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Respiratory Complications of ICIs
- Acute respiratory failure (ARF) is the leading cause of ICU admission for immunocompromised patients.
- While infectious etiologies remain the most common cause of ARF in these patients, there is an increasing prevalence of non-infectious, treatment-related causes.
- Immune check-point inhibitors (ICIs) are now used with increasing frequency, and can cause severe pulmonary toxicity in approximately 6% of patients.
- Pearls for ICI pulmonary toxicity include:
- Acute pneumonitis is the most common presentation
- Median time of onset of approximately 4 months after treatment initiation
- Symptoms include dry cough, hypoxemia, and infiltrates not c/w CHF, infection, or progression of malignancy
- Treatment is to DC the ICI and initiate steroids
References
Ferreyro BL, Munshi L. Causes of acure respiratory failure in the immunocompromised host. Curr Opin Crit Care. 2019;25:21-8.