in hematopoietic stem cell transplant recipients"
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                            4 => "S&#46;G&#46; Peters"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000065761.51367.2D"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "31"
                        "paginaInicial" => "1715"
                        "paginaFinal" => "1721"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12794410"
                            "web" => "Medline"
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              ]
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              "identificador" => "bib0155"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The ICU Trial&#58; a new admission policy for cancer patients requiring mechanical ventilation"
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                            0 => "L&#46; Lecuyer"
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                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000256846.27192.7A"
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                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "808"
                        "paginaFinal" => "814"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17235261"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0160"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Severity-of-illness scores for neutropenic patients in an intensive care unit&#58; which is the best predictor&#63; Do multiple assessment times improve the predictive value&#63;"
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                        0 => array:2 [
                          "etal" => false
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                            4 => "B&#46; Leclerq"
                            5 => "G&#46; Niteberg"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "26"
                        "paginaInicial" => "488"
                        "paginaFinal" => "493"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9504577"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis of hematologic malignancies does not predict intensive care unit mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;B&#46; Massion"
                            1 => "A&#46;M&#46; Dive"
                            2 => "C&#46; Doyen"
                            3 => "P&#46; Bulpa"
                            4 => "J&#46; Jamart"
                            5 => "A&#46; Bosly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000030456.11264.EF"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "30"
                        "paginaInicial" => "2260"
                        "paginaFinal" => "2270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12394954"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Six-month prognosis of patients with lung cancer admitted to the intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Roques"
                            1 => "A&#46; Parrot"
                            2 => "A&#46; Lavole"
                            3 => "P&#46;Y&#46; Ancel"
                            4 => "V&#46; Gounant"
                            5 => "M&#46; Djibre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-009-1625-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2009"
                        "volumen" => "35"
                        "paginaInicial" => "2044"
                        "paginaFinal" => "2050"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19768453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive care outcomes among patients with lung cancer in the surveillance&#58; epidemiology&#44; and end results-medicare registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;G&#46; Slatore"
                            1 => "L&#46;M&#46; Cecere"
                            2 => "J&#46;L&#46; Letourneau"
                            3 => "M&#46;E&#46; O&#8217;Neil"
                            4 => "J&#46;P&#46; Duckart"
                            5 => "R&#46;S&#46; Wiener"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2011.40.0846"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "1686"
                        "paginaFinal" => "1691"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22473159"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcomes and quality of life in critically patients with haematological or solid malignancies&#58; a single center study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;G&#46; Oeyen"
                            1 => "D&#46;D&#46; Benoit"
                            2 => "L&#46; Annemans"
                            3 => "P&#46;O&#46; Depuydt"
                            4 => "S&#46;J&#46; Van Belle"
                            5 => "R&#46;I&#46; Troisi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2791-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "889"
                        "paginaFinal" => "898"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23248039"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics and outcomes of patients with cancer requiring admission to intensive care units&#58; a prospective multicenter study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Soares"
                            1 => "P&#46; Caruso"
                            2 => "E&#46; Silva"
                            3 => "J&#46;M&#46; Teles"
                            4 => "S&#46;M&#46; Lobo"
                            5 => "G&#46; Friedman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3181c0349e"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2010"
                        "volumen" => "38"
                        "paginaInicial" => "9"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19829101"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome and predictors of mortality in patients requiring invasive mechanical ventilation due to acute respiratory failure while undergoing ambulatory chemotherapy for solid cancers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;Y&#46; Park"
                            1 => "S&#46;Y&#46; Lim"
                            2 => "S&#46;W&#46; Um"
                            3 => "W&#46;J&#46; Koh"
                            4 => "M&#46;P&#46; Chung"
                            5 => "H&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00520-012-1709-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Support Care Cancer"
                        "fecha" => "2013"
                        "volumen" => "21"
                        "paginaInicial" => "1647"
                        "paginaFinal" => "1653"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23314602"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of acute respiratory distress syndrome &#40;ARDS&#41; in elderly patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;R&#46; Eachempati"
                            1 => "L&#46;J&#46; Hydo"
                            2 => "J&#46; Shou"
                            3 => "P&#46;S&#46; Barie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TA.0b013e3180eea5a1"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2007"
                        "volumen" => "63"
                        "paginaInicial" => "344"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17693834"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decreasing frequency but worsening mortality of acute respiratory failure secondary to AIDS-related <span class="elsevierStyleItalic">Pneumocystis carinii</span> pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;H&#46; Hawley"
                            1 => "J&#46;J&#46; Ronco"
                            2 => "S&#46;A&#46; Guillemi"
                            3 => "J&#46; Quieffin"
                            4 => "J&#46;A&#46; Russell"
                            5 => "L&#46;M&#46; Lawson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1994"
                        "volumen" => "106"
                        "paginaInicial" => "1456"
                        "paginaFinal" => "1459"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7956401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome of older patients receiving mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Esteban"
                            1 => "A&#46; Anzueto"
                            2 => "F&#46; Frutos-Vivar"
                            3 => "I&#46; Alia"
                            4 => "E&#46;W&#46; Ely"
                            5 => "L&#46; Brochard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-004-2160-5"
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                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "639"
                        "paginaFinal" => "646"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14991097"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective cohort study comparing sequential organ failure assessment and acute physiology&#44; age&#44; chronic health evaluation <span class="elsevierStyleSmallCaps">iii</span> scoring systems for hospital mortality prediction in critically ill cirrhotic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46;C&#46; Chen"
                            1 => "Y&#46;C&#46; Tian"
                            2 => "N&#46;J&#46; Liu"
                            3 => "Y&#46;P&#46; Ho"
                            4 => "C&#46; Yang"
                            5 => "Y&#46;Y&#46; Chu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1742-1241.2005.00634.x"
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                        "tituloSerie" => "Int J Clin Pract"
                        "fecha" => "2006"
                        "volumen" => "60"
                        "paginaInicial" => "160"
                        "paginaFinal" => "166"
                        "link" => array:1 [
                          0 => array:2 [
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Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2014.03.001

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