Survival outcome among 54 intubated pediatric bone marrow transplant patients

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Abstract

Objectives:

To assess the outcome of children who required endotracheal intubation after bone marrow transplantation and to determine whether prognostic indicators that might assist decision-making regarding the institution of mechanical ventilation could be identified.

Design:

Retrospective chart review.

Setting:

Critical care, reverse isolation unit at a university hospital.

Patients:

Fifty-four pediatric bone marrow transplant recipients who required endotracheal intubation.

Interventions:

None.

Measurements and Main Results:

The following variables were assessed for effect on survival: a) the presence of additional nonhematoporetic organ system failure; b) the duration of required ventilatory assistance; c) the etiology of respiratory failure; d) the presence of significant graft vs. host disease; and e) the underlying disease for which the transplant was done. Six of 54 intubated pediatric bone marrow transplant recipients were extubated and discharged from the hospital. No patient with a diagnosis of leukemia or with multiple organ system failure could be extubated or discharged from the hospital. The presence of pulmonary parenchymal disease indicated poor prognosis for survival.

Conclusions:

The decision to intubate a pediatric bone marrow transplant patient remains a difficult one. In this population, multiple organ system failure and primary pulmonary parenchymal disease were associated with a high mortality rate. These factors should be taken into account before and throughout the course of mechanical ventilation in this patient population. (Crit Care Med 1994; 22:171-176)

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