Critical care medicine · 2002
Deterioration of previous acute lung injury during neutropenia recovery.
СтатьяНазвание и аннотация: Перевод в очереди
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Azoulay Elie, Darmon Michael, Delclaux Christophe, Fieux Fabienne, Bornstain Caroline, Moreau Delphine, Attalah Habiba, Le Gall Jean-Roger, Schlemmer Benoît
Аннотация
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.
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.