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Bone Marrow Transplant ; 55(2): 341-348, 2020 02.
Article in English | MEDLINE | ID: mdl-31527817

ABSTRACT

In this multicenter study, we investigated the kinetics of neutrophil recovery in relation to acuity and survival among 125 children undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who required invasive mechanical ventilation (IMV). Recovery of neutrophils, whether prior to or after initiation of IMV, was associated with a significantly decreased risk of death relative to never achieving neutrophil recovery. A transient increase in acuity (by oxygenation index and vasopressor requirements) occurred among a subset of the patients who achieved neutrophil recovery after initiation of IMV; 61.5% of these patients survived to discharge from the intensive care unit (ICU). Improved survival among patients who subsequently achieved neutrophil recovery on IMV was not limited to those with peri-engraftment respiratory distress syndrome. The presence of a respiratory pathogen did not affect the risk of death while on IMV but was associated with an increased length of IMV (p < 0.01). Among patients undergoing HCT who develop respiratory failure and require advanced therapeutic support, neutrophil recovery at time of IMV and/or presence of a respiratory pathogen should not be used as determining factors when counseling families about survival.


Subject(s)
Hematopoietic Stem Cell Transplantation , Respiratory Distress Syndrome , Respiratory Insufficiency , Child , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Kinetics , Neutrophils , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy
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