• ARDS
• Hypoxemia
• Immunocompromised
• Lung
• Ventilation

• Humans
• Immunocompromised Host
• Acute Lung Injury/etiology
• Acute Lung Injury/therapy
• Acute Lung Injury/diagnosis

• extracorporeal membrane oxygenation
• hematology
• intensive care unit
• malignancy
• oncology

• Acute respiratory distress syndrome
• Hematological malignancies
• Intensive care unit
• Mortality

• Acute respiratory distress syndrome
• Hematologic malignancies
• Hematopoietic stem cell transplantation
• The New definition of ARDS

• Humans
• Hematopoietic Stem Cell Transplantation/adverse effects
• Male
• Retrospective Studies
• Female
• Hospital Mortality
• Respiratory Distress Syndrome/mortality
• Respiratory Distress Syndrome/therapy
• Middle Aged
• Risk Factors
• Adult
• Transplantation, Homologous/adverse effects
• Aged
• Logistic Models
• Young Adult

• GSWS2019009 Key Health Talents in Gusu

• Humans
• Hematopoietic Stem Cell Transplantation/mortality
• Male
• Female
• Middle Aged
• Adult
• Respiratory Function Tests
• Critical Care
• Cohort Studies
• Survival Rate
• Aged
• Transplantation, Homologous
• Allografts
• Adolescent
• Lung/physiopathology

• K23HL151671 U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI)

• acute respiratory failure
• cancer
• non-invasive ventilation
• epidemiology

• Humans
• United States/epidemiology
• Positive-Pressure Respiration/methods
• Respiration, Artificial/methods
• Neoplasms/complications
• Neoplasms/epidemiology
• Hematologic Neoplasms/complications
• Hematologic Neoplasms/epidemiology
• Respiratory Insufficiency/epidemiology
• Respiratory Insufficiency/etiology
• Respiratory Insufficiency/therapy

• K23 HL151671 NHLBI NIH HHS

• Lung Injury Prevention Score
• acute respiratory distress syndrome
• acute respiratory failure
• bone marrow transplant
• hematopoietic stem cell transplantation

• Humans
• Bone Marrow Transplantation/adverse effects
• Lung Injury/complications
• Cohort Studies
• Respiratory Distress Syndrome/therapy
• Respiratory Distress Syndrome/complications
• Respiratory Insufficiency/therapy

• K23 HL151671 NHLBI NIH HHS
• K23HL151671 NHLBI NIH HHS
• National Heart, Lung, and Blood Institute

• Bone marrow transplantation
• bronchiolitis obliterans
• diffusing capacity
• pulmonary function
• spirometry

• Humans
• Prognosis
• Retrospective Studies
• Hematopoietic Stem Cell Transplantation/adverse effects
• Chronic Disease
• Cyclophosphamide
• Recurrence
• Transplantation Conditioning
• Bronchiolitis Obliterans/etiology

• K23 HL151671 NHLBI NIH HHS
• R01 HL062150 NHLBI NIH HHS

• Humans
• Pneumonia/etiology
• Hematopoietic Stem Cell Transplantation

• as
• co-expression
• hsct-ards
• rbps
• rna-seq

• Humans
• Alternative Splicing/genetics
• Reactive Oxygen Species/metabolism
• Hematopoietic Stem Cell Transplantation/adverse effects
• Respiratory Distress Syndrome/genetics
• Respiratory Distress Syndrome/therapy
• RNA-Binding Proteins/genetics
• RNA-Binding Proteins/metabolism
• Antiviral Agents

• cancer patient
• extracorporeal membrane oxygenation
• intensive care unit

• Adult
• Humans
• Extracorporeal Membrane Oxygenation/adverse effects
• Retrospective Studies
• Prospective Studies
• Neoplasms/complications
• Neoplasms/therapy
• Heart

• Chronic graft-versus-host disease
• Emergency department
• Hematopoietic stem cell transplantation
• Organ dysfunction

• Hematopoietic stem cell transplantation
• Pulmonary complications

• Humans
• Bronchiolitis Obliterans/etiology
• Bronchiolitis Obliterans/therapy
• Pneumonia/etiology
• Hematopoietic Stem Cell Transplantation/adverse effects
• Bronchiolitis Obliterans Syndrome

• ARDS
• ICU
• bone marrow transplant
• hematopoietic stem cell transplantation
• immunocompromised host
• respiratory failure

