ICU Management & Practice, Volume 19 - Issue 3, 2019
Background
Research Groups to Gather Data and Transfer Knowledge About the Care of Cancer Patients
Current Opportunities to Transfer Knowledge About Immunocompromised Patients
The Blood Diseases In The ICU (BDI) Training Course
The GRRR-OH Basic Functioning
- Strong Clinical Skills: Every GRRR-OH member is recognised as a clinical leader for the care of critically ill immunocompromised patients, and may have expertise in a specific field of critical care. Acute respiratory failure remains the leading domain of interest. However, as the GRRR-OH grew up and evolved, themes such as acute kidney injury, sepsis, antibiotic stewardship, invasive fungal infections, and transfusion have broadened the research domains.
- Multidisciplinary Management: Our ICUs follow the model of closed ICUs, led by independent and autonomous medical teams. We have accumulated experience in severe forms of critical care illness that complicates haematological malignancies and solid tumours (e.g. leukostasis, leukaemic infiltration, tumour lysis syndrome, urgent need for chemotherapy, as well as complications of CAR-T cell therapy and immunotherapy for solid tumours). We work closely with haematologists and oncologists. By managing numerous critically ill onco-haematological patients in the ICU, we have learned how to address patient needs and provide them specialised care. A daily discussion with haematologists and oncologists is the rule for every patient. Patients and relatives are informed by the two teams and treatment plans as well as the goals of care are set up with patients and families by the two teams on a daily basis. Along this line, residents and fellows from both specialties are trained in both haematology/oncology and critical care.
- A Fine-Tuned Organisation at the St-Louis Hospital, but Multiple Leaderships: The GRRR-OH benefits from an organisation completely driven from St-Louis Hospital in Paris. All the administrative and organisational aspects are set up there. However, clinical and scientific leaderships are fairly distributed and shared across the GRRR-OH leaders. There is no doubt that our force is the sum of our expertise. For instance, each of us applies independently to various grants to fund studies, on behalf of the entire group. The GRRR-OH has a scientific advisory board, with each an expert in his own field of expertise.
- Transfer of Knowledge: The GRRR-OH is a research group that has a large interest in transferring and acquiring knowledge. Besides the training courses listed above, every day advice is sought among the GRRR-OH experts. This is mostly related to the need to be guided through diagnosis, to validate therapeutic management, to discuss the goals of care, or to know more about a disease.
- International Collaboration: The GRRR-OH has a strong collaboration with colleagues outside France. The GRRR-OH is originally French and Belgian. Also, since 2015, the multinational network named Nine-I has broadened the vision and expertise of the GRRR-OH. Experts from 16 countries (68 ICUs) have played an active role and have opened discussions, raised controversies, and brought new area of expertise to our group. In the future, we will be seeking to develop collaborations with everyone at stake and interested with the management of immunocompromised patients. We look forward to collaborating with our colleagues and friends from the Middle-East, Asia, Australia, and New-Zealand, and from everywhere in the world.
Conclusion
Key Points
- Educating ICU clinicians to improve their clinical skills when managing immunocompromised patients remains a major endeavour.
- The Groupe de Recherche en Réanimation Respiratoire chez les patients d’OncoHématologie (GRRR-OH) is a group of 32 centres in France and Belgium performing studies about acute respiratory failure in immunocompromised patients.
- Nine-I is a research network that focuses more broadly on all immunocompromised patients, with special emphasis on cancer patients.
- The Blood Diseases in the ICU is a training course that covers malignant and non-malignant haematological diseases.
References:
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