Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Transplant Toxicities

Outcome of invasive mechanical ventilation after pediatric allogeneic hematopoietic SCT: results from a prospective, multicenter registry

Bone Marrow Transplantation volume 49, pages 1287–1292 (2014)Cite this article

Subjects

Abstract

Exact data on prognosis of children receiving invasive mechanical ventilation (IMV) after allogeneic hematopoietic SCT (HSCT) is lacking. We therefore started a prospective registry in four European university HSCT centers (Leiden, Paris, Prague and Utrecht) and their pediatric intensive care units (PICUs). The registry started in January 2009. In January 2013, the four centers together had treated a total of 83 admissions with IMV. The case fatality rate in these patients was 52%. Mortality 6 months after PICU discharge was 45%. There were significant differences between centers in the proportion of children who received IMV after HSCT (6–23%, P<0.01), in severity of disease on admission to PICU (predicted mortality 14–37%, P<0.01), in applying noninvasive ventilation before IMV (3–75% of admissions, P<0.01) and in the use of renal replacement therapy (RRT) (8–58% of admissions, P<0.01). Severe impairment in oxygenation, use of RRT and CMV viremia were independent predictors of mortality. Our study shows that mortality in children receiving IMV after HSCT remains high, but has clearly improved compared with older studies. Patient selection and treatment in PICU differed significantly between centers, which underscores the need to standardize and optimize the PICU admission criteria, ventilatory strategies and therapies applied in PICU.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 2010; 25: 2091–2101.

    Article  Google Scholar 

  2. Oshima K, Hanada R, Kobayashi R, Kato K, Nagatoshi Y, Tabuchi K et al. Hematopoietic stem cell transplantation in patients with severe congenital neutropenia: an analysis of 18 Japanese cases. Pediatr Transplant 2010; 14: 657–663.

    Article  CAS  PubMed  Google Scholar 

  3. Bhatia M, Walters MC . Hematopoietic cell transplantation for thalassemia and sickle cell disease: past, present and future. Bone Marrow Transplant 2008; 41: 109–117.

    Article  CAS  PubMed  Google Scholar 

  4. Boelens JJ . Trends in haematopoietic cell transplantation for inborn errors of metabolism. J Inherit Metab Dis 2006; 29: 413–420.

    Article  PubMed  Google Scholar 

  5. van Gestel JP, Bollen CW, van der Tweel I, Boelens JJ, van Vught AJ . Intensive care unit mortality trends in children after hematopoietic stem cell transplantation: a meta-regression analysis. Crit Care Med 2008; 36: 2898–2904.

    Article  PubMed  Google Scholar 

  6. Duncan CN, Lehmann LE, Cheifetz IM, Greathouse K, Haight AE, Hall MW et al. Clinical outcomes of children receiving intensive cardiopulmonary support during hematopoietic stem cell transplant. Pediatr Crit Care Med 2013; 14: 261–267.

    Article  PubMed  Google Scholar 

  7. Nichols DG, Walker LK, Wingard JR, Bender KS, Bezman M, Zahurak ML et al. Predictors of acute respiratory failure after bone marrow transplantation in children. Crit Care Med 1994; 22: 1485–1491.

    Article  CAS  PubMed  Google Scholar 

  8. van Gestel JP, Bollen CW, Bierings MB, Boelens JJ, Wulffraat NM, van Vught AJ . Survival in a recent cohort of mechanically ventilated pediatric allogeneic hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant 2008; 14: 1385–1393.

    Article  PubMed  Google Scholar 

  9. Tamburro RF, Barfield RC, Shaffer ML, Rajasekaran S, Woodard P, Morrison RR et al. Changes in outcomes (1996–2004) for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation. Pediatr Crit Care Med 2008; 9: 270–277.

    Article  PubMed  Google Scholar 

  10. Cole TS, Johnstone IC, Pearce MS, Fulton B, Cant AJ, Gennery AR et al. Outcome of children requiring intensive care following haematopoietic SCT for primary immunodeficiency and other non-malignant disorders. Bone Marrow Transplant 2012; 47: 40–45.

