Managing Immune Checkpoint Inhibitor Pneumonitis in the ICU

Kristina Montemayor, MD, MHS; Mohammad I. Ghanbar, MD; Abigail L. Koch, MD, MHS; Karthik Suresh, MD; Robert Scott Stephens, MD

CHEST Critical Care (Mar 2025)

Managing Immune Checkpoint Inhibitor Pneumonitis in the ICU

Kristina Montemayor, MD, MHS,
Mohammad I. Ghanbar, MD,
Abigail L. Koch, MD, MHS,
Karthik Suresh, MD,
Robert Scott Stephens, MD

Affiliations

Kristina Montemayor, MD, MHS: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
Mohammad I. Ghanbar, MD: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
Abigail L. Koch, MD, MHS: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
Karthik Suresh, MD: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
Robert Scott Stephens, MD: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; CORRESPONDENCE TO: Robert Scott Stephens, MD

Journal volume & issue: Vol. 3, no. 1
p. 100126

Abstract

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Recent advancements in the management of non-small cell lung cancer, especially with immunotherapeutic agents like immune checkpoint inhibitors (ICIs), have improved patient outcomes significantly. However, despite their effectiveness, ICIs can cause immune-related adverse events, including checkpoint inhibitor pneumonitis. Diagnosing and managing pneumonitis can be particularly challenging and patients with moderate or severe symptoms typically require ICU level of care. The management of patients with ICI pneumonitis requires a multidisciplinary approach and numerous treatment decisions, including the use of systemic corticosteroids and adjunctive therapies in certain cases. In this How I Do It article, we offer a case-based discussion covering evaluation, common radiographic changes, diagnosis, grading, and management of ICI pneumonitis in patients in the ICU. We also address common clinical decisions related to corticosteroid dosing, guidance on initiation of adjunctive therapies, and future use of ICI therapy.

Published in CHEST Critical Care

ISSN: 2949-7884 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/chest-critical-care

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Abstract

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