Factors affecting survival in children requiring intensive care after hematopoietic stem cell transplantation. A retrospective single‐center study |
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Authors: | Zofia Szmit Magdalena Komider‐urawska Anna Krl Monika obos Justyna Mikiewicz‐Bujna Marzena Zieliska Krzysztof Kawak Monika Mielcarek‐Siedziuk Magorzata Salamonowicz‐Bodzioch Jowita Frczkiewicz Marek Ussowicz Joanna Owoc‐Lempach Ewa Gorczyska |
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Institution: | Zofia Szmit,Magdalena Ko?mider‐?urawska,Anna Król,Monika ?obos,Justyna Mi?kiewicz‐Bujna,Marzena Zielińska,Krzysztof Ka?wak,Monika Mielcarek‐Siedziuk,Ma?gorzata Salamonowicz‐Bodzioch,Jowita Fr?czkiewicz,Marek Ussowicz,Joanna Owoc‐Lempach,Ewa Gorczyńska |
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Abstract: | Allo‐HSCT is associated with life‐threatening complications. Therefore, a considerable number of patients require admission to a PICU. We evaluated the incidence and outcome of PICU admissions after allo‐HSCT in children, along with the potential factors influencing PICU survival. A retrospective chart review of 668 children who underwent first allo‐HSCT in the Department of Pediatric Hematology/Oncology and BMT in Wroc?aw during years 2005‐2017, particularly focusing on patients admitted to the PICU within 1‐year post‐HSCT. Fifty‐eight (8.7%) patients required 64 admissions to the PICU. Twenty‐four (41.5%) were discharged, and 34 (58.6%) patients died. Among the discharged patients, 6‐month survival was 66.7%. Compared with survivors, death cases were more likely to have required MV (31/34; 91.2% vs. 16/24; 66.7% P = .049), received more aggressive cardiac support (17/34; 50% vs. 2/24; 8.3% P = .002), and had a lower ANC on the last day of their PICU stay (P = .004). Five patients were successfully treated with NIV and survived longer than 6 months post‐discharge. The intensity of cardiac support and ANC on the last day of PICU treatment was independent factors influencing PICU survival. Children admitted to the PICU after allo‐HSCT have a high mortality rate. Mainly those who needed a more aggressive approach and had a lower ANC on the last day of treatment had a greater risk of death. While requiring MV is associated with decreased PICU survival, early implementation of NIV might be considered. |
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Keywords: | complications critical care granulocytes hematopoietic stem cell transplantation mechanical ventilation non‐invasive ventilation |
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