The Oncology and Immunocompromised Patient in the ICU

Overview & definition

The immunocompromised patient in the ICU deteriorates fast and presents faintly — the neutrophils are absent, the fever may be blunted, and the opportunistic organisms are the ones that kill. Whether the immune defect comes from chemotherapy (neutropenia), transplantation (solid organ or haematopoietic stem cell), immunosuppressive medication (steroids, biologics), or HIV (CD4 below 200), the approach is the same: broad differential, early empiric therapy, aggressive organ support. The single highest-yield cognitive manoeuvre is to classify the dominant immune defect before choosing empiric therapy — the defect predicts the pathogen, the pathogen predicts the drug, and the drug given inside the first hour predicts survival.^[1][14]

References52ShowHide

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