Little attention has been given to ARDS in cancer patients, despite their high risk for pulmonary complications. We sought to describe outcomes in cancer patients with ARDS meeting the Berlin definition. Data from a cohort of patients admitted to 14 ICUs between 1990 and 2011 were used for a multivariable analysis of risk factors for hospital mortality. Of 1,004 included patients (86 % with hematological malignancies and 14 % with solid tumors), 444 (44.2 %) had neutropenia. Admission SOFA score was 12 (10–13). Etiological categories were primary infection-related ARDS (n = 662, 65.9 %; 385 bacterial infections, 213 invasive aspergillosis, 64 Pneumocystis pneumonia); extrapulmonary septic shock-related ARDS (n = 225, 22.4 %; 33 % candidemia); noninfectious ARDS (n = 76, 7.6 %); and undetermined cause (n = 41, 4.1 %). Of 387 (38.6 %) patients given noninvasive ventilation (NIV), 276 (71 %) subsequently required endotracheal ventilation. Hospital mortality was 64 % overall. According to the Berlin definition, 252 (25.1 %) patients had mild, 426 (42.4 %) moderate and 326 (32.5 %) severe ARDS; mortality was 59, 63 and 68.5 %, respectively (p = 0.06). Mortality dropped from 89 % in 1990–1995 to 52 % in 2006–2011 (p < 0.0001). Solid tumors, primary ARDS, and later admission period were associated with lower mortality. Risk factors for higher mortality were allogeneic bone-marrow transplantation, modified SOFA, NIV failure, severe ARDS, and invasive fungal infection. In cancer patients, 90 % of ARDS cases are infection-related, including one-third due to invasive fungal infections. Mortality has decreased over time. NIV failure is associated with increased mortality. The high mortality associated with invasive fungal infections warrants specific studies of early treatment strategies.

Acute respiratory distress syndrome in patients with malignancies

Acute respiratory distress syndrome (ARDS) is difficult to treat and is associated with a high mortality rate. The most severe form of coronavirus disease 2019 (COVID-19) also leads to life-threatening ARDS. Neutrophil counts are positively correlated with disease severity in ARDS. Neutrophil activation not only plays a significant role in immune defense against infections, but also causes tissue damage and leads to inflammatory diseases. Activated neutrophils rapidly migrate to inflamed lung tissue, releasing toxic granular contents and generating neutrophil extracellular traps. In the last few decades, it has become apparent that neutrophils occupy a central role in ARDS pathology. In this review, we summarize the neutrophil inflammatory responses and their relationships to ARDS. According to the current literature, understanding the function of neutrophils may be helpful in the treatment of ARDS.

Understanding the role of neutrophils in acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is a severe pulmonary reaction requiring hospitalization, which is incited by many causes, including bacterial and viral pneumonia as well as near drowning, aspiration of gastric contents, pancreatitis, intravenous drug use, and abdominal trauma. In humans, ARDS is very well defined by a list of clinical parameters. However, until recently no consensus was available regarding the criteria of ARDS that should be evident in an experimental animal model. This lack was rectified by a 2011 workshop report by the American Thoracic Society, which defined the main features proposed to delineate the presence of ARDS in laboratory animals. These should include histological changes in parenchymal tissue, altered integrity of the alveolar capillary barrier, inflammation, and abnormal pulmonary function. Murine ARDS models typically are defined by such features as pulmonary edema and leukocyte infiltration in cytological preparations of bronchoalveolar lavage fluid and/or lung sections. Common pathophysiological indicators of ARDS in mice include impaired pulmonary gas exchange and histological evidence of inflammatory infiltrates into the lung. Thus, morphological endpoints remain a vital component of data sets assembled from animal ARDS models.

https://journals.sagepub.com/doi/pdf/10.1177/0192623315598399

Mouse Models of Acute Respiratory Distress Syndrome: A Review of Analytical Approaches, Pathologic Features, and Common Measurements

Background
In severe sepsis, guidelines recommend de-escalating the empirical antimicrobial treatment as soon as the microbiological results are available. We aimed to determine the rate of de-escalation of the empirical antimicrobial treatment in neutropenic patients with severe sepsis. The characteristics of antimicrobial treatment associated with de-escalation and its impact on short- and long-term survival were also determined.

