Courtney M Rowan1, Jennifer McArthur2,3, Deyin D Hsing4, Shira J Gertz5, Lincoln S Smith6, Ashley Loomis7, Julie C Fitzgerald8, Mara E Nitu1, Elizabeth A S Moser9, Christine N Duncan10, Kris M Mahadeo11, Jerelyn Moffet12, Mark W Hall13, Emily L Pinos14, Robert F Tamburro14, Ira M Cheifetz15. 1. Department of Pediatrics, Division of Critical Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN. 2. Department of Pediatrics, Division of Critical Care, St. Jude's Children's Research Hospital, Memphis, TN. 3. Department of Pediatrics Division of Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI. 4. Department of Pediatrics, Division of Critical Care, Weil Cornell Medical College, New York Presbyterian Hospital, New York City, NY. 5. Department of Pediatrics, St Barnabas Medical Center, Livingston, NJ. 6. Department of Pediatrics, Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA. 7. Department of Pediatrics, Division of Critical Care, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN. 8. Department of Anesthesiology and Critical Care, Division of Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 9. Department of Biostatistics, Indiana University, Indianapolis, IN. 10. Department of Pediatrics, Pediatric Oncology, Dana-Farber Cancer Institute Harvard University, Boston, MA. 11. Department of Pediatrics, Division of Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY. 12. Department of Pediatrics, Division of Blood and Marrow Transplant, Duke Children's Hospital, Duke University, Durham, NC. 13. Department of Pediatrics, Division of Critical Care, Nationwide Children's Hospital, The Ohio State University, Columbus, OH. 14. Department of Pediatrics, Division of Critical Care, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey, PA. 15. Department of Pediatrics, Division of Critical Care, Duke Children's Hospital, Duke University, Durham, NC.
Abstract
OBJECTIVES: Acute respiratory failure is common in pediatric hematopoietic cell transplant recipients and has a high mortality. However, respiratory prognostic markers have not been adequately evaluated for this population. Our objectives are to assess respiratory support strategies and indices of oxygenation and ventilation in pediatric allogeneic hematopoietic cell transplant patients receiving invasive mechanical ventilation and investigate how these strategies are associated with mortality. DESIGN: Retrospective, multicenter investigation. SETTING: Twelve U.S. pediatric centers. PATIENTS: Pediatric allogeneic hematopoietic cell transplant recipients with respiratory failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two-hundred twenty-two subjects were identified. PICU mortality was 60.4%. Nonsurvivors had higher peak oxygenation index (38.3 [21.3-57.6] vs 15.0 [7.0-30.7]; p < 0.0001) and oxygen saturation index (24.7 [13.8-38.7] vs 10.3 [4.6-21.6]; p < 0.0001), greater days with FIO2 greater than or equal to 0.6 (2.4 [1.0-8.5] vs 0.8 [0.3-1.6]; p < 0.0001), and more days with oxygenation index greater than 18 (1.4 [0-6.0] vs 0 [0-0.3]; p < 0.0001) and oxygen saturation index greater than 11 (2.0 [0.5-8.8] vs 0 [0-1.0]; p < 0.0001). Nonsurvivors had higher maximum peak inspiratory pressures (36.0 cm H2O [32.0-41.0 cm H2O] vs 30.0 cm H2O [27.0-35.0 cm H2O]; p < 0.0001) and more days with peak inspiratory pressure greater than 31 cm H2O (1.0 d [0-4.0 d] vs 0 d [0-1.0 d]; p < 0.0001). Tidal volume per kilogram was not different between survivors and nonsurvivors. CONCLUSIONS: In this cohort of pediatric hematopoietic cell transplant recipients with respiratory failure in the PICU, impaired oxygenation and use of elevated ventilator pressures were common and associated with increased mortality.