• Humans
• Case-Control Studies
• Risk Factors
• Sepsis/etiology
• Hematopoietic Stem Cell Transplantation/adverse effects
• Hospitals
• Retrospective Studies

• K23 HL151671 NHLBI NIH HHS

Acute respiratory distress syndrome (ARDS) is a life-threatening lung disease. It may occur during the pancytopenia phase following allogeneic hematopoietic cell transplantation (HCT). ARDS is rare following HCT. Mesenchymal stromal cells (MSCs) have strong anti-inflammatory effect and first home to the lung following intravenous infusion. MSCs are safe to infuse and have almost no side effects. During the Covid-19 pandemic many patients died from ARDS. Subsequently MSCs were evaluated as a therapy for Covid-19 induced ARDS. We report three patients, who were treated with MSCs for ARDS following HCT. Two were treated with MSCs derived from the bone marrow (BM). The third patient was treated with MSCs obtained from the placenta, so-called decidua stromal cells (DSCs). In the first patient, the pulmonary infiltrates cleared after infusion of BM-MSCs, but he died from multiorgan failure. The second patient treated with BM-MSCs died of aspergillus infection. The patient treated with DSCs had a dramatic response and survived. He is alive after 7 years with a Karnofsky score of 100%. We also reviewed experimental and clinical studies using MSCs or DSCs for ARDS. Several positive reports are using MSCs for sepsis and ARDS in experimental animals. In man, two prospective randomized placebo-controlled studies used adipose and BM-MSCs, respectively. No difference in outcome was seen compared to placebo. Some pilot studies used MSCs for Covid-19 ARDS. Positive results were achieved using umbilical cord and DSCs however, optimal source of MSCs remains to be elucidated using randomized trials.

• Animals
• Female
• Humans
• Male
• COVID-19/complications
• COVID-19/therapy
• Hematopoietic Stem Cell Transplantation/adverse effects
• Mesenchymal Stem Cell Transplantation
• Mesenchymal Stem Cells/physiology
• Prospective Studies
• Respiratory Distress Syndrome/therapy

• ARDS
• implementation science
• mechanical ventilation
• pediatrics
• qualitative research
• user-centered design

• Acute Lung Injury
• Adult
• Child
• Humans
• Intensive Care Units, Pediatric
• Respiration, Artificial/methods
• Respiratory Distress Syndrome/diagnosis
• Respiratory Distress Syndrome/therapy
• Retrospective Studies

Published experience with autologous stem-cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) from the Indian subcontinent is extremely limited. Here, we describe the activity and outcomes of this treatment modality at a large tertiary care center in India.

• critical care
• hematopoietic stem cell transplantation
• mortality
• bone marrow transplantation
• renal replacement therapy
• hematological malignancy
• intensive care
• mechanical ventilation
• vasopressors

• Humans
• Brazil/epidemiology
• Retrospective Studies
• Intensive Care Units
• Hospitalization
• Hematopoietic Stem Cell Transplantation/adverse effects
• Hematopoietic Stem Cells
• Neoplasms

• Respiratory failure
• Respiratory insufficiency
• acute hypoxemic respiratory failure
• acute respiratory distress syndrome
• bone marrow transplantation
• hematologic malignancies
• hematopoietic stem cell transplantation

• cytokines
• hematopoietic stem cell transplantation
• microbiota
• phenotype
• pneumonia

Management of hematopoietic stem cell transplant complicated by respiratory failure has been facilitated by the use of extracorporeal membrane oxygenation as a bridge to curative chemotherapeutic options. This is the first report of hematopoietic stem cell transplantation on extracorporeal membrane oxygenation in the adult population.

• acute respiratory distress syndrome
• aplastic anemia
• engraftment
• extracorporeal life support
• extracorporeal membrane oxygenation
• hematopoietic stem cell transplantation

• acute respiratory distress syndrome
• bone marrow transplant
• engraftment syndrome
• hematopoietic stem cell transplantation
• respiratory failure

• PERDS
• immunosuppression
• periengraftment
• respiratory failure
• stem cell transplant

Non-invasive ventilation (NIV) was one of the first-line ventilation supports for hematopoietic stem-cell transplantation (HSCT) patients with acute respiratory distress syndrome (ARDS). Successful NIV may avoid need for intubation. However, the influence NIV failure had on patients’ outcome and its risk factors were hardly known.

In this retrospective observational study, we reported risk factors and incidence of NIV failure in HSCT patients who were admitted to the Intensive Care Unit (ICU) with a diagnosis of ARDS and supported with mechanical ventilation, in a 5-year period. Patient outcomes, such as ventilator-free days, ICU-free days, and ICU mortality were also reported.

Of all the 94 patients included, 70 patients were initially supported with NIV. NIV failure occurred in 44 (63%) patients. Male sex, elevated serum galactomannan (GM) test, (1-3)-β-D-glucan (BG) assay, or elevated serum creatinine level were risk factors for NIV failure. When compared with the NIV success group, failure of NIV was associated with much fewer ICU-free days (22 versus 0, p < 0.001, Cohen’s d = 0.62) and higher ICU mortality (9.5% versus 75.5%, p < 0.001, Pearson’s r = 0.75). There was no difference in ICU-free days, ventilator-free days and ICU mortality between NIV failure and initial invasive mechanical ventilation (IMV) groups. Patients who failed in NIV support had a higher ICU mortality (75.5%) than those who succeeded (9.5%).

In a small cohort of HSCT patients with mainly moderate severity of ARDS, male patients with elevated serum GM/BG test or serum creatinine level had a higher risk of NIV failure. Both NIV failure and initial IMV groups were characterized by high mortality rate and extremely low ICU-free days and ventilator-free days; failure of NIV support may further aggravate patient prognosis.

The reviews of this paper are available via the supplemental material section.

• acute respiratory distress syndrome
• hematopoietic stem-cell transplantation
• non-invasive ventilation

Acute respiratory failure (ARF) is the main reason for ICU admission following allogeneic hematopoietic stem cell transplantation (HSCT). Extracorporeal CO₂ removal (ECCO₂R) can be used as an adjunct to mechanical ventilation in patients with severe hypercapnia but has not been assessed in HSCT recipients. Retrospective analysis of all allogeneic HSCT recipients ≥18 years treated with ECCO₂R at two HSCT centers. 11 patients (m:f = 4:7, median age: 45 [IQR: 32‐58] years) were analyzed. Acute leukemia was the underlying hematologic malignancy in all patients. The time from HSCT to ICU admission was 37 [8‐79] months, and 9/11 (82%) suffered from chronic graft‐versus‐host disease (GVHD) with lung involvement. Pneumonia was the most frequent reason for ventilatory decompensation (n = 9). ECCO₂R was initiated for severe hypercapnia (P_aCO₂: 96 [84‐115] mm Hg; pH: 7.13 [7.09‐7.27]) despite aggressive mechanical ventilation (invasive, n = 9; non‐invasive, n = 2). ECCO₂R effectively resolved blood gas disturbances in all patients, but only 2/11 (18%) could be weaned off ventilatory support, and one (9%) patient survived hospital discharge. Progressive respiratory and multiorgan dysfunction were the main reasons for treatment failure. ECCO₂R was technically feasible but resulted in a low survival rate in our cohort. A better understanding of the prognosis of ARF in patients with chronic GVHD and lung involvement is necessary before its use can be reconsidered in this setting.

• extracorporeal CO2 removal
• hematology
• hematopoietic stem cell transplantation
• intensive care unit

• acute respiratory distress syndrome
• corticosteroids
• hematopoietic stem cell transplantation

• bronchoscopy
• critical care
• diffuse parenchymal lung disease
• interventional pulmonology
• transbronchial cryobiopsy

• Complications
• Critical care
• Hematopoietic stem cell transplantation
• Mechanical ventilation
• Sepsis

• bone marrow transplant
• diffuse alveolar hemorrhage
• hematology

• Acute renal failure
• Acute respiratory distress syndrome
• Bone marrow transplant
• Cytokine release syndrome
• Engraftment syndrome
• Graft-versus-host disease
• Hematopoietic stem cell transplant
• Neutropenic sepsis

• Critical Care
• Hematopoietic Stem Cell Transplantation/adverse effects
• Humans
• Respiratory Insufficiency/etiology
• Respiratory Insufficiency/therapy
• Sepsis/etiology
• Sepsis/therapy

• chimeric antigen receptor T-cell (CAR-T) therapy
• endothelial cell dysfunction
• endothelial-related disorders
• haematopoietic cell transplantation
• treatment for post-HCT complications

Hematopoietic stem cell transplant (HSCT) is an essential treatment modality for many malignant and non-malignant hematologic diseases. Advances in HSCT techniques have dramatically decreased peri-transplant morbidity and mortality, but it remains a high-risk procedure, and a significant number of patients will require critical care during the transplant process. Complications of HSCT are both infectious and non-infectious, and the intensivist must be familiar with common infections, the management of neutropenic sepsis and septic shock, the management of respiratory failure in the immunocompromised host, and a plethora of HSCT-specific complications. Survival from critical illness after HSCT is improving, but the mortality rate remains unacceptably high. Continued research and optimization of critical care provision in this population should continue to improve outcomes.

