The care of critically ill children after hematopoietic SCT: a North American survey

McArthur, Jennifer; Pettersen, Géraldine; Jouvet, Philippe; Christensen, Melissa; Tamburro, Robert F.

doi:10.1038/bmt.2010.89

Cited by 20 publications

(16 citation statements)

References 15 publications

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“…The early institution of continuous veno-venous hemofiltration may help to improve survival and oxygenation in some pediatric patients [59,60]. Moreover, in a survey of North American pediatric HSCT centers, more than half of the centers report using renal replacement therapy prior to intubation in patients who develop respiratory distress [61]. However, prospective studies addressing the use of this treatment in this patient population are lacking.…”

Section: The Diagnostic and Therapeutic Approach To Patients With Ipsmentioning

confidence: 99%

Idiopathic pneumonia syndrome following hematopoietic stem cell transplantation

Klein

Cooke

2015

J Pediatr Intensive Care

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Onlangs is in Europa een grootschalig onderzoek gestart naar voedselallergie bij kinderen. Nederland neemt deel aan het onderzoek. Voedselallergie komt vaker voor bij kinderen (vijf tot acht procent) dan bij volwassenen (een tot twee procent). Bovendien stijgt de laatste decennia het aantal gevallen van voedselallergie bij kinderen.Onderzoeksbureau EuroPrevall onderzoekt de komende vier jaar hoe een voedselallergie voorkomen kan worden. Daarnaast kijkt het bureau naar de oorzaken en kosten van een allergie. Het Nederlandse deel van het onderzoek wordt uitgevoerd door het AMC, het Flevoziekenhuis Almere en verloskundigen van de Zorggroep Almere. Op Europees niveau nemen 12.000 kinderen deel aan het project; in Nederland hoopt men 1.500 kinderen te kunnen onderzoeken.Bij een voedselallergie reageert het afweersysteem van het lichaam te sterk op bepaalde allergenen in de voeding. Daardoor ontstaan klachten als eczeem, dyspnoe, diarree en braken. Hoe vaak voedselallergie voorkomt, wat de oorzaken zijn en welke sociaaleconomische gevolgen het heeft, is niet duidelijk. EuroPrevall onderzoekt dit bij kinderen in de leeftijd van nul tot dertig maanden.

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Section: The Diagnostic and Therapeutic Approach To Patients With Ipsmentioning

confidence: 99%

Idiopathic pneumonia syndrome following hematopoietic stem cell transplantation

Klein

Cooke

2015

J Pediatr Intensive Care

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“…In the last 30 years, reported PICU mortality for this population has dropped impressively from over 85% to below 44% (2–4, 6–13), likely in part due to advances in reduced intensity conditioning, lung shielding for total body irradiation (TBI), human leukocyte antigen matching, infection prophylaxis, and mechanical ventilation (14, 15). However, the interpretation of this reduction in mortality is confounded by institutional variation in PICU admission criteria, heterogeneous transplant indications among cohorts, and lack of standardization of patients through illness severity scores such as the Pediatric Index of Mortality (PIM)-2 and Pediatric Risk of Mortality (PRISM)-3 (6, 16, 17). As a result, there is an active debate over whether and how much PICU mortality has decreased for these patients (6, 16, 18).…”

