title: Intensive Care Utilization for Hematopoietic Cell Transplant Recipients.
abstract: Blood and marrow transplantation (BMT) is a potentially curative therapy for a number of malignant and nonmalignant diseases. Multiple variables, including age, comorbid conditions, disease, disease stage, prior therapies, degree of donor-recipient matching, type of transplantation, and dose intensity of the preparative regimen, affect both morbidity and mortality. Despite tremendous gains in supportive care, BMT remains a high-risk medical therapy. A critically ill BMT recipient may require transfer to an intensive care unit (ICU) and the specialized medical and nursing care that can be provided, such as mechanical ventilation and vasopressor support. Mortality for BMT recipients requiring care in an ICU is high. This paper will describe the experience of the Stanford Blood and Marrow Transplant Program in developing and implementing guidelines to maximize the benefit of intensive care for critically ill BMT recipients.
authors.affiliation: Blood and Marrow Transplant Program, Stanford Health Care, Stanford, California.
authors.forename: Patricia
authors.initials: P
authors.lastname: Jenkins
authors.affiliation: Department of Medicine, Stanford Medicine, Stanford, California.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Johnston
authors.affiliation: Patient Care Services, Stanford Medicine, Stanford, California.
authors.forename: David
authors.initials: D
authors.lastname: Pickham
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Medicine, Stanford, California.
authors.forename: Beverly
authors.initials: B
authors.lastname: Chang
authors.affiliation: Intensive Care Units, Stanford Medicine, Stanford, California.
authors.forename: Norman
authors.initials: N
authors.lastname: Rizk
authors.affiliation: Blood and Marrow Transplant Program, Stanford Health Care, Stanford, California. Electronic address: dtierney@stanfordhealthcare.org.
authors.forename: D Kathryn
authors.initials: DK
authors.lastname: Tierney
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D016638:Critical Illness; D005260:Female; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D019653:Myeloablative Agonists
keywords: Hematopoietic cell transplantation; Intensive care; Intensive care utilization