Improved outcomes for stem cell transplant recipients requiring pediatric intensive care
Improved outcomes for stem cell transplant recipients requiring pediatric intensive care
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DOI：
10.1097/pcc.0b013e318253c945
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发表时间：
2012-11-01
影响因子：
4.1
通讯作者：
Jodele, Sonata
中科院分区：
文献类型：
--
作者：
Chima, Ranjit S.;Daniels, Rodney C.;Jodele, Sonata
目的：需要入住儿科重症监护病房的造血干细胞移植患者的生存率可能会有所改善。本研究旨在回顾需要入住我们儿科重症监护病房的造血干细胞移植患者的结局，并确定影响生存的变量。设计：回顾性数据库审查。设置：儿科重症监护病房和儿童医院的骨髓移植服务。患者：2004年7月至2010年6月在我们中心接受造血干细胞移植的患者，需要同期入住儿科重症监护病房。测量和主要结果：在此期间，35% 的接受造血干细胞移植的患者（448 名患者中的 155 名）需要 319 名患者入院。在这 155 名患者中，63%（155 名患者中的 97 名）在最近一次入院后存活出院，100 天生存率为 51%（155 名患者中的 79 名）。 45%（155 名患者中的 69 名）在长期随访中仍然存活。 57%（155 名患者中的 88 名）需要插管和机械通气，其中 39%（88 名中的 34 名）患者在最后一次入住儿科重症监护病房时幸存下来。 25%（155 名患者中的 38 名）使用了肾脏支持，其中 34%（38 名中的 13 名）存活至儿科重症监护病房出院。与非幸存者相比，在儿科重症监护病房出院后幸存的入院儿童的儿科死亡风险 II 评分显着较低，儿科重症监护病房住院时间较短，插管和机械通气的使用率较低，呼吸机天数较少，并且肾支持的使用率较低。值得注意的是，每次入院儿科重症监护病房都会显着降低儿科重症监护病房的存活率。结论：我们报告，在 6 年期间入住我们儿科重症监护病房的所有造血干细胞移植患者中，儿科重症监护病房出院时的存活率为 63%，中位随访时间超过 2 年，其中 45% 的存活率。我们的数据表明，这一高危患者群体的生存结果得到了改善。 （儿科重症监护医学 2012 年；13：e336-e342）
Objectives: Survival for hematopoietic stem cell transplant patients requiring pediatric intensive care unit admission may be improving. This study was conducted to review outcomes for patients undergoing hematopoietic stem cell transplantation requiring admission to our pediatric intensive care unit and to identify variables impacting survival.Design: Retrospective database review.Setting: Pediatric intensive care unit and bone marrow transplant service of a children's hospital.Patients: Patients undergoing hematopoietic stem cell transplantation at our center from July 2004 through June 2010 requiring pediatric intensive care unit admission during the same period.Measurements and Main Results: Thirty-five percent of patients (155 of 448) undergoing hematopoietic stem cell transplantation required 319 admissions over this period. Of these 155 patients, 63% (97 of 155) were discharged alive following their most recent admission with a 100-day survival of 51% (79 of 155). Forty-five percent (69 of 155) of patients were still alive on long-term follow-up. Intubation and mechanical ventilation were required for 57% (88 of 155) of patients, with 39% (34 of 88) of patients surviving their last pediatric intensive care unit admission. Renal support was utilized for 25% (38 of 155) of patients with 34% (13 of 38) survival to pediatric intensive care unit discharge. Admissions surviving to pediatric intensive care unit discharge had significantly lower Pediatric Risk of Mortality II scores, shorter pediatric intensive care unit length of stay, lower utilization of intubation and mechanical ventilation with fewer ventilator days, and lower use of renal support when compared to nonsurvivors. Of note, each prior pediatric intensive care unit admission significantly reduced the odds of pediatric intensive care unit survival.Conclusions: We report a 63% survival to pediatric intensive care unit discharge, with 45% surviving at a median follow-up of over 2 yrs for all hematopoietic stem cell transplantation patients admitted to our pediatric intensive care unit over a 6-yr period. Our data suggest improved survival outcomes for this high risk patient population. (Pediatr Crit Care Med 2012; 13:e336-e342)