Related Experiment Videos
Prognosis of pediatric bone marrow transplant recipients requiring mechanical ventilation
R Rossi1, S D Shemie, S Calderwood
1University Children's Hospital, Münster, Germany.
Insights
Pediatric bone marrow transplant patients needing mechanical ventilation have a better prognosis than previously reported. Aggressive intensive care focusing on acute illness, not primary conditions, improves survival rates for these critically ill children.
Area of Science:
- Pediatric critical care medicine
- Hematology/Oncology
- Transplant medicine
Background:
- Mechanical ventilation is a critical intervention for pediatric bone marrow transplant recipients facing respiratory compromise.
- Prognosis and mortality risk factors for this specific patient population requiring mechanical ventilation are not well-defined.
Purpose of the Study:
- To evaluate the prognosis of pediatric bone marrow transplant recipients who require mechanical ventilation.
- To identify key risk factors associated with mortality in this cohort.
Main Methods:
- Retrospective chart review of pediatric patients admitted to a tertiary care pediatric intensive care unit (PICU).
- Inclusion criteria: endotracheal intubation and mechanical ventilation post-bone marrow transplantation (excluding perioperative ventilation).
- Outcome measures included extubation, PICU discharge, and 6-month survival.
Main Results:
- Overall survival to PICU discharge was 44% (17/39 patients), with a 6-month post-discharge survival rate of 36%.
- Preexisting conditions (primary disease, engraftment, graft-vs.-host disease) did not significantly impact survival.
- Multiple organ failure, particularly pulmonary and neurologic deterioration, were significant predictors of mortality.
Conclusions:
- The prognosis for pediatric bone marrow transplant recipients requiring mechanical ventilation appears improved compared to historical data.
- Early and aggressive intensive care is recommended for this vulnerable patient group.
- Treatment intensity decisions should prioritize acute illness factors over primary underlying conditions.
Objectives:
To assess the prognosis of pediatric bone marrow transplant recipients requiring mechanical ventilation and to identify risk factors for mortality.
Design:
Retrospective chart review.
Setting:
Pediatric intensive care unit (PICU), tertiary care center.
Patients:
Inclusion criteria were endotracheal intubation and mechanical ventilation after bone marrow transplantation; patients with perioperative ventilation were excluded. Outcome measures were extubation, PICU discharge, and 6-month survival. The 39 patients who met the inclusion criteria were ventilated on 41 occasions.
Interventions:
None.
Measurements And Main Results:
Overall survival rate to PICU discharge was 44% (17 of 39 patients). Six months after PICU discharge, 14 of these children were still alive, for a medium-term survival rate of 36%. Preexisting conditions (primary disease, bone marrow engraftment, or graft-vs.-host disease) had no significant effect on survival. Multiple organ failure, especially pulmonary failure and neurologic deterioration, were significant determinants of patient survival.
Conclusions:
The observed prognosis is improved over previous reports. Early initiation of aggressive intensive care treatment is warranted in this patient group. Decisions regarding intensity of treatment must be based on aspects of the acute illness rather than on the primary conditions.