    Article  CAS  PubMed  Google Scholar 

  11. Aspesberro F, Guthrie KA, Woolfrey AE, Brogan TV, Roberts JS . Outcome of pediatric hematopoietic stem cell transplant recipients requiring mechanical ventilation. J Intens Care Med 2014; 29: 31–37.

    Article  Google Scholar 

  12. Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974; 18: 295–304.

    Article  CAS  PubMed  Google Scholar 

  13. Wilkinson JD, Pollack MM, Glass NL, Kanter RK, Katz RW, Steinhart CM . Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit. J Pediatr 1987; 111: 324–328.

    Article  CAS  PubMed  Google Scholar 

  14. Keenan HT, Bratton SL, Martin LD, Crawford SW, Weiss NS . Outcome of children who require mechanical ventilatory support after bone marrow transplantation. Crit Care Med 2000; 28: 830–835.

    Article  CAS  PubMed  Google Scholar 

  15. Slater A, Shann F, Pearson G . PIM2: a revised version of the paediatric index of mortality. Intens Care Med 2003; 29: 278–285.

    Article  Google Scholar 

  16. Jacobe SJ, Hassan A, Veys P, Mok Q . Outcome of children requiring admission to an intensive care unit after bone marrow transplantation. Crit Care Med 2003; 31: 1299–1305.

    Article  PubMed  Google Scholar 

  17. Demaret P, Pettersen G, Hubert P, Teira P, Emeriaud G . The critically-ill pediatric hemato-oncology patient: epidemiology, management, and strategy of transfer to the pediatric intensive care unit. Ann Intens Care 2012; 2: 14.

    Article  Google Scholar 

  18. Tomaske M, Bosk A, Eyrich M, Bader P, Niethammer D . Risks of mortality in children admitted to the paediatric intensive care unit after haematopoietic stem cell transplantation. Br J Haematol 2003; 121: 886–891.

    Article  PubMed  Google Scholar 

  19. Kache S, Weiss IK, Moore TB . Changing outcomes for children requiring intensive care following hematopoietic stem cell transplantation. Pediatr Transplant 2006; 10: 299–303.

    Article  PubMed  Google Scholar 

  20. Flores FX, Brophy PD, Symons JM, Fortenberry JD, Chua AN, Alexander SR et al. Continous renal replacement therapy (CRRT) after stem cell transplantation. A report from the prospective pediatric CRRT Registry Group. Pediatr Nephrol 2008; 23: 625–630.

    Article  PubMed  Google Scholar 

  21. Modem V, Thompson M, Gollhofer D, Dhar AV, Quigley R . Timing of continuous renal replacement therapy and mortality in critically ill children. Crit Care Med 2014; 42: 943–953.

    Article  CAS  PubMed  Google Scholar 

  22. Broers AE, van der Holt R, van Esser JW, Gratama JW, Henzen-Logmans S, Kuenen-Boumeester V et al. Increased transplant-related morbidity and mortality in CMV-seropositive patients despite highly effective prevention of CMV disease after allogeneic T-cell-depleted stem cell transplantation. Blood 2000; 95: 2240–2245.

    CAS  PubMed  Google Scholar 

  23. Schmidt-Hieber M, Labopin M, Beelen D, Volin L, Ehninger G, Finke J et al. CMV serostatus still has an important prognostic impact in de novo acute leukemia patients after allogeneic stem cell transplantation: a report from the Acute Leukemia Working Party of EBMT. Blood 2013; 122: 3359–3364.

    Article  CAS  PubMed  Google Scholar 

  24. Matthes-Martin S, Potschger U, Bergmann K, Frommlet F, Brannath W, Bauer P et al. Risk-adjusted outcome measurement in pediatric allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2008; 14: 335–343.

    Article  PubMed  Google Scholar 

  25. McArthur J, Pettersen G, Jouvet P, Christensen M, Tamburro R . The care of critically ill children after hematopoietic SCT: a North American survey. Bone Marrow Transplant 2011; 46: 227–231.

    Article  CAS  PubMed  Google Scholar 

  26. Thiery G, Azoulay E, Darmon M, Ciroldi M, De MS, Levy V et al. Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 2005; 23: 4406–4413.

    Article  PubMed  Google Scholar 

  27. Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E . The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 2007; 35: 808–814.

    Article  PubMed  Google Scholar 

  28. Azoulay E, Mokart D, Pene F, Lambert J, Kouatchet A, Mayaux J et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol 2013; 31: 2810–2818.

    Article  PubMed  Google Scholar 

  29. Straney L, Clements A, Parslow RC, Pearson G, Shann F, Alexander J et al. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care*. Pediatr Crit Care Med 2013; 14: 673–681.

    Article  PubMed  Google Scholar 

  30. Cheuk DK, Ha SY, Lee SL, Chan GC, Tsoi NS, Lau YL . Prognostic factors in children requiring admission to an intensive care unit after hematopoietic stem cell transplant. Hematol Oncol 2004; 22: 1–9.

    Article  PubMed  Google Scholar 

  31. Gonzalez-Vicent M, Marin C, Madero L, Sevilla J, Diaz MA . Risk score for pediatric intensive care unit admission in children undergoing hematopoietic stem cell transplantation and analysis of predictive factors for survival. J Pediatr Hematol Oncol 2005; 27: 526–531.

    Article  PubMed  Google Scholar 

  32. Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C et al. Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 2001; 29: 519–525.

    Article  CAS  PubMed  Google Scholar 

  33. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 2001; 344: 481–487.

    Article  CAS  PubMed  Google Scholar 

  34. Molina R, Bernal T, Borges M, Borges M, Zaragoz R, Bonastre J et al. Ventilatory support in critically ill hematology patients with respiratory failure. Crit Care 2012; 16: R133.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Adda M, Coquet I, Darmon M, Thiery G, Schlemmer B, Azoulay E . Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure. Crit Care Med 2008; 36: 2766–2772.

    Article  PubMed  Google Scholar 

  36. Schnell D, Lemiale V, Azoulay E . Non-invasive mechanical ventilation in hematology patients: let's agree on several things first. Crit Care 2012; 16: 175.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Azoulay E, Lemiale V . Non-invasive mechanical ventilation in hematology patients with hypoxemic acute respiratory failure: a false belief? Bone Marrow Transplant 2012; 47: 469–472.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, University Medical Center Utrecht, The Wilhelmina Children’s Hospital, Utrecht, The Netherlands

    J P J van Gestel & C W Bollen

  2. Department of Pediatric Hematology, Immunology and Bone Marrow Transplantation, University Medical Center Utrecht, The Wilhelmina Children’s Hospital, Utrecht, The Netherlands

    M B Bierings

  3. Pediatric Intensive Care Unit, AP-HP, Robert-Debré Hospital and Paris Diderot University, Paris 7, Paris, France

    S Dauger

  4. Department of Pediatric Hematology, Immunology and Bone Marrow Transplantation, AP-HP, Robert-Debré Hospital and Paris Diderot University, Paris 7, Paris, France

    J-H Dalle

  5. Pediatric Intensive Care Unit, Charles University Hospital Motol, Prague, Czech Republic

    P Pavlíček

  6. Department of Pediatric Hematology and Oncology, Charles University Hospital Motol, Prague, Czech Republic

    P Sedláček

  7. Pediatric Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands

    L M Monteiro

  8. Department of Pediatric Hematology, Immunology and Bone Marrow Transplantation, Leiden University Medical Center, Leiden, The Netherlands

    A Lankester

Authors
  1. J P J van Gestel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M B Bierings
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Dauger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J-H Dalle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P Pavlíček
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P Sedláček
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L M Monteiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A Lankester
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C W Bollen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J P J van Gestel.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Author contributions

All authors have contributed substantially in the conception and design of the study. They all participated actively in the writing of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Gestel, J., Bierings, M., Dauger, S. et al. Outcome of invasive mechanical ventilation after pediatric allogeneic hematopoietic SCT: results from a prospective, multicenter registry. Bone Marrow Transplant 49, 1287–1292 (2014). https://doi.org/10.1038/bmt.2014.147

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2014.147

This article is cited by

Search

Advanced search

Quick links