De-escalation of antimicrobial treatment in neutropenic patients with severe sepsis: results from an observational study

The ability of the alveolar epithelium to prevent and resolve pulmonary edema is a crucial determinant of morbidity and mortality in acute lung injury (ALI). TNF has been implicated in ALI pathogenesis, but the precise mechanisms remain undetermined. We evaluated the role of TNF signaling in pulmonary edema formation in a clinically relevant mouse model of ALI induced by acid aspiration and investigated the effects of TNF p55 receptor deletion, caspase-8 inhibition, and alveolar macrophage depletion on alveolar epithelial function. We found that TNF plays a central role in the development of pulmonary edema in ALI through activation of p55-mediated death signaling, rather than through previously well-characterized p55-mediated proinflammatory signaling. Acid aspiration produced pulmonary edema with significant alveolar epithelial dysfunction, as determined by alveolar fluid clearance (AFC) and intra-alveolar levels of the receptor for advanced glycation end-products. The impairment of AFC was strongly correlated with lung caspase-8 activation, which was localized to type 1 alveolar epithelial cells by flow cytometric analysis. p55-deficient mice displayed markedly attenuated injury, with improved AFC and reduced caspase-8 activity but no differences in downstream cytokine/chemokine production and neutrophil recruitment. Caspase-8 inhibition significantly improved AFC and oxygenation, whereas depletion of alveolar macrophages attenuated epithelial dysfunction with reduced TNF production and caspase-8 activity. These results provide in vivo evidence for a novel role for TNF p55 receptor-mediated caspase-8 signaling, without substantial apoptotic cell death, in triggering alveolar epithelial dysfunction and determining the early pathophysiology of ALI. Blockade of TNF-induced death signaling may provide an effective early-phase strategy for ALI.

/pdf/tnf-induced-death-signaling-triggers-alveolar-epithelial-2y9ajyecew.pdf

TNF-Induced Death Signaling Triggers Alveolar Epithelial Dysfunction in Acute Lung Injury

To date, no study has been specifically designed to identify determinants of death in neutropenic cancer patients presenting with acute respiratory distress syndrome (ARDS). The aim of this study was to identify early predictive factors of 28-day mortality in these patients. Factors associated with 28-day mortality during intensive care unit (ICU) stay were also described. 70 consecutive cancer patients with ARDS and neutropenia were prospectively analysed over a 6-yr period. Mortality at 28 days was 63%. Factors independently associated with good prognosis were: lobar ARDS (OR 0.10, 95% CI 0.02-0.48), use of initial antibiotic treatment active on difficult to treat bacteria (ticarcillin-resistant Pseudomonas aeruginosa, Stenotrophomonas maltophilia or extended-spectrum β-lactamase-producing strains) (OR 0.08, 95% CI 0.02-0.33) and first-line chemotherapy (OR 0.08, 95% CI 0.02-0.37). During the ICU stay, mortality was associated with the markers of organ dysfunctions, the absence of neutropenia recovery and the use of vasopressors. During the first 3 weeks, the conditional probability of discharge alive from ICU did not decrease. At ICU admission, first-line chemotherapy, lobar ARDS and antibiotic treatment active on difficult-to-treat bacteria were associated with survival. During ICU stay, mortality was associated with organ dysfunctions and use of vasopressors. Most survivors have an ICU stay of >3 weeks.

