title: Successful treatment of patients with respiratory failure due to fungal infection after allogeneic hematopoietic stem cell transplantation.
abstract: The mortality rate associated with respiratory failure due to invasive fungal infections after allogeneic hematopoietic stem cell transplantation (HSCT) is exceedingly high. We present a retrospective analysis of 4 HSCT recipients who survived long-term artificial respiration subsequent to pulmonary mycosis, and compare our current findings with historic data. Several clinical parameters indicate a remarkable improvement in the clinical courses of those patients in recent years: weaning time, extubation rate, and improvement of additional organ failures were all significantly better in patients treated after the emergence of new antimycotic agents, resulting in prolonged overall survival. We propose that our observations reflect an improved management of these patients, mainly because of the use of new antimycotics with alternative mechanisms of action and decreased toxicity, allowing for earlier, more aggressive, and more effective antifungal treatment approaches. In addition, the optimized use of new technologies designed to augment spontaneous breathing efforts by patients, mechanical ventilation, as well as the advantages of early tracheotomy will contribute to better outcomes in the treatment of respiratory failure due to pulmonary mycoses following allogeneic HSCT.
authors.affiliation: Department of Bone Marrow Transplantation, University Hospital of Essen, Essen, Germany. michael.koldehoff@uni-essen.de
authors.forename: M
authors.initials: M
authors.lastname: Koldehoff
authors.forename: A H
authors.initials: AH
authors.lastname: Elmaagacli
authors.forename: N K
authors.initials: NK
authors.lastname: Steckel
authors.forename: R
authors.initials: R
authors.lastname: Trenschel
authors.forename: M
authors.initials: M
authors.lastname: Hlinka
authors.forename: M
authors.initials: M
authors.lastname: Ditschkowski
authors.forename: D W
authors.initials: DW
authors.lastname: Beelen
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents