Deterioration of previous acute lung injury during neutropenia recovery.

Abstract

DESIGN:

Although neutropenia recovery is associated with a high risk of deterioration of respiratory condition, no studies designed to identify risk factors for acute respiratory distress syndrome (ARDS) in this situation have been published.

SETTING:

Medical ICU in a French teaching hospital.

SUBJECTS:

We conducted a study to describe critically ill cancer patients with ARDS during neutropenia recovery (defined as the 7-day period centered on the day the neutrophil count rose above 1000/mm3 [day 0]) and to compare them with critically ill cancer patients without ARDS during neutropenia recovery.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

During a 10-yr period, 62 critically ill cancer patients recovered from neutropenia, of whom 21 experienced ARDS during neutropenia recovery, with a median time of -1 days (-2.5-1) between day 0 and ARDS. In-ICU mortality in these 21 patients was 61.9%. As compared with non-ARDS patients, ARDS patients were less likely to have myeloma and more likely to have leukemia/lymphoma treated with adriamycin, a history of pneumonia before neutropenia, and a neutropenia duration >10 days; they had a shorter time since malignancy diagnosis and a longer time from chemotherapy to neutropenia. Neither the leukocyte counts on day 0 nor those during the 6-day neutropenia recovery period were predictive of ARDS.

CONCLUSIONS:

Patients with acute respiratory failure after prolonged neutropenia complicated by pneumonia are at increased risk for ARDS.

• Authors: Elie Azoulay, Michael Darmon, Christophe Delclaux, Fabienne Fieux, Caroline Bornstain, Delphine Moreau, Habiba Attalah, Jean-Roger Le Gall, Benoît Schlemmer
• Journal: Critical care medicine (Crit Care Med) Vol. 30 Issue 4 Pg. 781-6 (Apr 2002) ISSN: 0090-3493 [Print] United States
• PMID: 11940745 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Critical Illness
• Humans
• Intensive Care Units
• Leukocyte Count
• Middle Aged
• Neoplasms (complications)
• Neutropenia (complications)
• Pneumonia (complications)
• Respiratory Distress Syndrome (physiopathology)
• Respiratory Insufficiency (etiology)
• Risk Factors