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Critical Care  2009 

Risk factors for acute respiratory distress syndrome during neutropenia recovery in patients with hematologic malignancies

DOI: 10.1186/cc8149

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Abstract:

We studied critically ill patients with hematologic malignancies with the dual objectives of describing patients with ARDS during neutropenia recovery and identifying risk factors for ARDS during neutropenia recovery. A cohort of consecutive neutropenic patients with hematologic malignancies who were admitted to the intensive care unit (ICU) was studied. During a 6-year period, 71 patients recovered from neutropenia, of whom 38 (53.5%) developed ARDS during recovery.Compared with non-ARDS patients, patients who experienced ARDS during neutropenia recovery were more likely to have pneumonia, be admitted to the ICU for respiratory failure, and receive mechanical ventilator therapy. The in-ICU mortality was significantly different between the two groups (86.8% versus 51.5%, respectively, for patients who developed ARDS during neutropenia recovery versus those who did not during neutropenia recovery). In multivariate analysis, only occurrence of pneumonia during the neutropenic episode was associated with a marked increase in the risk of ARDS (odds ratio, 4.76).Patients with hematologic malignancies complicated by pneumonia during neutropenia are at increased risk for ARDS during neutropenia recovery.Over the past two decades, the survival of patients with a hematologic malignancy has substantially improved as a result of new and intensive chemotherapeutic regimens, which may be followed by hematopoietic stem cell transplantation (HSCT) [1]. Unfortunately, the use of aggressive chemotherapeutic regimens frequently results in life-threatening complications, requiring transfer to the intensive care unit (ICU) for monitoring or advanced support [2]. Respiratory failure is the most common reason for ICU admission in critically ill patients with hematologic malignancies [3].Intensive chemotherapeutic treatment results in an increase in the number of patients with neutropenia. In cancer patients, neutropenia recovery may be associated with a deterioration in oxygenation and e

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