Outcome of Patients Requiring Medical ICU Admission Following Bone Marrow Transplantation

Paz, Harold L.; Crilley, Pamela; Weinar, Martha; Brodsky, Isadore

doi:10.1378/chest.104.2.527

Cited by 138 publications

(107 citation statements)

References 16 publications

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“…6 While the incidence of mechanical ventilation in our series was similar to that reported in other studies of ICU admission, 1,5 17% of our ventilated patients survived to hospital discharge and 15% survived for at least 6 months from the date of their ICU discharge. This is higher than that reported by other authors [4][5][6] in spite of the fact that the mean APACHE II scores of our patients were higher than in prior reports. It is possible that some of this increase in survival may reflect a pre-selection of patients prior to the initiation of ventilation with the avoidance of ventilatory support in patients who were deemed non-salvageable.…”

Section: Discussioncontrasting

confidence: 90%

“…The issue of length of ICU stay is also clouded by intangible factors. While some studies have found survivors tend to have shorter ICU stays than non-survivors, 3,5 we, like Afessa et al, 1 did not find this to be the case. Factors which may influence such results, including ICU bed availability, as well as the more difficult issue of when decisions are made to withdraw support in patients who are felt not to be salvageable make this issue one which will require ongoing study.…”

Section: Discussioncontrasting

confidence: 64%

“…The validity of such intervention in this group of patients has, however, been questioned in some prior studies which have shown a poor prognosis for BMT patients in ICU, especially those who have required mechanical ventilation. [1][2][3][4][5][6]16 Crawford,4 in the largest early reported series of ventilated patients, found that only 3% of patients survived more than 6 months after the initiation of ventilatory support; similar findings have been suggested in other studies. 6 While the incidence of mechanical ventilation in our series was similar to that reported in other studies of ICU admission, 1,5 17% of our ventilated patients survived to hospital discharge and 15% survived for at least 6 months from the date of their ICU discharge.…”

Section: Discussionsupporting

confidence: 60%

“…[1][2][3] The outcome for such patients is generally felt to be poor, especially if they require mechanical ventilation for respiratory failure, [4][5][6] with less than 5% of the latter reported to be alive 6 months later. 4,6 These data have led some authors to suggest that ventilatory support for BMT patients is generally 'futile' and others to question the value of ICU admission in patients who have undergone marrow transplantation or treatment for aggressive hematological malignancies.…”

mentioning

confidence: 99%

“…Previous retrospective studies of ICU admissions in patients with hematologic malignancies or who have undergone BMT have studied the value of utilizing the APACHE II scoring system [12][13][14] with conflicting results. 1,5 While advanced age and the need for mechanical ventilation are generally felt to be predictors of a poor outcome, further stratification of patients according to prognostic factors at the time of admission or early in their ICU stay remains limited and useful guidelines for physicians and family members about the likelihood of a given BMT patient surviving the ICU admission are difficult to find.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors

Jackson

Tweeddale

Barnett

et al. 1998

Bone Marrow Transplant

132

115

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Summary:The role of ICU support in BMT patients is controversial. In an era of constrained resources, the use of prognostic factors predicting outcome may be helpful in identifying patients who are most likely (or unlikely) to benefit from this intervention. We attempted to define the survival of patients admitted to ICU following autologous or allogeneic BMT and to identify those factors important in determining patient outcome. A retrospective study of all adult BMT recipients admitted to intensive care over a 6 year study period was performed to determine overall and prognostic indicators of poor outcome. Pre-treatment, pre-ICU admission and ICU admission data were analyzed to identify factors predicting long-term survival. 116 patients were admitted to ICU on 135 separate occasions with the primary reasons for admission being respiratory failure (66%), sepsis associated with hypotension (10%), and cardiorespiratory failure (8%). No pre-ICU characteristics were predictive of survival. Univariate analysis identified the number of support measures required, the need for ventilation or hemodynamic support, the APACHE II score, the year of ICU admission and the serum bilirubin as significant predictors of post-discharge survival. On multivariate analysis the year of ICU admission, the need for hemodynamic support and the serum bilirubin remained significant. The APACHE II score significantly underestimated survival in the 46% of patients with scores less than 35, and could only be used to predict 100% mortality when it exceeded 45. Twenty-three percent of all BMT patients admitted to the ICU and 17% of ventilated patients survived to hospital discharge. Of the 27 patients surviving to leave hospital, 16 remain alive with a median follow-up of 4. was identified which could be used to predict futility but patients requiring both hemodynamic support and mechanical ventilation, and those with an APACHE II score greater than 45 have a very poor prognosis and are unlikely to benefit from lengthy ICU support.

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Section: Discussioncontrasting

confidence: 90%