Outcome of Children Requiring Intensive Care Following Hematopoietic Stem Cell Transplantation: A Single Center...

Area of Science:

• Pediatric Intensive Care
• Hematopoietic Stem Cell Transplantation
• Critical Care Medicine

Background:

• Hematopoietic stem cell transplantation (HSCT) can lead to serious complications requiring pediatric intensive care unit (PICU) support.
• Data on PICU outcomes for pediatric HSCT patients in middle-income countries (MICs) are scarce.

Purpose of the Study:

• To describe the characteristics and outcomes of children admitted to the PICU following HSCT in Colombia.
• To identify factors associated with mortality in these critically ill pediatric patients.

Main Methods:

• A retrospective review of 104 children undergoing HSCT between January 2012 and June 2019.
• Analysis of baseline characteristics, clinical course, PICU admissions, treatments, and survival.
• Bivariate analysis to compare characteristics of survivors and non-survivors in the PICU.

Main Results:

• Twenty-five PICU admissions were recorded, with an overall survival rate of 64% from PICU discharge.
• The most common underlying disease was immunodeficiency (33%).
• Primary reasons for PICU admission were respiratory problems (48%) and cardiovascular instability (40%).
• Cardiovascular support (84%) and respiratory support (72%) were the most frequent PICU interventions.
• Allogeneic HSCT patients admitted to the PICU had a high mortality rate.
• Invasive respiratory support, high vasoactive-inotropic scores, renal replacement therapy, and multi-organ failure were linked to mortality.

Conclusions:

• Children requiring PICU admission post-HSCT, particularly after allogeneic HSCT, face significant mortality risks.
• Prompt recognition and management of respiratory and cardiovascular complications are crucial.
• Factors like invasive ventilation, hemodynamic support needs, renal failure, and multi-organ dysfunction predict poor outcomes in critically ill pediatric HSCT patients.