Chest
Volume 121, Issue 1, January 2002, Pages 185-188
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Clinical Investigations in Critical Care
Outcome From Mechanical Ventilation After Autologous Peripheral Blood Stem Cell Transplantation

https://doi.org/10.1378/chest.121.1.185Get rights and content

Study objective

To report the outcome of patients with autologous peripheral blood stem cell transplantation (PBSCT) receiving mechanical ventilation.

Design

Retrospective observational study.

Setting

Active hematopoietic stem cell transplantation center and a university hospital medical ICU.

Patients

Patients with autologous PBSCT receiving mechanical ventilation.

Method

A review of the medical records of patients with autologous PBSCT receiving mechanical ventilation. Data collection was restricted to the first episode of mechanical ventilation.

Results

A total of 78 autologous PBSCT patients received mechanical ventilation for > 24 h. Twenty patients (26%) were extubated and discharged alive from the hospital. Thirteen hospital survivors (60%) were alive at 6 months. Lung injury (LI), vasopressor use, and hepatic and renal failure (HRF) were used to predict survival after mechanical ventilation. Sixty patients (76%) had no organ failure, or had isolated LI or only required treatment with vasopressors. Their hospital survival and 6-month survival were 32% and 20%, respectively. Hospital and 6-month survival for the patients with HRF or LI and vasopressor use was 6% and 0%, respectively.

Conclusions

Prolonged mechanical ventilation and aggressive ICU support is justified for autologous PBSCT patients receiving mechanical ventilation with no organ failure, or who have only isolated LI, or who only require treatment with vasopressors.

Section snippets

Materials and Methods

This was an observational study. All patients who received autologous PBSCT at UAMS between March 1, 1991, and April 30, 1999, were eligible for the study. The UAMS Human Research Advisory Committee approved the study.

Autologous PBSCT patients with acute respiratory failure requiring mechanical ventilation were transferred to the university hospital medical ICU, a closed ICU where patients are cared for by the pulmonary and critical care staff and fellows, and the internal medicine house staff.

Study Population

From March 1991 to April 1999, 1,301 patients received autologous PBSCT at UAMS. Seventy-eight patients (6%) received mechanical ventilation for ≥ 24 h. The mean age was 55.4 ± 12 years. Sixty-two percent were male patients. The indications for transplantation were multiple myeloma (n = 68; 87%), solid tumors (n = 7; 9%), and lymphoma (n = 3; 4%). The median duration of mechanical ventilation was 7 days (range, 1 to 63 days).

Hospital Survival and Mechanical Ventilation

Hospital survival for the autologous PBSCT patients was 20 of 78

Discussion

This study describes the survival for a large group of autologous PBSCT patients receiving mechanical ventilation. The principle finding of this study was that autologous PBSCT patients receiving mechanical ventilation without organ failure or with isolated LI or isolated vasopressor use represented 77% of all BSCT patients receiving mechanical ventilation, and those patients had better hospital survival (32%) than autologous PBSCT patients receiving mechanical ventilation with LI and

Conclusion

Hospital survival for autologous PBSCT patients receiving mechanical ventilation who did not have two-organ failure was 32%, and prolonged mechanical ventilation is justified.

ACKNOWLEDGMENT

The authors thank Mr. Clyde Bailey from the Myeloma and Transplantation Research Center, Miss Angela Johnson from Medical Records, and Mr. Trey Spencer from the Department of Biostatistics.

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