Prognosis of pediatric bone marrow transplant recipients requiring mechanical ventilation

Objectives: To assess the prognosis of pediatric bone marrow transplant rec ipients requiring mechanical ventilation and to identify risk factors for m ortality. Design: Retrospective chart review. Setting: Pediatric intensive care unit (PICU), tertiary care center, Patients: Inclusion criteria were endotracheal intubation and mechanical ve ntilation after bone marrow transplantation; patients with perioperative ve ntilation were excluded. Outcome measures were extubation, PICU discharge, and 6-month survival. The 39 patients who met the inclusion criteria were v entilated on 41 occasions. Interventions: None. Measurements and Main Results: Overall survival rate to PICU discharge was 44% (17 of 39 patients). Six months after PICU discharge, 14 of these child ren were still alive, for a medium-term survival rate of 36%. Preexisting c onditions (primary disease, bone marrow engraftment, or graft-vs.-host dise ase) had no significant effect on survival. Multiple organ failure, especia lly pulmonary failure and neurologic deterioration, were significant determ inants of patient survival. Conclusions: The observed prognosis is improved over previous reports. Earl y initiation of aggressive intensive care treatment is warranted in this pa tient group. Decisions regarding intensity of treatment must be based on as pects of the acute illness rather than on the primary conditions.