364: Predictors of Hospital Mortality Following Pediatric Hematopoietic Stem Cell Transplantation (Hsct)

Olson, Taylor; Pollack, Murray M.; Saldaña, Blachy Dávila; Patel, Anita

doi:10.1097/01.ccm.0000907184.30480.29

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“…In a 2019 systematic review, Wösten-van Asperen et al (1) reported a pooled weighted mortality of 28.7% among pediatric oncology patients admitted to the PICU, with increased odds of mortality if MV was required (OR, 18.49 [95% CI, 13.79–24.78]). Mortality rates among HSCT requiring MV, published within the last decade, range from 42.5% to 60.4% (3, 4, 17). Such rates are substantially higher than those described in this study; the mortality for those undergoing tracheostomy greater than 30 days after admission was still on the lower end of the range at 36.2%.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes for Pediatric Oncology and Hematopoietic Stem Cell Transplantation Patients Who Undergo Tracheostomy Placement: A Pediatric Health Information System Database Cohort Study, 2009–2020

Murphy Salem,

Perez,

Staffa

et al. 2024

Pediatric Critical Care Medicine

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Objectives: To describe the epidemiology, surgical complications, and long-term outcomes after tracheostomy in pediatric oncology and/or hematopoietic stem cell transplantation (HSCT) patients in U.S. Children’s Hospitals. Design: Retrospective cohort from the Pediatric Health information System (PHIS) database, 2009–2020. Setting: The PHIS dataset incorporates data from 48 pediatric hospitals in the Children’s Hospital Association. Patients: Patients 0–21 years old with an oncologic diagnosis and/or underwent HSCT, received a tracheostomy, and were discharged from hospital between January 1, 2009, and December 31, 2020. Interventions: None. Measurements and Main Results: There were 1061 patients included in the dataset, and 217 (20.5%) had undergone HSCT. The annual prevalence in tracheostomy usage did not change over the study period. The majority of patients (62.2%) underwent tracheostomy early (< 30 d) in the admission and those who underwent the procedure later (> 90 d) had a significant increase in mortality (52.6% vs. 17.6%; p < 0.001) and mechanical ventilation (MV) at discharge (51.9% vs. 24.5%; p < 0.001) compared with the early tracheostomy patients. Complications reported included tracheostomy site bleeding (< 1%) and infection (24%). The overall rate of MV at discharge was 32.6% and significantly associated with chronic lung (adjusted odds ratio [OR], 1.54; 95% CI, 1.03–2.32) and acute lung disease (OR, 2.18; 95% CI, 1.19–3.98). The overall rate of mortality was 19.6% within the cohort and significantly associated with HSCT (OR, 5.45; 95% CI, 3.88–7.70), diagnosis of sepsis (OR, 2.09; 95% CI, 1.28–3.41), and requirement for renal replacement therapy (OR, 2.76; 95% CI, 1.58–4,83). Conclusions: This study demonstrated a static prevalence of tracheostomy placement in the cohort population relative to the increasing trends in other reported groups. Regardless of underlying diagnosis, the study patients incurred substantial morbidity and mortality. However, tracheostomy specific complication rates were comparable with that of the general pediatric population and were not associated with increased odds of mortality within this population.

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Section: Discussionmentioning

confidence: 99%

“…These morbidities can accrue before, during, and long after primary disease directed therapy. Respiratory failure is both among the most common reasons for these patients to require intensive care (1, 2) and is also seen as a long-term morbidity of disease and treatment (1–4).…”

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confidence: 99%