Semin Respir Crit Care Med 2024; 45(02): 255-265
DOI: 10.1055/s-0043-1778137
Review Article

Severe Community-Acquired Pneumonia in Immunocompromised Patients

Dara Chean
1   Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
,
Camille Windsor
2   Medical Intensive Care Unit, AP-HP Henri Mondor University Hospital, Créteil, France
,
Antoine Lafarge
1   Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
,
Thibault Dupont
1   Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
,
Sabrine Nakaa
1   Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
,
Livia Whiting
1   Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
,
Adrien Joseph
1   Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
,
Virginie Lemiale
1   Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
,
Elie Azoulay
1   Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
› Institutsangaben
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Abstract

Due to higher survival rates with good quality of life, related to new treatments in the fields of oncology, hematology, and transplantation, the number of immunocompromised patients is increasing. But these patients are at high risk of intensive care unit admission because of numerous complications. Acute respiratory failure due to severe community-acquired pneumonia is one of the leading causes of admission. In this setting, the need for invasive mechanical ventilation is up to 60%, associated with a high hospital mortality rate of around 40 to 50%. A wide range of pathogens according to the reason of immunosuppression is associated with severe pneumonia in those patients: documented bacterial pneumonia represents a third of cases, viral and fungal pneumonia both account for up to 15% of cases. For patients with an undetermined etiology despite comprehensive diagnostic workup, the hospital mortality rate is very high. Thus, a standardized diagnosis strategy should be defined to increase the diagnosis rate and prescribe the appropriate treatment. This review focuses on the benefit-to-risk ratio of invasive or noninvasive strategies, in the era of omics, for the management of critically ill immunocompromised patients with severe pneumonia in terms of diagnosis and oxygenation.

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Artikel online veröffentlicht:
24. Januar 2024

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