Abstract
Acute respiratory failure is a major cause of morbidity in cancer patients and the most common organ failure leading to ICU admission in neutropenic patients. In these patients, acute respiratory failure often stems from a combination of factors that may be closely intertwined, such as infection and cardiogenic edema or alveolar hemorrhage. Several lines of evidence point to an association between neutropenia recovery and declining oxygenation with exacerbation of pre-existing pulmonary disease. Overall, the prevalence of acute respiratory failure during neutropenia recovery may be as high as 50% in patients with risk factors. These factors include the occurrence of pneumonia during neutropenia, delayed or prolonged neutropenia, a fast rate of neutrophil recovery, and invasive pulmonary aspergillosis. In addition, several clinical and laboratory findings suggest that granulocyte colony-stimulating factor may exacerbate the clinical manifestations of neutropenia recovery. Here, we review the evidence suggesting that neutropenia recovery may be associated with exacerbation of acute respiratory failure, and we discuss the factors suspected to be associated with respiratory failure during neutropenia recovery.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Azoulay E, Thiery G, Chevret S et al (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 83:360–370
Kress JP, Christenson J, Pohlman AS et al (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 160:1957–1961
Rinaldo JE, Borovetz H (1985) Deterioration of oxygenation and abnormal lung microvascular permeability during resolution of leukopenia in patients with diffuse lung injury. Am Rev Respir Dis 131:579–583
Azoulay E, Darmon M, Delclaux C et al (2002) Deterioration of previous acute lung injury during neutropenia recovery. Crit Care Med 30:781–786
Karlin L, Darmon M, Thiery G et al (2005) Respiratory status deterioration during G-CSF-induced neutropenia recovery. Bone Marrow Transplant 6:1–6
Azoulay E, Attalah H, Yang K et al (2003) Exacerbation with granulocyte colony-stimulating factor of prior acute lung injury during neutropenia recovery in rats. Crit Care Med 31:157–165
Todeschini G, Murari C, Bonesi R et al (1999) Invasive aspergillosis in neutropenic patients: rapid neutrophil recovery is a risk factor for severe pulmonary complications. Eur J Clin Invest 29:453–457
Rhee CK, Kang JY, Kim YH et al (2009) Risk factors for acute respiratory distress syndrome during neutropenia recovery in patients with hematologic malignancies. Crit Care 13:R173
Lehrnbecher T, Koehl U, Wittekindt B et al (2008) Changes in host defence induced by malignancies and antineoplastic treatment: implication for immunotherapeutic strategies. Lancet Oncol 9:269–278
Bodey GP (1986) Infection in cancer patients. A continuing association. Am J Med 81:11–26
Bodey GP, Rodriguez V, Chang HY et al (1978) Fever and infection in leukemic patients: a study of 494 consecutive patients. Cancer 41:1610–1622
Cartoni C, Dragoni F, Micozzi A et al (2001) Neutropenic enterocolitis in patients with acute leukemia: prognostic significance of bowel wall thickening detected by ultrasonography. J Clin Oncol 19:756–761
Maschmeyer G (2001) Pneumonia in febrile neutropenic patients: radiologic diagnosis. Curr Opin Oncol 13:229–235
Puig N, De La Rubia J, Jarque I et al (2007) Characteristics of and risk factors for pneumonia in patients with hematological malignancies developing fever after autologous blood stem cell transplantation. Leuk Lymphoma 48: 2367–2374
Meyer E, Beyersmann J, Bertz H et al (2007) Risk factor analysis of blood stream infection and pneumonia in neutropenic patients after peripheral blood stem-cell transplantation. Bone Marrow Transplant 39:173–178
Darmon M, Azoulay E, Alberti C et al (2002) Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients. Intensive Care Med 28: 1775–1780
Hughes WT, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751
Ognibene FP, Martin SE, Parker MM et al (1986) Adult respiratory distress syndrome in patients with severe neutropenia. N Engl J Med 315:547–551
Braude S, Apperley J, Krausz T et al (1985) Adult respiratory distress syndrome after allogeneic bone-marrow transplantation: evidence for a neutrophil-independent mechanism. Lancet 1:1239–1242
Maunder RJ, Hackman RC, Riff E et al (1986) Occurrence of the adult respiratory distress syndrome in neutropenic patients. Am Rev Respir Dis 133:313–316
Laufe MD, Simon RH, Flint A et al (1986) Adult respiratory distress syndrome in neutropenic patients. Am J Med 80:1022–1026
Mokart D, Guery BP, Bouabdallah R et al (2003) Deactivation of alveolar macrophages in septic neutropenic ARDS. Chest 124:644–652
Mokart D, Kipnis E, Guerre-Berthelot P et al (2008) Monocyte deactivation in neutropenic acute respiratory distress syndrome patients treated with granulocyte colony-stimulating factor. Crit Care 12:R17
Glauser FL, Fairman RP (1985) The uncertain role of the neutrophil increased permeability pulmonary edema. Chest 88:601–607
Tate RM, Repine JE (1983) Neutrophils and the adult respiratory distress syndrome. Am Rev Respir Dis 128:552–559
King J, Deboisblanc BP, Mason CM et al (1995) Effect of granulocyte colony-stimulating factor on acute lung injury in the rat. Am J Respir Crit Care Med 151:302
Azoulay E, Herigault S, Levame M et al (2003) Effect of granulocyte colony-stimulating factor on bleomycin-induced acute lung injury and pulmonary fibrosis. Crit Care Med 31:1442–1448
Aggarwal A, Baker CS, Evans TW et al (2000) G-CSF and IL-8 but not GM-CSF correlate with severity of pulmonary neutrophilia in acute respiratory distress syndrome. Eur Respir J 15:895–901
Wiedermann FJ, Mayr AJ, Hobisch-Hagen P et al (2003) Association of endogenous G-CSF with anti-inflammatory mediators in patients with acute respiratory distress syndrome. J Interferon Cytokine Res 23:729–736
Azoulay E, Attalah H, Harf A et al (2001) Granulocyte colony-stimulating factor or neutrophil-induced pulmonary toxicity: myth or reality? Systematic review of clinical case reports and experimental data. Chest 120:1695–1701
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Azoulay, É., Ezingeard, E., Berckowski, CS., Darmon, M. (2011). ARDS During Neutropenia Recovery. In: Azoulay, E. (eds) Pulmonary Involvement in Patients with Hematological Malignancies. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15742-4_41
Download citation
DOI: https://doi.org/10.1007/978-3-642-15742-4_41
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-15741-7
Online ISBN: 978-3-642-15742-4
eBook Packages: MedicineMedicine (R0)