Managing the oncologic patient with suspected pneumonia in the intensive care unit

ABSTRACT

Introduction: Solid cancer patients are frequently admitted in intensive care units for critical events. Improving survival rates in this setting is considered an achievable goal today. Respiratory failure is the main reason for admission, representing a primary target for research.

Areas covered: This review presents a diagnostic and therapeutic algorithm for pneumonia and other severe respiratory events in the solid cancer population. It aims to increase awareness of the risk factors and the different etiologies in this changing scenario in which neutropenia no longer seems to be a decisive factor in poor outcome. Bacterial pneumonia is the leading cause, but opportunistic diseases and non-infectious etiologies, especially unexpected adverse effects of radiation, biological drugs and monoclonal antibodies, are becoming increasingly frequent. Options for respiratory support and diagnostics are discussed and indications for antibiotics in the management of pneumonia are detailed.

Expert commentary: Prompt initiation of critical care to facilitate optimal decision-making in the management of respiratory failure, early etiological assessment and appropriate antibiotic therapy are cornerstones in management of severe pneumonia in oncologic patients.

KEYWORDS:

• Solid organ
• pneumonia
• drugs and radiation
• ICU admission
• window of opportunity
• antimicrobials

Acknowledgments

The authors express their gratitude to Michael Maudsley for the English language editing work and to Toni Perez for a critical review of the manuscript.

Declaration of interest

J. Rello has served as a consultant and on the speakers’ bureau for Astellas, Pfizer, Basilea, Paratek, Astra-Zeneca. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was supported in part by CIBERES PCI Pneumonia (2016–18) – Instituto de Salud Carlos III and FEDER.