title: Clinical outcomes of children receiving intensive cardiopulmonary support during hematopoietic stem cell transplant.
abstract: OBJECTIVE
  We investigated the short-term and 1-year clinical outcomes of 129 children who received intensive cardiopulmonary support during hematopoietic stem cell transplant. Intensive cardiopulmonary support was defined as receiving at least one of the following interventions: continuous positive pressure ventilation, dopamine infusion greater than or equal to 10 mcg/kg/minute, or the use of any other vasoactive infusion. Duration of intensive cardiopulmonary support, survival to hospital discharge, and predictors of these outcome variables were compared with 387 hematopoietic stem cell transplant patients who did not receive intensive support during the same period. We also report the 1-year survival; presence of chronic graft-versus-host disease; and renal, cardiac, and pulmonary function for all patients.
  
  
  METHODS
  A multicenter retrospective cohort study.
  
  
  METHODS
  The ICU and hematopoietic stem cell transplant unit of nine pediatric tertiary care centers.
  
  
  METHODS
  Children undergoing hematopoietic stem cell transplant who required intensive cardiopulmonary support.
  
  
  METHODS
  None.
  
  
  RESULTS
  Predictors of the need for intensive support included unrelated donor allogeneic transplant, glomerular filtration rate less than 85 mL/minute/1.73 m, and nonmalignant disease as the indication for transplant. The survival to discontinuation of intensive support for all patients was 62% and 58% for patients who received invasive mechanical ventilatory support. The duration of mechanical ventilation was not predictive of survival. Predictors of intensive support mortality included macroscopic bleeding, engraftment, and pediatric logistic organ dysfunction score greater than one in two domains. Survival to hospital discharge was 50% for the intensive support group and 99% for the nonintensive support group. Overall 1-year survival was 40% in the intensive support population and 65% in the nonintensive support group. There were no significant differences in the survival, rates of chronic graft-versus-host disease, creatinine, forced expiratory volume in 1-minute, cardiac shortening fraction, or performance status in intensive and nonintensive support patients who survived to hospital discharge.
  
  
  CONCLUSIONS
  Intensive cardiopulmonary support plays an important and potentially life-saving role in the care of pediatric stem cell transplant patients. Survivors of intensive support do not have compromised 1-year survival or organ function compared with children who did not receive intensive support.
authors: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. christine_duncan@dfci.harvard.edu
authors: Christine N
authors: CN
authors: Duncan
authors: Leslie E
authors: LE
authors: Lehmann
authors: Ira M
authors: IM
authors: Cheifetz
authors: Kristin
authors: K
authors: Greathouse
authors: Ann E
authors: AE
authors: Haight
authors: Mark W
authors: MW
authors: Hall
authors: Amber
authors: A
authors: Herschberger
authors: Katherine S
authors: KS
authors: Hill
authors: Jerelyn R
authors: JR
authors: Moffet
authors: R Ray
authors: RR
authors: Morrison
authors: Angela L
authors: AL
authors: Norris
authors: Aleksandra
authors: A
authors: Petrovic
authors: Debra A
authors: DA
authors: Spear
authors: Marie E
authors: ME
authors: Steiner
authors: Julie-An M
authors: JA
authors: Talano
authors: Robert F
authors: RF
authors: Tamburro
authors: John
authors: J
authors: Wagner
authors: Jennifer
authors: J
authors: McArthur
mesh_terms: D000293:Adolescent; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure / Q000401:mortality; D004298:Dopamine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D004298:Dopamine