• Chin Kook Rhee, Ji Young Kang, Yong Hyun Kim, Jin Woo Kim, Hyung Kyu Yoon, Seok Chan Kim, Soon Suk Kwon, Young Kyoon Kim, Kwan Hyung Kim, Hwa Sik Moon, Sung Hak Park, Hee Je Kim, Seok Lee, and Jeong Sup Song.
• Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seocho-Gu, Seoul 137-701, Korea. chinkook@catholic.ac.kr
• Crit Care. 2009 Jan 1; 13 (6): R173.

IntroductionNeutropenia recovery may be associated with deterioration in oxygenation and exacerbation of pre-existing pulmonary disease. However, risk factors for acute respiratory distress syndrome (ARDS) during neutropenia recovery in patients with hematologic malignancies have not been studied.MethodsWe studied critically ill patients with hematologic malignancies with the dual objectives of describing patients with ARDS during neutropenia recovery and identifying risk factors for ARDS during neutropenia recovery. A cohort of consecutive neutropenic patients with hematologic malignancies who were admitted to the intensive care unit (ICU) was studied. During a 6-year period, 71 patients recovered from neutropenia, of whom 38 (53.5%) developed ARDS during recovery.ResultsCompared with non-ARDS patients, patients who experienced ARDS during neutropenia recovery were more likely to have pneumonia, be admitted to the ICU for respiratory failure, and receive mechanical ventilator therapy. The in-ICU mortality was significantly different between the two groups (86.8% versus 51.5%, respectively, for patients who developed ARDS during neutropenia recovery versus those who did not during neutropenia recovery). In multivariate analysis, only occurrence of pneumonia during the neutropenic episode was associated with a marked increase in the risk of ARDS (odds ratio, 4.76).ConclusionsPatients with hematologic malignancies complicated by pneumonia during neutropenia are at increased risk for ARDS during neutropenia recovery.

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