Prognosis of pediatric bone marrow transplant recipients requiring mechanical ventilation

Objectives: To assess the prognosis of pediatric bone marrow transplant recipients requiring mechanical ventilation and to identify risk factors for mortality. Design: Retrospective chart review. Setting: Pediatric intensive care unit (PICU), tertiary care center, Patients: Inclusion criteria were endotracheal intubation and mechanical ventilation after bone marrow transplantation; patients with perioperative ventilation were excluded. Outcome measures were extubation, PICU discharge, and 6-month survival. The 39 patients who met the inclusion criteria were ventilated on 41 occasions. Interventions: None. Measurements and Main Results: Overall survival rate to PICU discharge was 44% (17 of 39 patients). Six months after PICU discharge, 14 of these children were still alive, for a medium-term survival rate of 36%. Preexisting conditions (primary disease, bone marrow engraftment, or graft-vs.-host disease) had no significant effect on survival. Multiple organ failure, especially pulmonary failure and neurologic deterioration, were significant determinants of patient survival. Conclusions: The observed prognosis is improved over previous reports. Early initiation of aggressive intensive care treatment is warranted in this patient group. Decisions regarding intensity of treatment must be based on aspects of the acute illness rather than on the primary conditions.