Pediatric Pulmonary and Critical Care
Weekly Conference
January 13, 1998
Survival of Intubated Bone Marrow Transplant Recipients
Pulmonary and non-pulmonary complications post-BMT
Imad Y. Haddad, MD
Survival studies after mechanical ventilation (one pediatric study).
1. Rubenfeld et al."Withdrawing life support from
mechanically ventilated recipients of bone marrow transplants: a case for
evidence-based guidelines." Annals of Internal Medicine 125:625-633, 1996.
- 1980-1992
- Patients n=3635 ventilated n=865 (25%) survived n=53 (6.1%)
- Survival improved with time: 1988 (5%) 1992 (16%)
2. Todd et al. "Survival outcome among 54 intubated
pediatric bone marrow transplant patients." Critical Care Medicine 22: 171-176, 1994.
- 1973-1990
- Patients n=285 ventilated n=54 (20%) survived n=6 (11.1%)
3. Prognostic factors. From the Rubenfeld Study:
Case-control study.
- No differences between survivors and non-survivors in
- underlying diagnosis.
- preparative regimen.
- donor-recipient histocompatibility.
- duration of mechanical ventilation.
Survival was associated with:
- younger age.
- lower APACHE III score on day 1.
- early intubation in course of transplantation.
- absence of hepatic failure, renal failure, vasopressors, or lung injury.
Timing of predictors of death:
Risk factors that predicted death developed 6 ventilator days, and 9
hospital days before death.
Retrospective chart review. (Todd Study)
Role of non-respiratory complications- predictive of survival.
- 0% of multiple organ failure (intubation plus another organ failure)
survived.
Duration of ventilation- pedictive of survival.
- 5/6 patients who survived were extubated for < 72 h.
Etiology of respiratory failure- predictive of survival.
- Parenchymal pulmonary disease worse outcome.
Role of GVHD- predictive of survival.
This page was created and last updated 1/14/98
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