Invasive Mechanical Ventilation and Mortality in Pediatric Hematopoietic Stem Cell Transplantation

Abstract

This study suggests that perhaps earlier more aggressive critical care interventions in the pediatric hematopoietic stem cell transplant patient with respiratory failure requiring invasive mechanical ventilation may offer an opportunity to improve outcomes.

High frequency oscillatory ventilation in a cohort of children with respiratory failure

“…In our study we observed significantly shorter duration of CMV prior to HFOV for survivors who were immunocompromised when compared to non‐immunocompromised patients suggesting that early HFOV use may be beneficial in this cohort of patients . This finding is consistent with a recent, previously discussed study that found transition to HFOV within two days of initiation of CMV was associated with a decreased odds of death among SCT patients …”

“…Recent data demonstrates a mortality of 75% for pediatric SCT recipients with severe ARDS independent of the type of ventilatory support . Our mortality rate of 83% for SCT patients supported with HFOV is similar to what was recently demonstrated . Our study differentiates itself from prior studies as we were able to differentiate immunocompromised patients into stem cell transplant and non‐stem cell transplant patients.…”

Weight gain and supplemental O2: Risk factors during the hematopoietic cell transplant admission in pediatric patients

“…However, noninfectious causes of respiratory failure are numerous . Also, in a large multicenter study of intubated pediatric patients with HCT, only 36% were found to have documented infections …”

“…It has been reported that between 20 and 44% of pediatric HCT recipients are admitted to the PICU . Those admissions that require mechanical ventilation have a mortality rate between 41 and 71% . Given the high incidence of acute respiratory failure in this population and the associated poor prognosis, it would be beneficial to determine who is likely to develop this complication so that timely preventive and therapeutic interventions could be instituted.…”

“…1,7 Those admissions that require mechanical ventilation have a mortality rate between 41 and 71%. 4,[7][8][9][10][11][12] Given the high incidence of acute Abbreviations: GFR, glomerular filtration rate; GVHD, graft versus host disease; HCT, hematopoietic cell transplant; NC, nasal cannula; OR, odds ratio; PICU, pediatric intensive care unit; VOD, veno-occlusive disease respiratory failure in this population and the associated poor prognosis, it would be beneficial to determine who is likely to develop this complication so that timely preventive and therapeutic interventions could be instituted.…”