Abstract
The initial management of the hematology patient in a critical state is crucial and poses a great challenge both for the hematologist and the intensive care unit (ICU) physician. After years of clinical practice, there is still a delay in the proper recognition and treatment of critical situations, which leads to late admission to the ICU. There is a much-needed systematic ABC (Airway, Breathing, Circulation) approach for the patients being treated on the wards as well as in the high dependency units because the underlying hematological disorder, as well as disease-related complications, have an increasing frequency. Focusing on score-based decision-making on the wards (Modified Early Warning Score (MEWS), together with Quick Sofa score), active sepsis screening with inflammation markers (C-reactive protein, procalcitonin, and presepsin), and assessment of microcirculation, organ perfusion, and oxygen supply by using paraclinical parameters from the ICU setting (lactate, central venous oxygen saturation (ScVO2), and venous-to-arterial carbon dioxide difference), hematologists can manage the immediate critical patient and improve the overall outcome.
Highlights
Critically Ill Hematology PatientsThe incidence of hematological malignancies has been increasing in the last few years
For the initial clinical evaluation, the Modified Early Warning Score (MEWS) (Table 2) has been the basic algorithm, already implemented in hospitals around the world and predicts patient outcomes, including cardiac arrest, intensive care unit (ICU) transfer, and in-hospital mortality [24]
SvO2 values less than 65% to 70% under acute patient conditions should alert us to the presence of tissue hypoxia or inadequate perfusion, which is associated with increased mortality in the general critical patient population
Summary
The incidence of hematological malignancies has been increasing in the last few years. The initial management of a patient diagnosed with a hematological malignancy in critical condition is crucial and poses a great challenge both for the hematologist and the ICU physician, because of the complex nature of the disease and the vast array of complications that arise. For the initial clinical evaluation, the Modified Early Warning Score (MEWS) (Table 2) has been the basic algorithm, already implemented in hospitals around the world and predicts patient outcomes, including cardiac arrest, ICU transfer, and in-hospital mortality [24]. 3. ABCDE (Airway, Breathing, Circulation, Disability, Exposure) of the Potential Critically Ill Patient on the Ward. Physicians must use a stepwise approach to resuscitation management, as a rapid assessment of the patient and lifesaving interventions gain more time in critical situations, called ABCDE (Airway, Breathing, Circulation, Disability, Exposure) [26,27,28].
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