Case 121 – Update 2!

We suspect cytokine-release syndrome (CRS) in our patient 5 days post CAR T-cell infusion. We manage her with aggressive fluid boluses, low-flow nasal cannula oxygen and paracetamol. We also complete a septic screen and cover her with broad-spectrum antibiotics. Her observations initially improve and she remains on the haematology ward. The next afternoon at 2pm you are asked to review the patient again.

She continues to spike high-grade fevers despite regular paracetamol and oxygen requirement has increased to 40% via facemask.

On further assessment, you also note that our patient appears a little muddled and less orientated.

What would be your next steps in the acute investigation and management of this patient?


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