ACUTE HYPOXEMIC RESPIRATORY-FAILURE IN CHILDREN FOLLOWING BONE-MARROWTRANSPLANTATION - AN OUTCOME AND PATHOLOGICAL-STUDY

Objectives: To describe the pulmonary pathology and clinical outcome i n children with acute hypoxemic respiratory failure after bone marrow transplantation.Design: Review of medical records and pathologic mater ial of patients diagnosed with acute hypoxemic respiratory failure aft er bone marrow transplantation. Setting: Pediatric intensive care unit (ICU) of a teaching hospital. Patients and Methods: Retrospective rev iew of a consecutive cohort of children, with a history of bone marrow transplantation admitted to the pediatric ICU during a 7-yr study per iod, and who met a published definition of acute hypoxemic respiratory failure. For each admission, the pediatric ICU course and outcome wer e reviewed. Pathologic material that was obtained from the patients wa s reexamined and assigned to one of the following categories: acute or organizing diffuse alveolar damage, pulmonary hemorrhage, nonspecific interstitial pneumonitis, or infectious pneumonia. Interventions: Non e. Measurements and Main Results: Forty-three patients satisfied crite ria for inclusion in the study group. Indications for bone marrow tran splantation were: solid tumor (30%), leukemia (44%), congenital immuno deficiency (19%), and aplastic anemia (7%). Patients were admitted to the pediatric ICU a median of 1 month (range 0 to 126) after bone marr ow transplantation. Thirty-eight (88%) patients died in the pediatric ICU. Tissue histologic material was available from 21 (49%) patients. Six (29%) of 21 patients had acute diffuse alveolar damage; one (5%) h ad organizing diffuse alveolar damage; three (14%) had nonspecific int erstitial pneumonitis; and two (10%) had pulmonary hemorrhage. Infecti ous pneumonia occurred in nine (43%) cases (five fungal; four viral). Conclusions: The acute mortality rate (88%) for children with acute hy poxemic respiratory failure after bone marrow transplantation is simil ar to that reported for adults with this combination of conditions. Di ffuse alveolar damage, the histologic hallmark of adult respiratory di stress syndrome, was present in a minority (33%) of patients. Infectio us pneumonia was the most frequent cause of acute hypoxemic respirator y failure in patients who had pathologic tissue available, emphasizing the need for aggressive diagnostic studies and early institution of a ntifungal and antiviral therapy.