Deterioration of previous acute lung injury during neutropenia recovery.
METHODS
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.


METHODS
Medical ICU in a French teaching hospital.


METHODS
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.


METHODS
None.


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.
Azoulay
Elie
E
Medical Intensive Care Unit, Saint Louis University Hospital, USA.
Darmon
Michael
M
Delclaux
Christophe
C
Fieux
Fabienne
F
Bornstain
Caroline
C
Moreau
Delphine
D
Attalah
Habiba
H
Le Gall
Jean-Roger
JR
Schlemmer
Benoît
B
D000328:Adult; D000368:Aged; D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D007958:Leukocyte Count; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000150:complications*; D011014:Pneumonia / Q000150:complications; D012128:Respiratory Distress Syndrome / Q000503:physiopathology*; D012131:Respiratory Insufficiency / Q000209:etiology; D012307:Risk Factors