Using outcomes research to improve the management of blood and marrow transplant recipients in the intensive care unit.
The practice of medicine is shaped by prior experiences. I believe that "outcomes research" involves studies that answer questions you need to resolve in order to more effectively practice medicine. Review of the outcomes of interventions is required to assess the effectiveness of our interventions. The major management problem of blood and marrow transplantation (BMT) recipients is the overwhelmingly high mortality with critical illness. A series of studies about these outcomes forms the basis of the present management strategies and decision-making after BMT. The questions involve survival after life support and the ability to identify survivors and nonsurvivors preemptively. The incidence of mechanical ventilation is associated with the characteristics of the recipients. Older age, receipt of an HLA-nonidentical graft, and malignancy in relapse at time of transplantation are associated with respiratory failure. These data are of limited value in predicting survival. It is extremely difficult to identify the small percentage of patients who will survive these episodes. However, experience suggests that patients can be identified who will not survive. Preliminary evidence suggests that physicians do not effectively utilize this mortality data in decisions about withdrawal of life support.
Crawford
S W
SW
University of California, San Diego Medical Center, 92103-8372, USA.
D001803:Blood Transfusion; D016026:Bone Marrow Transplantation; D003422:Critical Care / Q000379:methods* / Q000592:standards*; D005544:Forecasting; D006801:Humans; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis