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Survival outcome among 54 intubated pediatric bone marrow transplant patients
1Gwynne Hazen Cherry Memorial Laboratories, Department of Pediatrics, UCLA School of Medicine 90024-1752.
Insights
Pediatric bone marrow transplant recipients requiring mechanical ventilation have poor outcomes, especially with multiple organ failure or lung disease. These factors are critical for guiding ventilation decisions in this vulnerable population.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Oncology
Background:
- Endotracheal intubation and mechanical ventilation are critical interventions for pediatric bone marrow transplant (BMT) recipients experiencing respiratory failure.
- Identifying prognostic indicators is crucial for informed decision-making regarding mechanical ventilation in this high-risk patient group.
Purpose of the Study:
- To evaluate the outcomes of pediatric BMT patients who required endotracheal intubation.
- To identify prognostic factors that may aid in decisions about initiating mechanical ventilation.
Main Methods:
- Retrospective chart review of 54 pediatric BMT recipients who underwent endotracheal intubation.
- Analysis of variables including organ system failure, duration of ventilation, respiratory failure etiology, graft-versus-host disease, and underlying disease.
Main Results:
- Only 6 out of 54 intubated pediatric BMT patients were successfully extubated and discharged.
- Patients with leukemia or multiple organ system failure had no survival.
- Pulmonary parenchymal disease was associated with a poor prognosis.
Conclusions:
- The decision to intubate pediatric BMT patients is complex.
- Multiple organ system failure and primary pulmonary parenchymal disease are linked to high mortality rates in this population.
- These factors should be considered when initiating and managing mechanical ventilation.
Objectives:
To assess the outcome of children who required endotracheal intubation after bone marrow transplantation and to determine whether prognostic indicators that might assist decision-making regarding the institution of mechanical ventilation could be identified.
Design:
Retrospective chart review.
Setting:
Critical care, reverse isolation unit at a university hospital.
Patients:
Fifty-four pediatric bone marrow transplant recipients who required endotracheal intubation.
Interventions:
None.
Measurements And Main Results:
The following variables were assessed for effect on survival: a) the presence of additional nonhematoporetic organ system failure; b) the duration of required ventilatory assistance; c) the etiology of respiratory failure; d) the presence of significant graft vs. host disease; and e) the underlying disease for which the transplant was done. Six of 54 intubated pediatric bone marrow transplant recipients were extubated and discharged from the hospital. No patient with a diagnosis of leukemia or with multiple organ system failure could be extubated or discharged from the hospital. The presence of pulmonary parenchymal disease indicated poor prognosis for survival.
Conclusions:
The decision to intubate a pediatric bone marrow transplant patient remains a difficult one. In this population, multiple organ system failure and primary pulmonary parenchymal disease were associated with a high mortality rate. These factors should be taken into account before and throughout the course of mechanical ventilation in this patient population.