Pulmonary infiltrates in patients with malignancies: why and how neutropenia influences clinical reasoning

Azoulay, Élie

doi:10.1183/09031936.00164208

Cited by 6 publications

(3 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More patients are being treated, more intensive regimens are being used, and patients more often undergo stem cell transplantation with the primary goal to control the disease. The result, in most of the cases, is an increase in the number of cases of patients with neutropenia [ 2 ]. Infection is the major cause of morbidity and mortality in neutropenic patients [ 3 ].…”

Section: Reviewmentioning

confidence: 99%

How to treat severe infections in critically ill neutropenic patients?

Zafrani

Azoulay

2014

BMC Infect Dis

View full text Add to dashboard Cite

Severe infections in neutropenic patient often progress rapidly leading to life-threatening organ dysfunction requiring admission to the Intensive Care Unit. Management strategies include early adequate appropriate empirical antimicrobial, early admission to ICU to avoid any delay in the diagnostic and therapeutic management of organ dysfunction. This review discusses the main clinical situations encountered in critically ill neutropenic patients. Specific diagnostic and therapeutic approaches have been proposed for acute respiratory failure, shock, neutropenic enterocolitis, catheter-related infections, cellulitis and primary bacteriemia. Non anti-infectious agents and recent advances will also be discussed. At present, most of large-scale studies and recommendations in neutropenic patients stem from hematological patients and will need further validation in ICU patients.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-512) contains supplementary material, which is available to authorized users.

show abstract

Section: Reviewmentioning

confidence: 99%

How to treat severe infections in critically ill neutropenic patients?

Zafrani

Azoulay

2014

BMC Infect Dis

View full text Add to dashboard Cite

show abstract

“…[21][22][23][24][25][26][27] Most of the subjects (83.8%) had hematological malignancies. Neutropenia was a feature on ICU admission in 36% of subjects.…”

Section: Among Thementioning

confidence: 99%

“…2,[13][14][15][16][17] Invasive procedures such as bronchoalveolar lavage (BAL) or lung biopsy may be required to identify the cause but may also increase the risk of requiring invasive mechanical ventilation. 15,[18][19][20][21] Noninvasive ventilation (NIV) is an effective alternative to invasive mechanical ventilation in patients with malignancies and ARF. 22 Studies have shown that NIV may avoid intubation and improve survival rates.…”

Section: Introductionmentioning

confidence: 99%

Identifying Cancer Subjects With Acute Respiratory Failure at High Risk for Intubation and Mechanical Ventilation

Lemiale¹,

Lambert

Canet

et al. 2014

Respir Care

Self Cite

View full text Add to dashboard Cite

BACKGROUND: We sought to identify risk factors for mechanical ventilation in patients with malignancies and acute respiratory failure (ARF). METHODS:We analyzed data from a previous randomized controlled trial in which nonintubated oncology and hematology subjects with ARF were randomized to early bronchoalveolar lavage or routine care in 16 ICUs in France. Consecutive patients with malignancies were admitted to the ICU for ARF in 2005 and 2006 with no intervention. RESULTS: During the study period, 219 patients were admitted to the ICU for ARF, and 8 patients were not included due to a nonintubation order. Data on the underlying disease, pulmonary involvement, and extrapulmonary organ dysfunctions were recorded at admission in the 211 remaining subjects. Ventilatory support included oxygen only (49 subjects), noninvasive ventilation (NIV) only (81 subjects), NIV followed by invasive mechanical ventilation (49 subjects), and firstline invasive mechanical ventilation (32 subjects). The 81 subjects who required invasive mechanical ventilation were compared with the 130 subjects who remained on oxygen or NIV. Factors associated with invasive mechanical ventilation by multivariate analysis were the oxygen flow required at ICU admission, the number of quadrants involved on chest x-ray, and hemodynamic dysfunction. Mortality rates for subjects who had NIV failure were 65.3% compared with 50% for subjects who were first-line intubated (P ‫؍‬ .34). CONCLUSIONS: In cancer patients with ARF, hypoxemia, extent of pulmonary infiltration on chest x-ray, or hemodynamic dysfunction are risk factors for invasive mechanical ventilation. Mortality was not significantly different between NIV failure and first-line intubation.

show abstract