Outcome of children who require mechanical ventilatory support after bone marrow transplantation

Objective: To identify clinically measurable factors that could predict outcome far pediatric patients undergoing mechanical ventilatory support after bone marrow transplant. Design:Cohort study. Setting: A referral center for bone marrow transplant patients in Seattle, Washington. Patients: Children <17 yrs old who received a bone marrow transplant and subsequently required mechanical ventilatory support for greater than or equal to 24 hrs between 1983 and 1996. Interventions: None. Measurements and Main Results: Data were abstracted from the charts of 121 pediatric patients who received a bone marrow transplant and subsequently required mechanical ventilatory support. A total of 19 patients (16%) survived to be extubated and survived for greater than or equal to 30 days postextubation. Major risk factors for death included respiratory failure as the reason for endotracheal intubation (4% survival), the presence of pulmonary infection (6% survival), and impairment of more than one organ system (2% survival if mote than one organ system was dysfunctional an day 7 postintubation). Conclusions: Although the prognosis generally is poor among pediatric bone marrow transplant recipients who subsequently require mechanical ventilatory support, there appear to be some groups within this population in whom the likelihood of survival is close to 0. Because the chance of survival was so small for children with dysfunction of more than one organ system an day 7 after intubation, a recommendation to limit medical support for these children could be considered pending the results of other studies.