title: Use of mechanical ventilation and renal replacement therapy in critically ill hematopoietic stem cell transplant recipients.
abstract: Hematopoietic stem cell transplantation (HSCT) is a treatment option for both malignant and nonmalignant disorders. HSCT patients remain at high risk for multiorgan failure, with previous studies noting mortality rates exceeding 90% when mechanical ventilation (MV) is required. We propose that advancements in critical care management and HSCT practices have improved these dismal outcomes. We performed a retrospective review of admissions to our bone marrow transplant unit between 2006 and 2010. All HSCT recipients requiring admission to the bone marrow transplant unit who received MV or renal replacement therapy (RRT) were evaluated. A total of 68 patients required MV. Twenty patients required RRT, all of whom required MV. Fifty-nine of the 68 ventilated patients died, for an overall mortality rate of 86.8%. The presence of renal failure and concomitant respiratory or liver dysfunction at the time of intubation was associated with a mortality rate of 100%. High mortality persists in our HSCT population requiring artificial support despite overall advances in critical care and HSCT practices. Critical care triage and management decisions in this high-risk population remain challenging.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Pennsylvania State University School of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA. cgilbert1@hmc.psu.edu
authors.forename: Christopher
authors.initials: C
authors.lastname: Gilbert
authors.forename: Tajender S
authors.initials: TS
authors.lastname: Vasu
authors.forename: Michael
authors.initials: M
authors.lastname: Baram
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D017582:Renal Replacement Therapy / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome