Outcome of children who require mechanical ventilatory support after bone marrow transplantation.
OBJECTIVE
To identify clinically measurable factors that could predict outcome for pediatric patients undergoing mechanical ventilatory support after bone marrow transplant.


METHODS
Cohort study.


METHODS
A referral center for bone marrow transplant patients in Seattle, Washington.


METHODS
Children <17 yrs old who received a bone marrow transplant and subsequently required mechanical ventilatory support for > or =24 hrs between 1983 and 1996.


METHODS
None.


RESULTS
Data were abstracted from the charts of 121 pediatric patients who received a bone marrow transplant and subsequently required mechanical ventilatory support. A total of 19 patients (16%) survived to be extubated and survived for > or =30 days postextubation. Major risk factors for death included respiratory failure as the reason for endotracheal intubation (4% survival), the presence of pulmonary infection (6% survival), and impairment of more than one organ system (2% survival if more than one organ system was dysfunctional on day 7 postintubation).


CONCLUSIONS
Although the prognosis generally is poor among pediatric bone marrow transplant recipients who subsequently require mechanical ventilatory support, there appear to be some groups within this population in whom the likelihood of survival is close to 0. Because the chance of survival was so small for children with dysfunction of more than one organ system on day 7 after intubation, a recommendation to limit medical support for these children could be considered pending the results of other studies.
Keenan
H T
HT
Department of Pediatrics, University of North Carolina at Chapel Hill, USA.
Bratton
S L
SL
Martin
L D
LD
Crawford
S W
SW
Weiss
N S
NS
D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000401:mortality*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000401:mortality / Q000628:therapy; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D051437:Renal Insufficiency / Q000401:mortality / Q000628:therapy; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy; D012306:Risk; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors