title: Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).
abstract: Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.
authors.affiliation: Angouleme Hospital, Angoulême, France.
authors.forename: David
authors.initials: D
authors.lastname: Schnell
authors.affiliation: Saint-Louis University Hospital, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Intensive Care Unit, Ghent University Hospital, Ghent, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Benoit
authors.affiliation: Medical Intensive Care Unit, Pellegrin University Hospital, Bordeaux, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Clouzeau
authors.affiliation: Paediatric Intensive Care Unit, Centre Hospitalier Chrétien, Liège, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Demaret
authors.affiliation: Pediatric Hematological Unit, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ducassou
authors.affiliation: Microbiology Laboratory & Pediatric Immunology - Hematology Unit, Necker University Hospital, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Frange
authors.affiliation: Department of Infectious Diseases, Saint-Louis University Hospital, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Lafaurie
authors.affiliation: Surgical ICU and Burn Unit, Saint-Louis University Hospital, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Legrand
authors.affiliation: Thoracic Oncology Department and Oncologic Intensive Care Unit, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Anne-Pascale
authors.initials: AP
authors.lastname: Meert
authors.affiliation: Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmette, Marseille, France.
authors.forename: Djamel
authors.initials: D
authors.lastname: Mokart
authors.affiliation: Pediatric ICU, Robert Debré University Hospital, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Naudin
authors.affiliation: Cochin University Hospital Hospital, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pene
authors.affiliation: Respiratory Intensive Care Unit, Cochin University Hospital Hospital, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.affiliation: Department of Hematology, Saint-Louis University Hospital, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Raffoux
authors.affiliation: Department of Stem Cell Transplantation, Saint-Louis University Hospital, Paris, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.affiliation: Croix Rousse University Hospital, Lyon, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Richard
authors.affiliation: Montfermeil Hospital, Montfermeil, France.
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.affiliation: Infection Control Unit, Angers University Hospital, Angers, France.
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.affiliation: University Hospital, Saint-Etienne, France. michael.darmon@chu-st-etienne.fr.|Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Avenue Albert Raymond, 42270, Saint-Etienne, Saint-Priest-En-Jarez, France. michael.darmon@chu-st-etienne.fr.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
keywords: Antibiotics; Guidelines; Intensive care units; Isolation; Neutropenia; Prognosis