Outcomes following mechanical ventilation in children undergoing bone marrow transplantation

Abstract

Between 1976 and 1992, 869 patients <19 years of age underwent bmt at the university of minnesota for a variety of malignant and non-malignant disorders. one hundred and ninety-six required mechanical ventilation (mv) at some time from the start of pre-bmt cyto reduction through the first year following bmt. reasons for mv included respiratory compromise, upper airway management and non-pulmonary indications for respiratory support. in multivariate models, underlying diagnosis, receipt of hla-mismatched marrow and the presence of acute graft-versus-host disease (agvhd) were independent predictors of the need for mv. indication for mv, underlying diagnosis, and presence of agvhd were independent predictors of successful extubation. overall survival at 2 years was 14% among mv patients and 52% among non-mv patients. while the need for mv during bmt reduces the overall likelihood of survival, 40% of children who required mv were successfully extubated; 35% of these extubated patients were long-term survivors. this outcome is better than that reported for adult bmt patients requiring respiratory support, who show survival of <5% at 6 months following bmt. our data suggest extrapolation of outcome data from adult to pediatric patients is not appropriate and aggressive care of pediatric patients requiring respiratory support is not futile.