Respiratory Failure and Intensive Care Support Following Bone Marrow Transplantation

Recipients of allogeneic bone marrow transplantation frequently develop life threatening complications, which require intensive care management. The reported prognosis of bone marrow transplant (BMT) recipients who require admission to the intensive care unit (ICU) is poor [1], We retrospectively examined the records of 25 BMT patients at our centre who required ICU admission between January 1989 and May 1997. Respiratory failure was the most frequent reason for admission. Twenty five patients required ventilation and two of these survived. Fifteen patients were investigated at an early stage using bronchoscopy. Fifteen patients had bronchoalveolar lavage (BAL) and 8 had transbronchial biopsies (TBB). Despite positive findings in 5 BAL and 3 TBB and an appropriate change in treatment, none of these patients survived. In spite of early investigation and intensive support the prognosis of patients with severe respiratory failure after BMT remains poor. Early investigation with bronchoscopy provides a diagnosis in 50% of cases although we are unable to demonstrate a survival advantage in this group of patients.