Pathophysiology-directed therapy for acute hypoxemic respiratory failure in acute myeloid leukemia with hyperleukocytosis.
A 17-year-old with acute myeloid leukemia M4 and hyperleukocytosis developed fulminant hypoxemic respiratory failure at presentation. After failing to respond to conventional mechanical ventilation and leukapheresis, he was started on inhaled nitric oxide (iNO) with dramatic improvement in oxygenation. Following graduated chemotherapy, his pulmonary status again deteriorated coincident with tumor lysis. After failing to respond to increases in iNO, he was placed in prone position with immediate improvement. The patient was successfully extubated. Patients with myelomonocytic leukemias are at risk for early death due to pulmonary complications. The use of adjuvant therapies directed by specific pathophysiology might decrease this risk.
Schmidt
Jeffrey E
JE
Division of Critical Care Medicine, St. Jude Children's Research Hospital, 332 N. Lauderdale, MS# 323, Memphis, TN 38105, U.S.A. jeffrey.schmidt@stjude.org
Tamburro
Robert F
RF
Sillos
Elaine M
EM
Hill
D Ashley
DA
Ribeiro
Raul C
RC
Razzouk
Bassem I
BI
D000280:Administration, Inhalation; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D007964:Leukocytosis / Q000150:complications; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome
D009569:Nitric Oxide; D010100:Oxygen