mentioning

confidence: 99%

New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients*

Zinter

Dvorak

Spicer

et al. 2015

Critical Care Medicine

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Objectives Over 2,500 children undergo hematopoietic stem cell transplantation in the United States each year, and up to 35% require PICU support for life-threatening complications. PICU mortality has dropped from 85% to 44%, but interpretation is confounded by significant cohort heterogeneity. Reports conflict regarding outcomes for patients with different underlying hematopoietic stem cell transplantation indications, and the burden of infectious complications for these patients has not been evaluated. We aim to describe infections, critical care interventions, and mortality for pediatric hematopoietic stem cell transplantation patients requiring PICU admission. Design A retrospective multicenter cohort analysis. Setting One hundred twelve centers in the Virtual PICU Systems database, January 1, 2009, to June 30, 2012. Patients A total of 1,782 admissions for patients who are 21 years old or younger with prior hematopoietic stem cell transplantation. Interventions None. Measurements and Main Results Pediatric Index of Mortality-2, Pediatric Risk of Mortality-3, transplant indication, infections, interventions, and mortality were recorded from admission through PICU death or discharge. Pediatric hematopoietic stem cell transplantation patients comprised 0.7% of all PICU admissions (1,782/246,346), which resulted in 16.2% mortality compared with 2.4% mortality for non-hematopoietic stem cell transplantation admissions (odds ratio, 7.8; 95% CI, 6.8–8.8; p < 0.001). Mortality for admissions with underlying hematologic malignancy (22.7%) was similar to that of admissions with primary immunodeficiency (19.4%; p = 0.41) but significantly greater than admissions with underlying nonmalignant non-primary immunodeficiency hematologic disease (15.4%; p = 0.020), metabolic disorder (8.1%; p < 0.001), or solid malignancy (5.7%; p < 0.001). Infection was documented in 45.7% of admissions with 22.2% mortality; viral and fungal mortality were 28.5% and 33.7%, respectively. Invasive positive pressure ventilation and renal replacement therapy were used in only 34.6% and 11.9% of admissions, with mortality of 42.5% and 51.9%, respectively. Conclusions PICU mortality for pediatric hematopoietic stem cell transplantation patients may be as low as 16.2% but higher for those receiving intubation (42.5%) or replacement therapy (51.9%). Hematologic malignancy and primary immunodeficiency had greater risk for mortality than other transplant indications. Greater understanding of other risk factors affecting mortality and the need for critical care support is needed.

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“…Variations in treatments among centers have been reported in a recent survey among North American HSCT centers. 25 The consequences of these differences may be highly relevant: in several studies in adults, it was shown that triage decisions or therapeutic strategies [26][27][28] can influence survival. Further studies are warranted to explore the observed variations.…”

mentioning

confidence: 99%

Outcome of invasive mechanical ventilation after pediatric allogeneic hematopoietic SCT: results from a prospective, multicenter registry

Gestel

Bierings

Dauger

et al. 2014

Bone Marrow Transplant

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Exact data on prognosis of children receiving invasive mechanical ventilation (IMV) after allogeneic hematopoietic SCT (HSCT) is lacking. We therefore started a prospective registry in four European university HSCT centers (Leiden, Paris, Prague and Utrecht) and their pediatric intensive care units (PICUs). The registry started in January 2009. In January 2013, the four centers together had treated a total of 83 admissions with IMV. The case fatality rate in these patients was 52%. Mortality 6 months after PICU discharge was 45%. There were significant differences between centers in the proportion of children who received IMV after HSCT (6-23%, Po 0.01), in severity of disease on admission to PICU (predicted mortality 14-37%, P o0.01), in applying noninvasive ventilation before IMV (3-75% of admissions, P o0.01) and in the use of renal replacement therapy (RRT) (8-58% of admissions, P o 0.01). Severe impairment in oxygenation, use of RRT and CMV viremia were independent predictors of mortality. Our study shows that mortality in children receiving IMV after HSCT remains high, but has clearly improved compared with older studies. Patient selection and treatment in PICU differed significantly between centers, which underscores the need to standardize and optimize the PICU admission criteria, ventilatory strategies and therapies applied in PICU.

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The care of critically ill children after hematopoietic SCT: a North American survey

Cited by 20 publications

References 15 publications

Idiopathic pneumonia syndrome following hematopoietic stem cell transplantation

Idiopathic pneumonia syndrome following hematopoietic stem cell transplantation

New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients*

Outcome of invasive mechanical ventilation after pediatric allogeneic hematopoietic SCT: results from a prospective, multicenter registry

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