Prognosis of pediatric bone marrow transplant recipients requiring mechanical ventilation.
OBJECTIVE
To assess the prognosis of pediatric bone marrow transplant recipients requiring mechanical ventilation and to identify risk factors for mortality.


METHODS
Retrospective chart review.


METHODS
Pediatric intensive care unit (PICU), tertiary care center.


METHODS
Inclusion criteria were endotracheal intubation and mechanical ventilation after bone marrow transplantation; patients with perioperative ventilation were excluded. Outcome measures were extubation, PICU discharge, and 6-month survival. The 39 patients who met the inclusion criteria were ventilated on 41 occasions.


METHODS
None.


RESULTS
Overall survival rate to PICU discharge was 44% (17 of 39 patients). Six months after PICU discharge, 14 of these children were still alive, for a medium-term survival rate of 36%. Preexisting conditions (primary disease, bone marrow engraftment, or graft-vs.-host disease) had no significant effect on survival. Multiple organ failure, especially pulmonary failure and neurologic deterioration, were significant determinants of patient survival.


CONCLUSIONS
The observed prognosis is improved over previous reports. Early initiation of aggressive intensive care treatment is warranted in this patient group. Decisions regarding intensity of treatment must be based on aspects of the acute illness rather than on the primary conditions.
University Children's Hospital, Münster, Germany.
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Rossi
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SD
Shemie
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Calderwood
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality; D011336:Probability; D011379:Prognosis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate