Moller et al used the forced expiratory volume in 1 second (FEV1) as an early warning sign of pneumonia in a patient with acute myeloid leukemia (AML) and neutropenia. The authors are from Copenhagen University Hospital in Denmark.
Patient selection: AML with neutropenia (usually post combination chemotherapy)
FEV1 was measured daily and a personal baseline determined.
The risk for pneumonia increased when the FEV1 decreased > 15% (< 85% of baseline).
An FEV1 < 80% of baseline had a positive predictive value of 70% and negative predictive value of 94%
The authors found that use of positive expiratory pressure with a "PEP flute" (resistance of 10-20 cm H2O) several times a day during periods of neutropenia can reduce the frequency of pneumonia.
If FEV1 was >= 90% of usual FEV1 then use was 15 breaths >= 3 times for >= 2 times per day.
If FEV1 was less than 90% of usual FEV1 then use increased to 3-4 times a day.
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