THE OUTCOME OF CHILDREN REQUIRING ADMISSION TO AN INTENSIVE-CARE UNITFOLLOWING BONE-MARROW TRANSPLANTATION

We report the results of a retrospective study of the role of intensiv e care unit (ICU) admission in the management of 367 children who unde rwent bone marrow transplantation (BMT) at a tertiary referral institu tion. 39 patients (11%) required 46 ICU admissions for a median of 6 d . 70% received marrow from unrelated donors, half of which were mismat ched; 80% had leukaemia and two-thirds were considered high-risk trans plants. Respiratory failure was the major reason for admission to ICU. 75% of admissions required mechanical ventilation (for a median of 5 d and 20 patients had lung injury as defined by the criteria of the Se attle group. None of 11 patients with proven viral pneumonitis survive d (P = 0.06) and only one of 20 patients with lung injury survived (P < 0.01). Six of seven patients with a primary neurological problem sur vived (P < 0.001): these appear to represent a good outcome group. Age , the presence of graft-versus-host disease, the use of inotropes, iso lated renal or hepatic impairment, and paediatric risk of mortality (P RISM) score were not predictive of outcome. In total, 12 patients (27% of admissions) survived and were discharged from hospital 30 d or mor e after admission and eight (18%) survived >6 months. ICU admission ca n be beneficial to selected children post-BMT but it may be less usefu l in proven viral pneumonitis. Where mechanical ventilation is require d, the duration of this support should be limited unless there is rapi d improvement.