Immunotherapy on ICU: a narrative review.

Background: Patients with cancer account for 15% of all admissions to critical care and so an understanding of the pathophysiology and anticipated complications of specialist treatment is essential for the intensive care clinician. The development of chimeric antigen receptor T-cell therapy for haematological malignancies and immune checkpoint inhibitors for solid organ tumours has led to significant improvements in the prognosis of those patients whose tumours respond. This review is intended to provide the non-specialist with an understanding of the current concepts in pathophysiology, diagnosis and management of complications due to chimeric antigen receptor T-cell therapy and immune checkpoint inhibitors for malignant disease.

Critical care transfers and COVID-19: Managing capacity challenges through critical care networks.

The intensive care units in North West London are part of one of the oldest critical care networks in the UK, forming a mature and established strategic alliance to share resources, experience and knowledge for the benefit of its patients. North West London saw an early surge in COVID-19 admissions, which urgently threatened the capacity of some of its intensive care units even before the UK government announced lockdown. The pre-existing relationships and culture within the network allowed its members to unite and work rapidly to develop agile and innovative solutions, protecting any individual unit from becoming overwhelmed, and ultimately protecting its patients.

Learning from critical care: Improving intra- and inter-hospital transfer processes in enhanced care and the ward.

The Intensive Care Society (ICS) has recently published guidance on the transfer of critically ill adults. Since 2007, the North West London Critical Care Network has documented and audited patient transfers undertaken across 13 hospitals, and trained staff in transferring critically ill or injured patients. In 2015/16 the network introduced intra-hospital transfer documentation and applied the same transfer training and audit methodology for critically ill patients being moved within hospitals.

Opioids and cancer: friend or foe?

Purpose Of Review: Most cancer patients experience pain and many will require opioids. However, the effects of opioids on cancer progression, metastasis, and recurrence is increasingly being questioned. There is evidence that opioids affect immune system function, angiogenesis, apoptosis, and invasion in a potentially deleterious manner.

Long-term Survival for Patients Undergoing Volatile versus IV Anesthesia for Cancer Surgery: A Retrospective Analysis.

Background: Surgical resection remains the best option for long-term survival in many solid tumors. Surgery can, however, lead to tumor cell release into the circulation. Data have suggested differential effects of anesthetic agents on cancer cell growth.

Cardiopulmonary exercise testing for predicting postoperative morbidity in patients undergoing hepatic resection surgery.

Objectives: Cardiopulmonary exercise testing (CPET) may predict which patients are at risk for adverse outcomes after major abdominal surgery. The primary aim of this study was to determine whether CPET variables are predicative of morbidity.

Methods: High-risk patients undergoing elective, one-stage, open hepatic resection were preoperatively assessed using CPET.

Negotiating Transitions: Involvement of Critical Care Outreach Teams in End-of-Life Decision Making.

Background: Little research has examined the involvement of critical care outreach teams in end-of-life decision making.

Objective: To establish how much time critical care outreach teams spend with patients who are subsequently subject to limitation of medical treatment and end-of-life decisions and how much influence the teams have on those decisions.

Methods: A single-center retrospective review, with qualitative analysis, in a large cancer center.

Intensive care for the cancer patient - unique clinical and ethical challenges and outcome prediction in the critically ill cancer patient.

With the rising number of cancer cases and increasing survival times, cancer patients with critical illness are increasingly presenting to the intensive care unit. This article considers the unique challenges they pose in terms of oncological-specific disease processes and treatment and reviews current trends in outcome prediction. We also consider the ethical standpoints surrounding the treatment of patients for whom there may be no cure and their subsequent transition to palliative care, should it become necessary.