Outcome of bone marrow transplantation patients requiring mechanical ventilation

Objective: To identify outcome predictors in hone marrow transplantation (B MT) patients admitted to the intensive care unit (ICU) of The University of Texas M, D, Anderson Cancer Center who required endotracheal intubation an d mechanical ventilation, Design: Retrospective, comparative study. Setting: a 16-bed medical intensive care unit in a university teaching canc er center. Patients: The records of 60 consecutive BMT patients who developed respirat ory failure requiring mechanical ventilation were reviewed, Interventions: None, Measurements and Main Results: The most frequent complication leading to re spiratory failure was pneumonia (41%) followed by diffuse alveolar hemorrha ge (37%), Eighteen percent of the patients were extubated and discharged fr om the ICU, but only 5% were alive at 6 months, Craft vs, host disease was a predictor of a poor outcome (p <.05), Breast cancer as an underlying dise ase and pulmonary edema as a complication were favorable predictive factors (p <.05), Five of 26 patients with diffuse alveolar hemorrhage and four of 33 patients with pneumonia survived. We found no relationship between surv ival and age, gender, BMT type, or Acute Physiology and Chronic Health Eval uation ll score. Prolonged mechanical Ventilation (greater than or equal to 15 days) and late development of respiratory failure (>30 days after BMT) were associated with poor prognosis. Conclusions: The ICU survival rate of BMT patients who developed pulmonary complications and required mechanical ventilation was 18%, Prognostic facto rs were described identifying patients with a substantial survival rate as well as those in whom mechanical ventilation was futile.