Survival outcome among 54 intubated pediatric bone marrow transplant patients

Todd, Karen E.; Wiley, Frances M.; Landaw, Elliot M.; Gajewski, James; Bellamy, Paul E.; Harrison, Rick; Brill, Judith; Feig, Stephen A.

doi:10.1097/00003246-199401000-00030

Cited by 64 publications

(54 citation statements)

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“…2,3,6,7,17,20,21 We observed a high frequency of pulmonary and non-pulmonary infections. Pneumonia was clinically suspected in the majority of the patients who required mechanical ventilation.…”

Section: Referral Rate Time Of Referral and Indications For Intensivmentioning

confidence: 85%

“…These mostly retrospective studies have reported significantly varying results for both referral rates to the ICU and survival rates. [2][3][4][5][6][7][8]10 In general, studies that report a high demand of ICU support tend to report a more favorable outcome of ICU treatment following HSCT. It can be assumed that specific referral strategies rather than significant differences in the quality of ICU support may account for these discrepancies, as a restricted use of ICU referrals will select only the most compromised patients, thus resulting in an inferior outcome compared to other studies with higher ICU referral rates.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it has to be considered that in some studies patients referred to the ICU after standard surgical procedures have been included, which could result in an overestimation of the overall survival rates. 2,7 Different HSCT cohorts may also account for divergent referral and survival rates because allogeneic and unrelated HSCT are associated with a higher demand for ICU support (Table 1). In addition, we observed a high proportion of patients in у2nd remission of the underlying disease, and probably the higher amount of pretreatment and treatmentrelated organ toxicity may further contribute to the substantial risk of these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports have shown that once the patients require ICU support, their prognosis is poor and efforts have been made to define prognostic parameters in order to avoid extended and inappropriate ICU treatment. [1][2][3][4][5][6][7][8] These studies revealed that the predictive value of the standard ICU prognostic scores is limited in the post transplantation setting, and that standard scores tend to underestimate mortality. 3,5,9,10 This may be explained by other contributing factors (eg presence of GVHD, bleeding, infection etc) that are not included in the standard scoring systems.…”

mentioning

confidence: 99%

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Introduction of the oncological pediatric risk of mortality score (O-PRISM) for ICU support following stem cell transplantation in children

Schneider

Lemburg

Sprock

et al. 2000

Bone Marrow Transplant

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Summary:Prognostic scoring systems based on physiological parameters have been established in order to predict the outcome of ICU patients. It has been demonstrated that the predictive value of these scores is limited in patients following hematopoietic stem cell transplantation (HSCT). Therefore, we evaluated patients from the Dü sseldorf pediatric stem cell transplantation center with regard to predisposing factors and prognostic variables for ICU treatment and outcome. Between January 1989 and December 1998, 180 HSCT have been performed. The clinical, laboratory and HSCT-related parameters such as conditioning treatment, engraftment, GVHD, infections and HSCT toxicity were prospectively recorded and retrospectively analyzed. Established pediatric scoring systems (PRISM, TISS, P-TISS) were applied. Twenty-eight patients required intensive care (16 male, 12 female, median age: 10.9 years (range: 0.4 to 18.9 years), five autologous, 13 allogeneic-related and 10 unrelated transplanted patients). Ventilator-dependent respiratory failure was the most frequent cause of admission to the ICU (n ‫؍‬ 23). Fourteen of 28 patients were discharged from ICU, and six of 28 patients achieved a long-term survival (110 to 396 weeks). At admission to the ICU, impaired cardiovascular status, high CRP levels and presence of macroscopic bleeding were each associated with fatal outcome (P Ͻ 0.05). The Pediatric Risk of Mortality (PRISM) score was not prognostically significant at the 0.

