Faculty Collaboration Database

Clinical outcomes of children receiving intensive cardiopulmonary support during hematopoietic stem cell transplant. Pediatr Crit Care Med 2013 Mar;14(3):261-7

Date

02/09/2013

Pubmed ID

23392372

DOI

10.1097/PCC.0b013e3182720601

Scopus ID

2-s2.0-84874940076 (requires institutional sign-in at Scopus site)   55 Citations

Abstract

OBJECTIVE: We investigated the short-term and 1-year clinical outcomes of 129 children who received intensive cardiopulmonary support during hematopoietic stem cell transplant. Intensive cardiopulmonary support was defined as receiving at least one of the following interventions: continuous positive pressure ventilation, dopamine infusion greater than or equal to 10 mcg/kg/minute, or the use of any other vasoactive infusion. Duration of intensive cardiopulmonary support, survival to hospital discharge, and predictors of these outcome variables were compared with 387 hematopoietic stem cell transplant patients who did not receive intensive support during the same period. We also report the 1-year survival; presence of chronic graft-versus-host disease; and renal, cardiac, and pulmonary function for all patients.

DESIGN: A multicenter retrospective cohort study.

SETTING: The ICU and hematopoietic stem cell transplant unit of nine pediatric tertiary care centers.

PATIENTS: Children undergoing hematopoietic stem cell transplant who required intensive cardiopulmonary support.

INTERVENTIONS: None.

RESULTS: Predictors of the need for intensive support included unrelated donor allogeneic transplant, glomerular filtration rate less than 85 mL/minute/1.73 m, and nonmalignant disease as the indication for transplant. The survival to discontinuation of intensive support for all patients was 62% and 58% for patients who received invasive mechanical ventilatory support. The duration of mechanical ventilation was not predictive of survival. Predictors of intensive support mortality included macroscopic bleeding, engraftment, and pediatric logistic organ dysfunction score greater than one in two domains. Survival to hospital discharge was 50% for the intensive support group and 99% for the nonintensive support group. Overall 1-year survival was 40% in the intensive support population and 65% in the nonintensive support group. There were no significant differences in the survival, rates of chronic graft-versus-host disease, creatinine, forced expiratory volume in 1-minute, cardiac shortening fraction, or performance status in intensive and nonintensive support patients who survived to hospital discharge.

CONCLUSION: Intensive cardiopulmonary support plays an important and potentially life-saving role in the care of pediatric stem cell transplant patients. Survivors of intensive support do not have compromised 1-year survival or organ function compared with children who did not receive intensive support.

Author List

Duncan CN, Lehmann LE, Cheifetz IM, Greathouse K, Haight AE, Hall MW, Herschberger A, Hill KS, Moffet JR, Morrison RR, Norris AL, Petrovic A, Spear DA, Steiner ME, Talano JA, Tamburro RF, Wagner J, McArthur J, Pediatric Acute Lung Injury and Sepsis (PALISI) Network

Author

Julie-An M. Talano MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Cardiotonic Agents
Child
Child, Preschool
Combined Modality Therapy
Continuous Positive Airway Pressure
Dopamine
Female
Follow-Up Studies
Hematopoietic Stem Cell Transplantation
Humans
Infant
Infant, Newborn
Logistic Models
Male
Postoperative Complications
Retrospective Studies
Survival Rate
Treatment Outcome
Vasoconstrictor Agents
Vasodilator Agents
Young Adult