Acute respiratory distress syndrome (ARDS) is a heterogeneous form of acute, diffuse lung injury that is characterized by dysregulated inflammation, increased alveolar-capillary interface permeability, and non-cardiogenic pulmonary edema. In the general population, the incidence and mortality associated with ARDS over the last two decades have steadily declined in parallel with optimized approaches to pneumonia and other underlying causes of ARDS as well as increased utilization of multimodal treatment strategies that include lung-protective ventilation. In the cancer settings, significant declines in the incidence and mortality of ARDS over the past two decades have also been reported, although these rates remain significantly higher than those in the general population. Epidemiologic studies identify infection, including disseminated fungal pneumonias, as a major underlying cause of ARDS in the cancer setting. More than half of cancer patients who develop ARDS will not survive to hospital discharge. Those who do survive often face a protracted and often incomplete recovery, resulting in significant long-term physical, psychological, and cognitive sequelae. The residual organ dysfunction and poor functional status after ARDS may delay or preclude subsequent cancer treatments. As such, close collaboration between the critical care physicians and oncology team is essential in identifying and reversing the underlying causes and optimizing treatments for cancer patients with ARDS. This chapter reviews the diagnosis and common causes of ARDS in cancer and gives an update on the general management principles for cancer patients with ARDS in the ICU.

• Autologous stem-cell transplantation
• Brain neoplasms
• Chemotherapy
• Medulloblastoma
• Pediatrics

• PCP
• PJP
• immunosuppression
• pneumocystis
• respiratory failure

• Acute respiratory distress syndrome (ARDS)
• Bone marrow transplant
• Hematopoietic stem cell transplantation
• RNA sequencing
• RNA-Seq
• Respiratory failure
• Transcriptome profiling

• Adult
• Female
• Hematopoietic Stem Cell Transplantation/adverse effects
• Hematopoietic Stem Cell Transplantation/trends
• Humans
• Male
• Middle Aged
• Registries
• Respiratory Distress Syndrome/blood
• Respiratory Distress Syndrome/genetics
• Respiratory Distress Syndrome/therapy
• Sequence Analysis, RNA/methods
• Sequence Analysis, RNA/trends
• Transcriptome/genetics

• K08 GM102695 NIGMS NIH HHS
• R01 HL141992 NHLBI NIH HHS
• T32 HL007586 NHLBI NIH HHS
• R01 HL135142 NHLBI NIH HHS
• R01 HL133433 NHLBI NIH HHS
• R56 HL142767 NHLBI NIH HHS
• K08 HL143197 NHLBI NIH HHS
• R01 HL112747 NHLBI NIH HHS
• National Institute of General Medical Sciences
• National Heart, Lung, and Blood Institute
• GlaxoSmithKline
• Marhsall Neilson Fund for GVHD Research

Recent decades have seen an increase in the number of patients living with cancer. This trend has resulted in an increase in intensive care unit (ICU) utilization across this population [1]. Acute respiratory failure is the most frequent medical complication leading to critical illness in oncologic patients [2–4]. Historically, there had been a reluctance to admit cancer patients to the ICU given their poor outcomes, particularly in the setting of hematologic malignancy and invasive mechanical ventilation [5]. ICU treatment limitations or refusal of admission was advocated [6]. Major advances in oncologic care, critical care and more meticulous attention to where the conditions overlap, have resulted in marked improvement in short-term survival in this population [1, 7, 8]. Despite these major advances, acute respiratory failure in this population remains complex with unique challenges surrounding diagnosis and management compared to the general ICU population. This chapter provides a comprehensive overview of acute respiratory failure in the oncologic population and highlights specific considerations for the intensivist. We will focus on the important differences between the immunocompromised oncologic patient and general intensive care population, the spectrum of causes of acute respiratory failure with a specific focus on toxicities related to newer cancer therapies, diagnostic approach, management and an up-to-date overview of prognosis.

