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Outcome of children who require mechanical ventilatory support after bone marrow transplantation
H T Keenan1, S L Bratton, L D Martin
1Department of Pediatrics, University of North Carolina at Chapel Hill, USA.
Insights
Prognosis is poor for pediatric bone marrow transplant patients needing mechanical ventilation. Factors like respiratory failure, infection, and multi-organ dysfunction significantly decrease survival chances.
Area of Science:
- Pediatric critical care medicine
- Hematology and oncology
- Transplant medicine
Background:
- Mechanical ventilatory support is a critical intervention for pediatric patients post-bone marrow transplant.
- Identifying predictive factors for outcomes in this vulnerable population is essential for clinical decision-making.
Purpose of the Study:
- To identify clinically measurable factors that predict outcomes for pediatric patients requiring mechanical ventilatory support after bone marrow transplantation.
Main Methods:
- A retrospective cohort study was conducted at a bone marrow transplant referral center.
- Data were abstracted from 121 pediatric patients (<17 years) who received a bone marrow transplant and required mechanical ventilatory support for ≥24 hours between 1983 and 1996.
Main Results:
- Overall survival to extubation and 30-day post-extubation survival was 16% (19 out of 121 patients).
- Key predictors of mortality included respiratory failure as the indication for intubation (4% survival), pulmonary infection (6% survival), and dysfunction of more than one organ system (2% survival if multiple organ systems were affected by day 7).
Conclusions:
- The prognosis for pediatric bone marrow transplant recipients requiring mechanical ventilation is generally poor.
- Children with multi-organ system dysfunction by day 7 post-intubation have an extremely low survival probability, suggesting a potential consideration for limiting medical support in select cases, pending further research.
Objective:
To identify clinically measurable factors that could predict outcome for pediatric patients undergoing mechanical ventilatory support after bone marrow transplant.
Design:
Cohort study.
Setting:
A referral center for bone marrow transplant patients in Seattle, Washington.
Patients:
Children <17 yrs old who received a bone marrow transplant and subsequently required mechanical ventilatory support for > or =24 hrs between 1983 and 1996.
Interventions:
None.
Measurements And Main Results:
Data were abstracted from the charts of 121 pediatric patients who received a bone marrow transplant and subsequently required mechanical ventilatory support. A total of 19 patients (16%) survived to be extubated and survived for > or =30 days postextubation. Major risk factors for death included respiratory failure as the reason for endotracheal intubation (4% survival), the presence of pulmonary infection (6% survival), and impairment of more than one organ system (2% survival if more than one organ system was dysfunctional on day 7 postintubation).
Conclusions:
Although the prognosis generally is poor among pediatric bone marrow transplant recipients who subsequently require mechanical ventilatory support, there appear to be some groups within this population in whom the likelihood of survival is close to 0. Because the chance of survival was so small for children with dysfunction of more than one organ system on day 7 after intubation, a recommendation to limit medical support for these children could be considered pending the results of other studies.