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Section: Referral Rate Time Of Referral and Indications For Intensivmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Introduction of the oncological pediatric risk of mortality score (O-PRISM) for ICU support following stem cell transplantation in children

Schneider

Lemburg

Sprock

et al. 2000

Bone Marrow Transplant

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“…19,20,29,30 In our study, we show that ⩾ 96 h of invasive mechanical ventilation is associated with the highest odds of in-hospital mortality, hospital charges and length of stay. Prolonged mechanical ventilation (⩾96 h) may suggest severe respiratory failure, the lack of adequate response to conventional ventilator therapy or multifactorial issues that may portend poor outcomes.…”

Section: Duringmentioning

confidence: 51%

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

Allareddy

Roy

Rampa

et al. 2014

Bone Marrow Transplant

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SCT indications and procedures are increasing worldwide. We sought to estimate the prevalence of acute respiratory failure (ARF) of any cause in hospitalized SCT patients, and assess the impact of invasive mechanical ventilation (IMV) on outcomes. We hypothesize that duration of IMV in such patients is an independent predictor of higher mortality. We performed a retrospective analysis of the largest all-payer hospitalization data set in the United States, Nationwide In-patient Sample for years [2004][2005][2006][2007][2008][2009][2010]. Of the 101 462 SCT hospitalizations, 6074 (6%) developed ARF and were the final cohort. Type of SCT with ARF included autologous 1987 (32.7%), allogeneic 3467 (57.1%) and cord blood 655 (10.8%). Duration of IMV included o96 h (17.1%) and ⩾ 96 h (41.1%). Overall in-hospital mortality (IHM) was 50.6% (3075). Predictors of IHM were IMV o96 h (odds ratio = 3.42 (2.44-4.79), P o0.0001) or IMV ⩾ 96 h (OR = 4.61 (3.17-6.70), P o 0.0001). Type of SCT, comorbid burden, gender, hospital-teaching status/bed size or insurance did not influence IHM. IMV ⩾ 96 h was associated with higher hospital charges (mean $762 515, 95% estimate 0.3991 (0.3123-0.4859), increase of $304 474, P o 0.0001) and higher length of stay (mean 61.5 days, 95% estimate 0.2198 (0.1531-0.2866), increase of 13 days, P o 0.0001). In conclusion, ARF in hospitalized SCT patients is not an uncommon occurrence and is associated with 50% mortality. Duration of IMV (⩾96 h) was an independent predictor of higher mortality rates. Hospital resource utilization was significant.

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Prognostic factors in children requiring admission to an intensive care unit after hematopoietic stem cell transplant

Cheuk

Lee

et al. 2004

Hematological Oncology

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The objectives of this study are to identify prognostic factors of survival to discharge in pediatric hematopoietic stem cell transplant (HSCT) recipients requiring intensive care unit (ICU) admission, and to determine the utility of the Oncological Pediatric Risk of Mortality (O-PRISM) in predicting death of these patients. A retrospective cohort of 125 pediatric HSCT recipients from October 1992 to September 2002 was analysed to evaluate risk factors of mortality in those admitted to ICU after HSCT. Nineteen patients (median age 7.8 years, 14 boys) required 24 ICU admissions post-HSCT. The most frequent underlying diseases were acute myeloid leukemia (n=5). The survival rate on discharge from ICU was 54%. In univariate analysis, risk factors of mortality included earlier requirement of ICU admission post-HSCT (median 34 versus 166 days, p=0.002), a longer delay before ICU admission (median 12 versus 5 h, p=0.02), lack of neutrophil (p=0.011) or platelet engraftment (p=0.008), macroscopic hemorrhage (p<0.001), tachypnoea (p=0.033), hypoxemia (p=0.031), renal impairment (p=0.011), coagulopathy (p=0.012), mechanical ventilation (p<0.001), and an increasing number of organ failures (p=0.003). Macroscopic hemorrhage and mechanical ventilation remained significant in multivariate analysis. Both PRISM and O-PRISM scores were significant composite prognosticators. It was concluded that mortality of post-HSCT children requiring ICU admission is high, especially in those with poor prognosticators.

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Survival outcome among 54 intubated pediatric bone marrow transplant patients

Cited by 64 publications

References 0 publications

Introduction of the oncological pediatric risk of mortality score (O-PRISM) for ICU support following stem cell transplantation in children

Introduction of the oncological pediatric risk of mortality score (O-PRISM) for ICU support following stem cell transplantation in children

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

Prognostic factors in children requiring admission to an intensive care unit after hematopoietic stem cell transplant

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