OBJECTIVES: Acute respiratory failure is common in pediatric hematopoietic cell transplant recipients and has a high mortality. However, respiratory prognostic markers have not been adequately evaluated for this population. Our objectives are to assess respiratory support strategies and indices of oxygenation and ventilation in pediatric allogeneic hematopoietic cell transplant patients receiving invasive mechanical ventilation and investigate how these strategies are associated with mortality. DESIGN: Retrospective, multicenter investigation. SETTING: Twelve U.S. pediatric centers. PATIENTS: Pediatric allogeneic hematopoietic cell transplant recipients with respiratory failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two-hundred twenty-two subjects were identified. PICU mortality was 60.4%. Nonsurvivors had higher peak oxygenation index (38.3 [21.3-57.6] vs 15.0 [7.0-30.7]; p < 0.0001) and oxygen saturation index (24.7 [13.8-38.7] vs 10.3 [4.6-21.6]; p < 0.0001), greater days with FIO2 greater than or equal to 0.6 (2.4 [1.0-8.5] vs 0.8 [0.3-1.6]; p < 0.0001), and more days with oxygenation index greater than 18 (1.4 [0-6.0] vs 0 [0-0.3]; p < 0.0001) and oxygen saturation index greater than 11 (2.0 [0.5-8.8] vs 0 [0-1.0]; p < 0.0001). Nonsurvivors had higher maximum peak inspiratory pressures (36.0 cm H2O [32.0-41.0 cm H2O] vs 30.0 cm H2O [27.0-35.0 cm H2O]; p < 0.0001) and more days with peak inspiratory pressure greater than 31 cm H2O (1.0 d [0-4.0 d] vs 0 d [0-1.0 d]; p < 0.0001). Tidal volume per kilogram was not different between survivors and nonsurvivors. CONCLUSIONS: In this cohort of pediatric hematopoietic cell transplant recipients with respiratory failure in the PICU, impaired oxygenation and use of elevated ventilator pressures were common and associated with increased mortality.
Authors: Matt S Zinter; Brent R Logan; Caitrin Fretham; Anil Sapru; Allistair Abraham; Mahmoud D Aljurf; Staci D Arnold; Andrew Artz; Jeffery J Auletta; Saurabh Chhabra; Edward Copelan; Christine Duncan; Robert P Gale; Eva Guinan; Peiman Hematti; Amy K Keating; David I Marks; Richard Olsson; Bipin N Savani; Celalettin Ustun; Kirsten M Williams; Marcelo C Pasquini; Christopher C Dvorak Journal: Biol Blood Marrow Transplant Date: 2019-09-26 Impact factor: 5.742
Authors: Matt S Zinter; Caroline A Lindemans; Birgitta A Versluys; Madeline Y Mayday; Sara Sunshine; Gustavo Reyes; Marina Sirota; Anil Sapru; Michael A Matthay; Sandhya Kharbanda; Christopher C Dvorak; Jaap J Boelens; Joseph L DeRisi Journal: Blood Date: 2021-03-25 Impact factor: 22.113
Authors: Saad Ghafoor; Kimberly Fan; Sarah Williams; Amanda Brown; Sarah Bowman; Kenneth L Pettit; Shilpa Gorantla; Rebecca Quillivan; Sarah Schwartzberg; Amanda Curry; Lucy Parkhurst; Marshay James; Jennifer Smith; Kristin Canavera; Andrew Elliott; Michael Frett; Deni Trone; Jacqueline Butrum-Sullivan; Cynthia Barger; Mary Lorino; Jennifer Mazur; Mandi Dodson; Morgan Melancon; Leigh Anne Hall; Jason Rains; Yvonne Avent; Jonathan Burlison; Fang Wang; Haitao Pan; Mary Anne Lenk; R Ray Morrison; Sapna R Kudchadkar Journal: Front Oncol Date: 2021-03-08 Impact factor: 6.244
Authors: Courtney M Rowan; Lincoln Smith; Matthew P Sharron; Laura Loftis; Sapna Kudchadkar; Christine N Duncan; Francis Pike; Paul A Carpenter; David Jacobsohn; Catherine M Bollard; Conrad Russell Y Cruz; Abhijeet Malatpure; Sherif Farag; Jamie Renbarger; Morgan R Little; Phillip R Gafken; Robert A Krance; Kenneth R Cooke; Sophie Paczesny Journal: Blood Adv Date: 2022-03-22