Outcome of pediatric hematopoietic stem cell transplant recipients requiring mechanical ventilation

J Intensive Care Med. 2014 Jan-Feb;29(1):31-7. doi: 10.1177/0885066612457343. Epub 2012 Aug 17.

Abstract

Purpose: To assess the risk factors for intensive care unit admission among children receiving hematopoietic stem cell transplantation (HSCT) and to test the hypothesis that multiple organ failure (MOF) increases the odds of death among HSCT patients who receive mechanical ventilation (MV).

Methods: The chart of all consecutive HSCTs at Seattle Children's Hospital and pediatric HSCT patients admitted to the pediatric critical care unit of a tertiary care pediatric hospital from January 2000 to September 2006 were reviewed retrospectively.

Results: Charts of 266 HSCT patients were reviewed. Nonmalignant disease compared to hematologic malignancy, acute graft versus host disease grades III and IV, and second transplant increased the odds of pediatric intensive care unit admission. Among patients receiving MV for >24 hours, 9 (25%) survived for 6 months, while 8 patients (22%) were long-term survivors with a median follow-up time of 3.6 years, a significant improvement compared to a long-term survival of 7% (odds ratio 0.25, 95% confidence intervals: 0.09-0.72, P = .01) reported in a previously published cohort of pediatric HSCT patients at the same institution from 1983 to 1996. Cardiovascular failure, duration of MV for greater than 1 week, and prolonged receipt of continuous renal replacement therapy (CRRT) increased the risk of mortality.

Conclusions: Six-month survival of pediatric HSCT patients was 25% and the odds of death were increased by cardiovascular failure but not by MOF. Receipt of mechanical support (ventilation, CRRT) or cardiovascular support (inotropic agents) decreased the likelihood of long-term survival.

Keywords: cardiovascular failure; fluid overload; hematopoietic stem cell transplant (HSCT); mechanical ventilation; respiratory failure.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Child
  • Cohort Studies
  • Female
  • Glasgow Coma Scale
  • Heart Failure / etiology
  • Heart Failure / mortality
  • Heart Failure / therapy
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Transplantation / mortality*
  • Hematopoietic Stem Cell Transplantation / statistics & numerical data
  • Humans
  • Intensive Care Units, Pediatric / statistics & numerical data
  • Male
  • Multiple Organ Failure / etiology
  • Multiple Organ Failure / mortality
  • Multiple Organ Failure / therapy
  • Odds Ratio
  • Patient Admission / statistics & numerical data*
  • Renal Replacement Therapy / adverse effects
  • Renal Replacement Therapy / statistics & numerical data
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / statistics & numerical data*
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / therapy*
  • Risk Factors
  • Survival Rate
  • Time Factors
  • Treatment Outcome
  • Washington