The outcome of children requiring admission to an intensive care unit following bone marrow transplantation.
We report the results of a retrospective study of the role of intensive care unit (ICU) admission in the management of 367 children who underwent bone marrow transplantation (BMT) at a tertiary referral institution. 39 patients (11%) required 44 ICU admissions for a median of 6 d. 70% received marrow from unrelated donors, half of which were mismatched; 80% had leukaemia and two-thirds were considered high-risk transplants. Respiratory failure was the major reason for admission to ICU. 75% of admissions required mechanical ventilation (for a median of 5 d) and 20 patients had lung injury as defined by the criteria of the Seattle group. None of 11 patients with proven viral pneumonitis survived (P = 0.06) and only one of 20 patients with lung injury survived (P < 0.01). Six of seven patients with a primary neurological problem survived (P < 0.001); these appear to represent a good outcome group. Age, the presence of graft-versus-host disease, the use of inotropes, isolated renal or hepatic impairment, and paediatric risk of mortality (PRISM) score were not predictive of outcome. In total, 12 patients (27% of admissions) survived and were discharged from hospital 30d or more after admission and eight (18%) survived >6 months. ICU admission can be beneficial to selected children post-BMT but it may be less useful in proven viral pneumonitis. Where mechanical ventilation is required, the duration of this support should be limited unless there is rapid improvement.
Hayes
C
C
Department of Paediatric Intensive Care, Bristol Royal Hospital for Sick Children.
Lush
R J
RJ
Cornish
J M
JM
Foot
A M
AM
Henderson
J
J
Jenkins
I
I
Murphy
P
P
Oakhill
A
A
Pamphilon
D H
DH
Steward
C G
CG
Weir
P
P
Wolf
A
A
Marks
D I
DI
D000208:Acute Disease; D000293:Adolescent; D000741:Anemia, Aplastic / Q000628:therapy; D016026:Bone Marrow Transplantation / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000628:therapy; D008171:Lung Diseases / Q000209:etiology / Q000628:therapy; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D011379:Prognosis; D012017:Referral and Consultation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors