Related Experiment Video
Updated: May 23, 2025
Author Spotlight: Exploring the Lifespan Dynamics of Healthy Human Hematopoiesis
Published on: December 8, 2023
Integrated Pediatric Intensive Care and Hematopoietic Stem Cell Transplantation Service Improves The Peri-Transplant
Nalla Anuraag Reddy1, Rachit Mehta2, Indira Jayakumar2
1Department of Paediatric Haematology, Oncology; Blood & Marrow Transplants, Apollo Cancer Centres, Teynampet, Chennai, India.
Insights
Pediatric intensive care unit (PICU) referral after hematopoietic stem cell transplantation (HSCT) is critical. Improved survival rates were observed in recent years, highlighting the importance of integrated care for these high-risk pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Hematopoietic stem cell transplantation (HSCT)
- Pediatric intensive care unit (PICU) outcomes
Background:
- The peri-transplant period following HSCT is high-risk for complications requiring PICU admission.
- Historically, outcomes for PICU patients post-HSCT, especially those needing advanced support, have been poor.
- This study evaluates the outcomes of children referred to the PICU after HSCT.
Purpose of the Study:
- To assess the outcomes of pediatric patients undergoing HSCT who require PICU referral.
- To identify factors associated with mortality in this population.
- To evaluate changes in outcomes over time.
Main Methods:
- Retrospective analysis of children (1-18 years) undergoing HSCT from 2016-2023.
- Definition of clinical deteriorating events (CDEs) leading to PICU referral or ICU-level intervention.
- Analysis of reasons for referral, interventions, and organ support (respiratory, renal, cardiac).
- Comparison of outcomes between two 4-year intervals (2016-2019 and 2020-2023).
Main Results:
- 272 out of 934 HSCT patients required PICU referral, with 415 CDEs recorded.
- Common CDEs included hypotension (43%), disproportionate tachycardia (42%), and respiratory distress (26%).
- Overall peri-transplant survival was 73.8%. Survival on mechanical ventilation improved significantly (4.5% to 27.5%, p=0.005) between intervals.
- Hypotension, disproportionate tachycardia, and acute GVHD were significant risk factors for mortality.
Conclusions:
- Integrated care involving PICU teams is crucial for improving survival in critically ill pediatric HSCT patients.
- Timely interventions and protocol-driven PICU care have led to increased survival.
- Team-based care approaches are recommended for centers managing pediatric HSCT patients.
Background:
Peri-transplant is a critical period which is associated with a myriad of complications that require pediatric intensive care unit (PICU) referral. PICU outcomes have been historically poor post-hematopoietic stem cell transplantation (HSCT), especially when associated with inotrope support, invasive ventilation, and renal replacement therapy. The study aimed to assess the outcomes of PICU referral in children undergoing HSCT.
Patients & Methods:
A retrospective analysis was performed of children between 1 to 18 years of age who underwent HSCT between 2016 to 2023. A clinical deteriorating event (CDE) was defined as an unplanned transfer to the intensive care unit (ICU) or requiring ICU-level intervention on the floor. The reason for PICU referral, place of intervention, cause for the CDE, and requirement of respiratory, renal, and cardiac support were noted. The study period was divided into two 4-year intervals to assess change over time, 2016-2019 and 2020-2023.
Results:
In an eight-year period, a total of 934 HSCTs were performed, with 272 patients requiring PICU referral. A total of 415 CDEs were recorded. CDEs for PICU referrals were hypotension (43%), disproportionate tachycardia (42%), respiratory distress (26%), hypertension (22%), altered sensorium (8%), seizures (7.4%), and major bleeds (7.3%). Overall peri-transplant survival was 73.8% (n=201/272). Comparing the two study intervals, 2016-2019 and 2020-2023, the survival of patients on mechanical ventilation had improved from 4.5% to 27.5% (p=0.005) and from 39.4% to 55.9% (p=0.11) among those who received inotropes. Patients with three organ dysfunctions had worse outcomes. Disproportionate tachycardia [OR 0.19 CI 95% (0.06-0.64); p=0.008], hypotension [OR 0.177 CI 95% (0.04-0.84); p=0.029] and acute GVHD [OR 28.46 CI 95% (3.66-221); p=0.001] were significant risk factors for peri-transplant mortality as per multivariate analysis.
Conclusion:
Integrated care with the PICU team is the first step towards improving survival in these critically ill children. With timely intervention on the floors for CDEs and protocol-driven care in the PICU, we have demonstrated an increase in overall survival over the past four years and would recommend similar team-based care for units catering to children.
More Related Videos
Related Concept Videos
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...
01:01Regulation of Hematopoietic Stem Cells
01:21Stem Cell Therapy for Tissue Regeneration
Types of Stem Cells used in Stem Cell Therapy
The two main cell...
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:22iPS Cell Differentiation