The febrile granulocytopenic patient in the intensive care unit

Granylocytopenic patients with neoplastic disease who receive cytotoxic chemotherapy have a high risk of developing life-threatening infections. Such patients may be admitted to the intensive care unit (ICU) for hemodynamic, pulmonary, or gastrointestinal complications of these infections. Moreover, cancer patients who are admitted to the ICU for the respiratory, cardiac, metabolic, or renal complications of cytotoxic chemotherapy or radiation therapy often develop profound granulocytopenia with its concomitant risks of severe infections. Patients treated aggressively for potentially curable neoplastic diseases are often admitted to the ICU with persistent curable neoplastic diseases are often admitted to the ICU with persistent profound granulocytopenia, diffuse gastrointestinal mucosal erosions, and other defects of host defense. Successful management of such granulocytopenic patients by the critical care team requires an organized, informed, and rational approach to treating infections. The purpose of this article, therefore, is to review the diagnosis and management of infections in granylocytopenic patients who are admitted to critical care units.