Acute respiratory failure in immunocompromised adults

Abstract

Acute respiratory failure occurs in up to half of patients with haematological malignancies and 15% of those with solid tumours or solid organ transplantation. Mortality remains high. Factors associated with mortality include a need for invasive mechanical ventilation, organ dysfunction, older age, frailty or poor performance status, delayed intensive care unit admission, and acute respiratory failure due to an invasive fungal infection or unknown cause. In addition to appropriate antibacterial therapy, initial clinical management aims to restore oxygenation and predict the most probable cause based on variables related to the underlying disease, acute respiratory failure characteristics, and radiographic findings. The cause of acute respiratory failure must then be confirmed using the most efficient, least invasive, and safest diagnostic tests. In patients with acute respiratory failure of undeter mined cause, a standardised diagnostic investi gation should be done immediately at admission before deciding whether to perform more invasive diagnostic procedures or to start empirical treatments. Collaborative and multidisciplinary clinical and research networks are crucial to improve our understanding of disease pathogenesis and causation and to develop less invasive diagnostic strategies and more targeted treatment options.www.thelancet.com/respiratory Vol

Equal critical care consideration for both immunocompromised and immunocompetent patients during the COVID-19 surge

“…Many developed ventilator-acquired pneumonia which negatively affected their prognosis. However, although running a high theoretical risk (21), our ICP did not develop invasive fungal infection, in contrast with reports concerning in uenza epidemics (21). Another feature illustrated was the persistence of a prolonged positive viral load in these ICP for reasons that remain to be determined.…”

“…Although the 28-day mortality of immuno-competent patients with COVID over the period was as usual in our department, strikingly the death rate for ICP was twice as high. In the context of other respiratory infections such as in uenza, ICP and immuno-competent patients have a similar mortality ratio (20,21). It may thus be that ICP patients are especially impacted by the SARS-COV-2.…”

Diagnosis of severe respiratory infections in immunocompromised patients

“…1), radiographic pattern, experience of the assessing clinician, clinical findings, and high-resolution computed tomography (HRCT) findings ( Fig. 2) [2,9,10]. Most of these variables are easily evaluated at the bedside, and their analysis usually restricts the number of possible etiologies to two or three.…”

“…Severe respiratory infection is the leading reason for intensive care unit (ICU) admission in immunocompromised patients, who are at risk for hypoxemic acute respiratory failure (ARF) and sepsis [2]. Life-supporting interventions must be implemented at the same time as extensive investigations are conducted to identify the cause of the pulmonary involvement [2]. Failure to identify the etiology of ARF is associated with a higher risk of dying [3].…”

Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus

“…Finally, to determine early management and establish probable cause of acute respiratory failure in immunocompromised adults, critical diagnostic investigations are needed to be applied to such patients. Azouly and colleagues summarized a standardized initial and basic diagnostic that should be performed immediately at the admission time for all immunocompromised patients with acute respiratory failure [10].…”