The number of patients receiving hematopoietic stem cell transplantation (HSCT) is rapidly rising worldwide. Despite substantial improvements in peri-transplant care, pulmonary complications resulting in respiratory failure remain a major contributor to morbidity and mortality in the post-transplant period, and represent a major barrier to the overall success of HSCT. Infectious complications include pneumonia due to bacteria, viruses, and fungi, and most commonly occur during neutropenia in the early post-transplant period. Non-infectious complications include idiopathic pneumonia syndrome, peri-engraftment respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary veno-occlusive disease, delayed pulmonary toxicity syndrome, cryptogenic organizing pneumonia, bronchiolitis obliterans syndrome, and post-transplant lymphoproliferative disorder. These complications have distinct clinical features and risk factors, occur at differing times following transplant, and contribute to morbidity and mortality.

• Respiratory failure
• Pulmonary complications
• Hematopoietic stem cell transplantation
• Stem cell transplant
• Immunocompromised host

Hematopoietic stem cell transplantation (HSCT) has been an effective method for treating a wide range of malignant or non-malignant disorders. In case of an autologous HSCT, patients receive their own stem cells after myeloablation before extraction. Allogeneic HSCT uses stem cells derived from a donor. Despite being associated with a high risk of early and long-term complications, it is often the last curative option. 229 pediatric patients, who between 1 January 2005 and 31 December 2015 received an HSCT at the University Children’s Hospital Wuerzburg, were studied. Correlations between two groups were calculated with the Chi square test or with a 2x2-contingency table. To calculate metric variables, the Mann-Whitney-U-test was used. Survival curves were calculated according to Kaplan and Meier. Significance was assumed for results with a p-value <0.05 (CI (Confident Interval) 95%). We retrospectively analyzed 229 pediatric patients (105 females, 124 males) for early and late complications of allogeneic and autologous hematopoietic stem cell transplantation. Median age at HSCT was seven years. Underlying diseases were leukemia (n = 73), lymphoma (n = 22), solid tumor (n = 65), CNS (central nervous system)- tumor (n = 41), and “other diseases” (n = 28). Survival times, overall survival, and event-free survival were calculated. Of all patients, 80.8% experienced complications of some degree, including mild and transient complications. Allo-HSCT (allogeneic HSCT) carried a significantly higher risk of complications than auto-HSCT (autologous HSCT) (n = 118 vs. n = 67; p = < .001) and the remission rate after allo-HSCT was also higher (58.7% vs. 44,7%; p = .032). Especially infection rates and pulmonary complications are different between auto- and allo-HSCT. Leukemia patients had the highest risk of early and late complications (95,0%; p < .001). Complications within HSCT are major risk factors following morbidity and mortality. In order to detect complications and risk factors early, strict recordings are needed to reduce the rate of complication by recognition and prevention of triggering factors. In the future, these factors should receive greater attention in the planning of HSCT post-transplantation care in order to improve the results of the transplantation and establish protocols to prevent their occurrence.

• Adolescent
• Child
• Child, Preschool
• Female
• Hematopoietic Stem Cell Transplantation/adverse effects
• Humans
• Infant
• Longitudinal Studies
• Male
• Retrospective Studies
• Risk Factors
• Survival Analysis
• Transplantation Conditioning
• Transplantation, Autologous/adverse effects
• Transplantation, Homologous/adverse effects

• Cancer patients
• Extracorporeal membrane oxygenation (ECMO)
• Feasibility
• Leucopenia
• Thrombocytopenia

• Adult
• Extracorporeal Membrane Oxygenation
• Female
• Hematologic Neoplasms/complications
• Hematologic Neoplasms/immunology
• Hematologic Neoplasms/mortality
• Hematologic Neoplasms/therapy
• Hematopoietic Stem Cell Transplantation
• Humans
• Immunocompromised Host
• Leukopenia/immunology
• Leukopenia/therapy
• Male
• Middle Aged
• Pneumonia/blood
• Pneumonia/immunology
• Pneumonia/mortality
• Pneumonia/therapy
• Respiratory Distress Syndrome/blood
• Respiratory Distress Syndrome/immunology
• Respiratory Distress Syndrome/mortality
• Respiratory Distress Syndrome/therapy
• Retrospective Studies
• Survival Rate
• Thrombocytopenia/immunology
• Thrombocytopenia/therapy
• Treatment Outcome