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Pediatric stem cell transplantation and critical care (an outcome evaluation)
1Cardinal Glennon Children's Hospital, 1465 S. Grand, St. Louis, MO 63104, USA.
Insights
Pediatric stem cell transplant patients needing mechanical ventilation had a 16% survival rate. Survival improved for those with respiratory failure from non-lung organ issues, but lung infections or multi-organ failure led to poor outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology/Oncology
- Transplantation Immunology
Background:
- Stem cell transplantation (SCT) is a life-saving procedure for various pediatric conditions.
- Critical care is sometimes required post-SCT due to complications.
- Outcomes for critically ill pediatric SCT patients, particularly those with respiratory failure, require further elucidation.
Purpose of the Study:
- To review and synthesize outcomes of children requiring critical care after SCT.
- To identify factors associated with survival in this vulnerable population.
- To analyze causes of mortality in pediatric SCT patients admitted to the ICU.
Main Methods:
- Systematic review of eight published studies.
- Inclusion of pediatric patients requiring critical care post-stem cell transplant.
- Analysis of survival rates based on respiratory support, etiology of lung injury, and organ system involvement.
Main Results:
- Approximately 14% of pediatric SCT patients required mechanical ventilation.
- Survival rates for ventilated children were low (16%).
- Survival varied significantly based on the cause of respiratory failure, with non-lung organ system disease showing better outcomes (33-39%) compared to primary lung injury (11%) or non-bacterial lung infections (poor survival).
- Development of multi-organ system failure (MOSF) in conjunction with lung disease was associated with poor survival.
- The primary causes of death were MOSF and pulmonary failure.
Conclusions:
- Pediatric patients requiring mechanical ventilation post-SCT have a guarded prognosis.
- The etiology of respiratory failure and the presence of multi-organ system failure are critical determinants of survival.
- Further research into preventing and managing critical care complications in pediatric SCT is warranted.
Abstract:
This paper reviews eight published studies of children who required critical care following a stem cell transplant. Approximately 14% of children required mechanical ventilation following stem cell transplant. Sixteen percent of these children survived. Eleven percent of children who had primary lung injury secondary to either infectious or non-infectious causes survived. Patients with respiratory failure induced by disease in organ systems other than the lungs had much better survival (33-39%). Children reported to have a non-bacterial infectious lung disease had very poor survival. Children who developed multi-organ system failure (MOSF) in addition to lung disease also had poor survival. The majority of children died of MOSF or pulmonary failure.