Outcome of bone marrow transplantation patients requiring mechanical ventilation.
OBJECTIVE
To identify outcome predictors in bone marrow transplantation (BMT) patients admitted to the intensive care unit (ICU) of The University of Texas M. D. Anderson Cancer Center who required endotracheal intubation and mechanical ventilation.


METHODS
Retrospective, comparative study.


METHODS
A 16-bed medical intensive care unit in a university teaching cancer center.


METHODS
The records of 60 consecutive BMT patients who developed respiratory failure requiring mechanical ventilation were reviewed.


METHODS
None.


RESULTS
The most frequent complication leading to respiratory failure was pneumonia (41%) followed by diffuse alveolar hemorrhage (37%). Eighteen percent of the patients were extubated and discharged from the ICU, but only 5% were alive at 6 months. Graft vs. host disease was a predictor of a poor outcome (p < .05). Breast cancer as an underlying disease and pulmonary edema as a complication were favorable predictive factors (p < .05). Five of 26 patients with diffuse alveolar hemorrhage and four of 33 patients with pneumonia survived. We found no relationship between survival and age, gender, BMT type, or Acute Physiology and Chronic Health Evaluation II score. Prolonged mechanical ventilation (> or =15 days) and late development of respiratory failure (>30 days after BMT) were associated with poor prognosis.


CONCLUSIONS
The ICU survival rate of BMT patients who developed pulmonary complications and required mechanical ventilation was 18%. Prognostic factors were described identifying patients with a substantial survival rate as well as those in whom mechanical ventilation was futile.
Huaringa
A J
AJ
Department of Medical Specialties, The University of Texas M.D. Anderson Cancer Center, Houston 77030-4095, USA. ahuaringa@mdanderson.org
Leyva
F J
FJ
Giralt
S A
SA
Blanco
J
J
Signes-Costa
J
J
Velarde
H
H
Champlin
R E
RE
D018806:APACHE; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D011379:Prognosis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome