Critical Care of the Hematopoietic Stem Cell Transplant Recipient
Critical Care of the Hematopoietic Stem Cell Transplant Recipient
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DOI：
10.1016/j.ccc.2009.09.001
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发表时间：
2010-01-01
影响因子：
4.3
通讯作者：
Azoulay, Elie
中科院分区：
文献类型：
--
作者：
Afessa, Bekele;Azoulay, Elie
据估计，全世界每年有5万至6万名患者接受造血干细胞移植（HSCT），其中15.7%的患者住进了重症监护病房（ICU）。最常见的ICU入院原因是呼吸衰竭，几乎所有患者都发展为单器官或多器官衰竭。大多数HSCT受者接受有创机械通气（MV）。入住ICU的HSCT受者的总体短期死亡率为65%，MV受者的总体短期死亡率为86.4%。随着时间的推移，患者的预后有所改善。不良预后指标包括高龄、功能不良、移植时的活动性疾病、同种异体移植、急性疾病的严重程度以及多器官功能衰竭的发展。ICU资源的限制常常导致患者的入院分诊决定。对于移植受者，作者建议(1)在移植前和没有疾病复发的证据时，入住ICU接受全面支持；(2)拒绝入住ICU的患者和卧床且疾病复发且除姑息治疗外无其他治疗选择的患者不得入住ICU；(3)对疾病复发状态未知且有可用治疗方案的患者进行ICU住院试验。
An estimated 50,000 to 60,000 patients undergo hematopoietic stem cell transplantation (HSCT) worldwide annually, of which 15.7% are admitted to the intensive care unit (ICU). The most common reason for ICU admission is respiratory failure and almost all develop single or multiorgan failure. Most HSCT recipients admitted to ICU receive invasive mechanical ventilation (MV). The overall short-term mortality rate of HSCT recipients admitted to ICU is 65%, and 86.4% for those receiving MV. Patient outcome has improved over time. Poor prognostic indicators include advanced age, poor functional status, active disease at transplant, allogeneic transplant, the severity of acute illness, and the development of multiorgan failure. ICU resource limitations often lead to triage decisions for admission. For HSCT recipients, the authors recommend (1) ICU admission for full support during their pre-engraftment period and when there is no evidence of disease recurrence; (2) no ICU admission for patients who refuse it and those who are bedridden with disease recurrence and without treatment options except palliation; (3) a trial ICU admission for patients with unknown status of disease recurrence with available treatment options.