Mechanical ventilation in hematopoietic stem cell transplantation - Can weeffectively predict outcomes?

Background: Survival rates from mechanical ventilation (MV) in allogeneic b one marrow transplantation are poor, but little is known about the need for and outcomes from MV in patients who undergo autologous hematopoietic stem cell transplantation (AHSCT), Study objective: To determine the frequency of and risk factors for the use of MV in recipients of AHSCT and to identify predictors of survival in mec hanically ventilated AHSCT patients. Design: Retrospective, cohort analysis Setting: Tertiary-care, university-affiliated medical center. Patients: One hundred fifty-nine consecutive patients who underwent AHSCT, Interventions: Patient surveillance and data collection. Measurements and results: The primary outcome measure was the need for MV, and the secondary end point was survival after MV. Of 159 patients, 17 requ ired PVN (10.7%), Three variables were associated with the need for MV: inc reasing age, use of total body irradiation in the conditioning regimen, and treatment with amphotericin B, As a screening test to predict the need for MV, no risk factor had a sensitivity or specificity > 82%. Three of the 17 mechanically ventilated patients (17,0%) survived to discharge. Only the m ean APACHE (acute physiology and chronic health evaluation) II score separa ted survivors from nonsurvivors (21.7 vs 31.4; p = 0.029), Both the duratio n of MV and the length of stay in the ICU were similar in survivors and non survivors, Conclusions: We conclude that MV is infrequently needed following AHSCT, Al though survival after MV in these patients is limited, clinical variables d o not reliably allow clinicians to prospectively identify patients destined to die.