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.
Medical ICU in a French teaching hospital.
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
Measurements and Main 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
treated with adriamycin, a history of pneumonia
, 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.
Patients with acute respiratory failure after prolonged neutropenia
complicated by pneumonia
are at increased risk for ARDS.