The outcome of children requiring admission to an intensive care unit following bone marrow transplantation

Autor: C, Hayes, R J, Lush, J M, Cornish, A M, Foot, J, Henderson, I, Jenkins, P, Murphy, A, Oakhill, D H, Pamphilon, C G, Steward, P, Weir, A, Wolf, D I, Marks
Rok vydání: 1998
Předmět:
Zdroj: British journal of haematology. 102(3)
ISSN: 0007-1048
Popis: We report the results of a retrospective study of the role of intensive care unit (ICU) admission in the management of 367 children who underwent bone marrow transplantation (BMT) at a tertiary referral institution. 39 patients (11%) required 44 ICU admissions for a median of 6 d. 70% received marrow from unrelated donors, half of which were mismatched; 80% had leukaemia and two-thirds were considered high-risk transplants. Respiratory failure was the major reason for admission to ICU. 75% of admissions required mechanical ventilation (for a median of 5 d) and 20 patients had lung injury as defined by the criteria of the Seattle group. None of 11 patients with proven viral pneumonitis survived (P = 0.06) and only one of 20 patients with lung injury survived (P0.01). Six of seven patients with a primary neurological problem survived (P0.001); these appear to represent a good outcome group. Age, the presence of graft-versus-host disease, the use of inotropes, isolated renal or hepatic impairment, and paediatric risk of mortality (PRISM) score were not predictive of outcome. In total, 12 patients (27% of admissions) survived and were discharged from hospital 30d or more after admission and eight (18%) survived6 months. ICU admission can be beneficial to selected children post-BMT but it may be less useful in proven viral pneumonitis. Where mechanical ventilation is required, the duration of this support should be limited unless there is rapid improvement.
Databáze: OpenAIRE
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