https://erj.ersjournals.com/content/erj/40/1/169.full.pdf

Prognosis of acute respiratory distress syndrome in neutropenic cancer patients

Up today, no study has been specifically designed to identify determinants of death neutropenic cancer patients presenting ARDS. The aim of this study was to identify early predictive factors of 28-day mortality in these patients. Factors associated with 28-day mortality during ICU stay were also described. Seventy consecutive cancer patients with ARDS and neutropenia were prospectively analyzed over a 6-year period. Mortality at 28-day was 63%. Factors independently associated with good prognosis were: lobar ARDS (odds ratio 0.10, 95% CI: 0.02 – 0.48), use of initial antibiotic treatment active on difficult to treat bacteria (ticarcillin-resistant Pseudomonas aeruginosa, Stenotrophomonas maltophilia, or ESBL-producing strains) (OR= 0.08, 95% CI: 0.02 – 0.33) and first line chemotherapy (OR=0.08, 95% CI: 0.02 – 0.37). During the ICU stay, mortality was associated with the markers of organ dysfunctions, the absence of neutropenia recovery and the use of vasopressors. During the first three weeks, the conditional probability of discharge alive from ICU did not decrease. At ICU admission, first line chemotherapy, lobar ARDS and antibiotic treatment active on DTT bacteria were associated with survival. During ICU stay, mortality was associated with organ dysfunctions and use of vasopressors. Most survivors have an ICU stay longer than three weeks. Abbreviations: ARDS= acute respiratory distress syndrome; ARF= acute respiratory failure; ICU= intensive care unit; DTT bacteria= difficult-to-treat bacteria; LOD score= Logistic organ dysfunction score; MV= mechanical ventilation; NIMV= non invasive mechanical ventilation; RRT= renal replacement therapy; TMP-SMX = trimethoprim-sulfamethoxazole . Introduction Recent advances in the treatment of solid and hematologic malignancies have led to a significant decrease over time in overall mortality in cancer patients.The tribute to pay for increasing treatment intensity and duration with the goal to improving survival is an important rise of treatment-related toxicities and susceptibility to infection. Patients with neutropenia stigmatize both conditions. In patients with febrile neutropenia lung involvement is a forefront complication, with 20% of the patients presenting with lung infiltrates 3 and 15% of the patients presenting respiratory events. In these circumstances neutropenic patients are at high risk to develop ARDS. Studies about ARDS in neutropenic patients are scarce but knowledge regarding cancer patients admitted to ICU for acute respiratory failure (ARF) is now abundant and instructive. About 15% of cancer patients develop ARF requiring an admission to ICU . Survival of cancer patients presenting ARF has improved over time to 60% . When these patients are ventilated they carry a hospital mortality rate of about 75%. No published study has been specifically designed to identify determinants of death in critically ill neutropenic cancer patients with ARDS. We sought to identify early predictive factors of 28-day mortality in 70 cancer patients presenting ARDS during chemotherapy-induced neutropenia. Factors associated with 28-day mortality during ICU stay were also described. Patients and method The Paoli-Calmettes Institute is a 207-bed cancer referral center, where about 10 000 patients (70% medical, 30% surgical) with a diagnostic of malignancy are hospitalized each year.All consecutive patients with haematological malignancy or solid tumors admitted to our medicalsurgical ICU between January 1, 2002, and December 31, 2008, were evaluated prospectively. Only patients admitted for ARDS with a neutropenia were included in this study. The study was approved by our Institutional Review Board which waived the need for informed consent. Definitions We used the definition of ARDS recommended by the American-European Consensus Conference 8 and sepsis was defined according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. “Diffuse”, “lobar” and “patchy” ARDS were diagnosed using previously reported criteria. Pulmonary and extra pulmonary ARDS were defined using previously reported criteria. Severe neutropenia was defined as absolute neutrophils count < 500 cells/L. Criteria for ICU admission In our institution, ICU admission policy is broad and includes most patients with a 'therapeutic project' regardless of their cancer status. Decisions to admit patients to the ICU for acute respiratory failure (ARF) were made by both referring oncologists or hematologists and a senior intensivist. ARF was defined as oxygen saturation less than 90% or PaO2 less than 60 mm Hg on room air combined with severe dyspnea at rest with inability to speak in sentences or respiratory rate greater than 30 breaths per minute or clinical signs of respiratory distress (recruitment of accessory respiratory muscles or respiratory muscle exhaustion). When possible, non invasive mechanical ventilation (NIMV) was delivered to the patient through a full-face mask, in all cases NIMV was only performed in the ICU. Patients considered to benefit from immediate ICU