title: Pediatric Hematopoietic Stem Cell Transplant and Intensive Care: Have Things Changed?
abstract: OBJECTIVE
  Mortality for pediatric patients who require intensive care posthematopoietic stem cell transplant still remains high. Previously at our institution, survival rates were 44% for patients who required mechanical ventilation posthematopoietic stem cell transplant. We conducted a review of patients to identify whether there has been any improvement in survival over the past 12 years and to identify any risk factors that contribute to mortality.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  PICU and hematopoietic stem cell transplant unit of a single tertiary children's hospital.
  
  
  METHODS
  Children less than 18 years old undergoing hematopoietic stem cell transplant who required admission to the ICU between January 2000 and December 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  There were 350 separate admissions to the ICU for 206 patients posthematopoietic stem cell transplant. Median Age was 9.3 years (range, 1-17 yr). Median time from hematopoietic stem cell transplant to admission was 35 days (interquartile range, 13-152 d), and 59% of patients were male. Survival to ICU discharge for all admissions was 75%, which equated to 57% of all patients. Of the admissions that required invasive mechanical ventilation, 48% survived to ICU discharge, with a survival to ICU discharge of 36% if there was more than one admission requiring mechanical ventilation. Survival to ICU discharge was 33% if renal replacement therapy was required. Mechanical ventilation, inotrope/vasopressor use, and number of organ dysfunction within an admission were predictors of mortality. Having an underlying malignant condition or an autologous hematopoietic stem cell transplant was associated with a more favorable outcome.
  
  
  CONCLUSIONS
  This is the largest single-center series for pediatric patients who require intensive care posthematopoietic stem cell transplant and demonstrates that this group of patients still faces high mortality. There has been an improvement in survival for those patients who require renal replacement therapy and also for patients who require mechanical ventilation more than once; however, the need for mechanical ventilation still remains a significant predictor of mortality.
authors.affiliation: 1Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada. 2University of Toronto, Toronto, Ontario, Canada. 3Royal Children's Hospital, Brisbane, Queensland, Australia. 4School of Medicine, University of Brisbane, Brisbane, Australia. 5CancerCare Manitoba, Winnipeg, Manitoba, Canada. 6Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Canada.
authors.forename: Corrine R
authors.initials: CR
authors.lastname: Balit
authors.forename: Rachael
authors.initials: R
authors.lastname: Horan
authors.forename: Tavey
authors.initials: T
authors.lastname: Dorofaeff
authors.forename: Helena
authors.initials: H
authors.lastname: Frndova
authors.forename: John
authors.initials: J
authors.lastname: Doyle
authors.forename: Peter N
authors.initials: PN
authors.lastname: Cox
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality* / Q000639:trends; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D008350:Manitoba; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome