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Synopsis Fungal pneumonias cause unacceptable morbidity among patients with hematologic malignancies (HM) and recipients of hematopoietic stem cell transplantation (HSCT). The high incidence of fungal pneumonias in HM/HSCT populations arises from their frequently severe, complex and persistent immune dysfunction caused by both the underlying disease and its treatment. The cytopenias, treatment toxicities and other immune derangements that make HM/HSCT patients susceptible to fungal pneumonia frequently also complicate its diagnosis by impeding generation of classically recognizable host response patterns and increase the intensity and duration of required antifungal therapy. This manuscript addresses the host factors that contribute to susceptibility, summarizes diagnostic recommendations, and reviews current guidelines for management of fungal pneumonia in HM/HSCT patients.

By reading this article you should be able to: Name the potential indications for endogenous steroid administration in the critically ill patient population. Describe the rationale for steroid administration in a given condition, based on the underlying pathophysiology. Evaluate the evidence base for steroid administration and discuss existing controversies in the literature. Appraise the benefits and potential harmful effects of steroid administration for a particular indication.

A 30 year-old Hispanic man with no significant previous medical history presented with refractory hypoxemia after flu-like symptoms. Because of progressive hypoxemia despite appropriate ventilator strategies, venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated for severe acute respiratory distress syndrome (ARDS). His course was complicated at our hospital by subarachnoid hemorrhage, right ventricular failure, multiple pneumothoraces, and significant deconditioning. He was able to be weaned off VV-ECMO after 193 days and was ambulatory at discharge from the hospital.