admission were managed systematically and daily by both the intensivist and the hematologist/oncologist until ICU admission. During the ICU stay the referring hematologists/oncologists were systematically involved in all medical decisions regarding cancer evaluation, cancer treatment and treatment limitations. Patient’s management Before ICU admission all patients beneficed from chest X-rays and high resolution computed tomography (CT) of the lung as recommended. Just after ICU admission and as recommended by guidelines initial antibiotic treatment was reconsidered and all patients beneficed from broad-spectrum antibiotic treatment including at least an antipseudomonallactam immediately after clinical evaluation and the realisation of microbiological samples. Beside antibiotics, most of patients beneficed from standardized supportive care according to the surviving sepsis campaign 15 and ARDS guidelines. Diagnostic strategy in neutropenic patients with ARDS Diagnoses were based on clinical, radiographic, microbiologic findings and were validated by the ICU team. Etiologic diagnoses of ARF were established by the physicians according to standardized definitions. All patients were initially treated as a clinically documented infection (presence of a clinical or radiological infectious focus, or both, without causative pathogen identification). Microbiologically documented infection was defined as a presence of a clinical or radiological infectious focus, or both, and pathogen identification. Microbiologically documented infection was considered only when the infection was the main cause of ARDS. Pneumocystis pneumonia (PCP) was diagnosed by the detection of P jiroveci using conventional staining methods (direct and indirect fluorescence antibody and toluidineblue-O, Grocott-Gomori silver stain, or Giemsa stains) in respiratory samples such as induced sputum or BAL fluid. In our institution, difficult-to-treat (DTT) bacteria were represented by a group of pathogens including ticarcillin-resistant Pseudomonas aeruginosa, Stenotrophomonas maltophilia, or rarely ESBL-producing strains. From ICU admission, initial antibiotic treatment active on DTT bacteria was defined as an antibiotic treatment usually active, in our institution, on the predefined DTT bacteria Data collection Patient’s characteristics that are reported in Tables1-2 were prospectively collected. Early predictive factors for 28-day mortality were collected at ICU admission (day 1).Early predictive factors were defined as factors available at ICU admission such as initial characteristics of the patient, the underlying malignancy and factors regarding the acute respiratory distress syndrome, they included : age, gender, the absence of comorbidity, underlying malignancies, the delay since malignancy at ICU admission (days), status of malignancy, bone marrow transplantation recipients, the delay since neutropenia at ICU admission (days), organ dysfunctions using LOD score and SAPS II score, arterial lactates concentration, causes of ARDS, lung morphology on CT scan, the occurrence of pulmonary or extra pulmonary ARDS, the existence of microbiological documentation at ICU admission and the antimicrobial treatment. Other factors associated with 28-day mortality were also collected during the ICU stay. Organ dysfunctions were reported according to the Logistic organ dysfunction (LOD) score. To assess the impact of the LOD score change between day 1 and day 7, we constructed a continuous variable by computing the difference (LOD day 7 − LOD day 1) = (∆LOD). Patients presenting a ∆LOD> 1 were considered as clinically worsened. Patients presenting -1≤∆LOD≤1, were considered as clinically stable. Patients presenting a ∆LOD<-1 were considered as clinically improved. SAPSII score was collected at ICU admission (day 1), LOD score and PaO2/FiO2 ratio were collected at day 1, day 3, day 7 and 2 days after neutropenia recovery. Other therapeutic interventions such as vasopressor use, need and duration of respiratory support non invasive mechanical ventilation (NIMV) or conventional mechanical ventilation (MV), renal replacement therapy (RRT), duration of renal replacement, length of ICU stay; ICU, 28-day , hospital and one-year mortality were also collected. Statistical analysis All data are presented as frequencies (percentage) for qualitative variables and medians (2575 percentiles) for quantitative variables. Characteristics of patients at admission and during ICU hospitalization were compared across the groups of day 28 survivors and decedents by using Fisher’s exact test and Wilcoxon rank-sum test. A multivariable logistic regression model was performed to identify independent predictors of day 28 mortality among baseline characteristics. Due to the relatively small sample size bootstrap was used to ensure the robustness of the 

Prognosis of acute respiratory distress syndrome (ARDS) in neutropenic cancer

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Jérôme Lambert

Author Tools

Chat about Author

Papers

Prognosis of acute respiratory distress syndrome in neutropenic cancer patients

Prognosis of acute respiratory distress syndrome (ARDS) in neutropenic cancer