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Outcome of pediatric hematopoietic stem cell transplant recipients requiring mechanical ventilation

François Aspesberro1, Katherine A Guthrie, Ann E Woolfrey

  • 1Seattle Children's Hospital, University of Washington, Seattle, WA, USA.

Journal of Intensive Care Medicine
|August 21, 2012
PubMed

Insights

Hematopoietic stem cell transplantation (HSCT) in children has improved survival. Factors like cardiovascular failure increase mortality risk, while mechanical support may decrease long-term survival.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Oncology

Background:

  • Hematopoietic stem cell transplantation (HSCT) is a critical treatment for pediatric hematologic malignancies and other diseases.
  • Identifying risk factors for intensive care unit (ICU) admission and mortality is crucial for improving outcomes in pediatric HSCT patients.
  • Previous survival rates for pediatric HSCT patients requiring mechanical ventilation were low.

Purpose of the Study:

  • To identify risk factors associated with pediatric intensive care unit (PICU) admission in children undergoing HSCT.
  • To evaluate the impact of multiple organ failure (MOF) on mortality among HSCT patients requiring mechanical ventilation (MV).

Main Methods:

  • Retrospective chart review of pediatric HSCT patients admitted to a tertiary care pediatric hospital's critical care unit between January 2000 and September 2006.
  • Analysis of 266 HSCT patient charts to determine risk factors for PICU admission and mortality.
  • Comparison of survival rates with a historical cohort (1983-1996).

Main Results:

  • Nonmalignant disease, acute graft-versus-host disease (grades III-IV), and second HSCT increased PICU admission odds.
  • Among patients on MV for >24 hours, 6-month survival was 25% and long-term survival was 22%, a significant improvement over historical data (7%).
  • Cardiovascular failure, MV >1 week, and prolonged continuous renal replacement therapy (CRRT) increased mortality risk.

Conclusions:

  • Six-month survival for pediatric HSCT patients was 25%.
  • Cardiovascular failure, not MOF, increased mortality risk in ventilated HSCT patients.
  • Mechanical support (MV, CRRT) and cardiovascular support (inotropic agents) were associated with decreased long-term survival.
Abstract

Keywords:
cardiovascular failurefluid overloadhematopoietic stem cell transplant (HSCT)mechanical ventilationrespiratory failure

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