SURVIVAL OF ADULT BONE-MARROW TRANSPLANT PATIENTS RECEIVING MECHANICAL VENTILATION - A CASE FOR RESTRICTED USE

A retrospective study of all adults receiving BMT over a 13 year perio d at a large transplant center was performed to determine overall surv ival and prognostic indicators of poor outcome among patients receivin g mechanical ventilation (MV). Of 653 adult BMT patients, 191 (29%) re ceived MV after transplant. Of these 191, 161 (84%) died on the ventil ator or within hours of extubation; 18 (10%) survived 1 week after ext ubation and 6 (3%) survived 6 months. Survival was not predicted by ty pe of graft, use of total body irradiation (TBI) or reason for intubat ion. The patient's age and the timing of intubation were predictive of survival. Of patients greater-than-or-equal-to 40 years, 98% died wit hin a week of extubation and all died within 30 days. Similarly, of th ose intubated within 90 days of transplant, 94% died within a week of extubation and all died by day 100. These results suggest that MV is r arely effective in achieving long-term survival in adult BMT recipient s, especially older patients and those early in their transplant cours e. An argument, based on cost/benefit considerations and medical futil ity, can be developed to withhold MV in certain patient subsets apart from a clinical research trial.