Pediatric Acute Respiratory Distress Syndrome in Pediatric Allogeneic Hematopoietic Stem Cell Transplants: A Multicenter Study*

Abstract

In this multicenter cohort, the majority of pediatric allogeneic hematopoietic stem cell transplant patients with respiratory failure met oxygenation criteria for pediatric acute respiratory distress syndrome based on the Pediatric Acute Lung Injury Consensus Conference definition within the first week of invasive mechanical ventilation. Length of invasive mechanical ventilation, length of PICU stay, and mortality increased as the severity of pediatric acute respiratory distress syndrome worsened.

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

“…Recent data demonstrates a mortality of 75% for pediatric SCT recipients with severe ARDS independent of the type of ventilatory support. 17 Our mortality rate of 83% for SCT patients supported with HFOV is similar to what was recently demonstrated. 11 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.…”

“…We demonstrated the risk of mortality for SCT patients is significantly higher than for both immunocompetent patients and immunocompromised non‐stem cell transplant 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 .…”

Supplemental Oxygen–Free Days in Hematopoietic Cell Transplant Recipients With Respiratory Syncytial Virus

“…The number of supplemental oxygen-free days as an endpoint was also evaluated in the current study. Supplemental oxygen use correlates with acute lung injury, which, in turn, is associated with mortality in HCT recipients [15,20,21]. Additionally, supplemental oxygen use typically requires hospitalization; thus, the number of supplemental oxygen-free days represent a composite endpoint that takes into account disease severity, need for hospitalization, and mortality.…”

Management guidelines for paediatric patients receiving chimeric antigen receptor T cell therapy

“…In recognition of the differences in acute res piratory distress syndrome (ARDS) between adult and paediatric patients, a 2015 publication by the Pediatric Acute Lung Injury Consensus Conference (PALICC) group provided paediatric specific definitions for pae diatric ARDS (P ARDS) 100 ; these criteria have since been applied among paediatric patients who have under gone HSCT 101,102 . We recommend application of the PALICC at risk P ARDS criteria for the CRS grading of hypoxia 100 (Table 1).…”

“…We recommend application of the PALICC at-risk P-ARDS criteria for the CRS grading of hypoxia[100][101][102] IIA BAcute kidney injury in children can be graded according to CTCAE using pRIFLE and KDIGO definitions of oliguria105,106 Tocilizumab paediatric dosing: patients weighing <30 kg are dosed at 12 mg/kg, and those weighing ≥30 kg are dosed at 8 mg/kg (ref 109 ). …”