Patients with bone marrow transplant may present with acute, life-threatening complications which frequently (40% of our cases) require intensive care unit treatment and result in an increased mortality (76% in this series). In an attempt to reach a more objective prognostic assessment, we have analyzed those factors related to the worst outcome in the 25 patients with bone marrow transplant admitted into our intensive care unit. Respiratory failure was the most frequent complication (72%), with an 83% mortality. Graft-versus-host disease and neutropenia led to a greater number of infectious complications with a poor outcome. Failure of more than three organ systems, septic shock and mechanical ventilation were statistically associated with mortality (p less than 0.05), and all patients who required mechanical ventilation for more than seven days or needed intensive therapy for more than 10 days died. The presence of septic shock, multisystem failure and severe neutropenia on admission should be considered as initial indicators of a poor prognosis. More than 7 days of mechanical ventilation and an intensive care unit stay of more than 10 days could be critical points in the reassessment of the intensity and prolongation of treatment.

214 patients among 282 consecutive admissions had at least one measurement of serum albumin (SA) during their stay on the ICU and were classified according to their lowest value of SA. Mean SA was 2.88 /+- 0.74 g/100 mg. Survivors had a mean SA (3.18 /+- 0.60) higher than non-survivors (2.35 /+- 0.68 g/100 ml) (p < 0.05). 64% of patients were admitted with an abnormally low SA (less than 3.5 g/100 ml) and in 56% of these the initial value was higher than the last. Mortality increased in the groups with lower SA and the level of SA was associated with infection (x2 = 73.9) and mortality (x2 = 69.7) (p < 0.05). The percentage of infected patients who died increased in groups with lower SA.

The in vivo and in vitro oxygen-binding capacity of haemoglobin was determined on 10 occasions in nine patients who required mechanical ventilation. The in vitro sample was tonometered with 97% oxygen for 10 min and then with air, while the in vivo sample was obtained after 20 min of lung ventilation with pure oxygen. Subsequent laboratory procedures were identical for both samples. The mean oxygen-binding capacity of haemoglobin in vitro and in vivo samples were almost equal (1.365 +2- 0.010 and 1,366 +/- 0.007 ml per g Hb). When the measured inactive fractions of haemoglobin (carboxy- and methaemoglobin) were taken into account, these values increased to 1.392 +/- 0.005 and 1.392 +/- 0.007 ml per g Hb respectively.

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Blood cultures were obtained from 39% of all 574 admissions to our Medical Intensive Care Unit. (ICU); in 109 (19%) a pathogenic organism was demonstrated. 45% of the septicaemias were detected within the first 48 h of ICU stay have been considered as "non ICU-acquired". Septicaemic patients were significantly older, had longer ICU stays and a higher mortality rate (62%) than non septicaemic patients (28%) (p less than 0.05). Gram negative organisms (69%) predominated over gram positive (29%) and Serratia marcescens and coagulase positive Staphylococcus were the most frequently isolated. Shock appeared in 32% and had an extremely high mortality (91%) and was associated with the presence of "multiple species septicaemia". Prior to the septicaemia the survivors differed from the fatalities only in the level of serum albumin; this was significantly lower in patients with gram negative in comparison with gram positive septicaemias and in patients who developed shock. Arterial, pulmonary artery and urinary catheters, and endotracheal devices were used frequently in these patients and were statistically associated with the presence of septicaemia. The airway was the most frequent possible source for the septicaemia.