title: Outcome of invasive mechanical ventilation after pediatric allogeneic hematopoietic SCT: results from a prospective, multicenter registry.
abstract: Exact data on prognosis of children receiving invasive mechanical ventilation (IMV) after allogeneic hematopoietic SCT (HSCT) is lacking. We therefore started a prospective registry in four European university HSCT centers (Leiden, Paris, Prague and Utrecht) and their pediatric intensive care units (PICUs). The registry started in January 2009. In January 2013, the four centers together had treated a total of 83 admissions with IMV. The case fatality rate in these patients was 52%. Mortality 6 months after PICU discharge was 45%. There were significant differences between centers in the proportion of children who received IMV after HSCT (6-23%, P<0.01), in severity of disease on admission to PICU (predicted mortality 14-37%, P<0.01), in applying noninvasive ventilation before IMV (3-75% of admissions, P<0.01) and in the use of renal replacement therapy (RRT) (8-58% of admissions, P<0.01). Severe impairment in oxygenation, use of RRT and CMV viremia were independent predictors of mortality. Our study shows that mortality in children receiving IMV after HSCT remains high, but has clearly improved compared with older studies. Patient selection and treatment in PICU differed significantly between centers, which underscores the need to standardize and optimize the PICU admission criteria, ventilatory strategies and therapies applied in PICU.
authors: Pediatric Intensive Care Unit, University Medical Center Utrecht, The Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: J P J
authors: JP
authors: van Gestel
authors: Department of Pediatric Hematology, Immunology and Bone Marrow Transplantation, University Medical Center Utrecht, The Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: M B
authors: MB
authors: Bierings
authors: Pediatric Intensive Care Unit, AP-HP, Robert-Debré Hospital and Paris Diderot University, Paris 7, Paris, France.
authors: S
authors: S
authors: Dauger
authors: Department of Pediatric Hematology, Immunology and Bone Marrow Transplantation, AP-HP, Robert-Debré Hospital and Paris Diderot University, Paris 7, Paris, France.
authors: J-H
authors: JH
authors: Dalle
authors: Pediatric Intensive Care Unit, Charles University Hospital Motol, Prague, Czech Republic.
authors: P
authors: P
authors: Pavlíček
authors: Department of Pediatric Hematology and Oncology, Charles University Hospital Motol, Prague, Czech Republic.
authors: P
authors: P
authors: Sedláček
authors: Pediatric Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands.
authors: L M
authors: LM
authors: Monteiro
authors: Department of Pediatric Hematology, Immunology and Bone Marrow Transplantation, Leiden University Medical Center, Leiden, The Netherlands.
authors: A
authors: A
authors: Lankester
authors: Pediatric Intensive Care Unit, University Medical Center Utrecht, The Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: C W
authors: CW
authors: Bollen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome