LETTER
Predicting Death in Mechanically Ventilated Recipients of Bone Marrow Transplants
Brian J. Hennessy, MB;
Mary White, MB; and
Gerard M. Crotty, MB
1 July 1997 | Volume 127 Issue 1 | Page 88
TO THE EDITOR:
Rubenfeld and Crawford [1] describe the experience of Seattle's 865 bone marrow transplant recipients who required mechanical ventilation. They propose the introduction of evidence-based guidelines for ventilatory support after transplantation. Their study sample represents the largest cohort to date, and their study consolidates the findings of previous studies. The guidelines represent a reasonable and logical approach to patients with an extremely low survival rate.
In the past 7 years, 141 patients received allogeneic bone marrow transplantation in our center. Fifteen percent (n = 21) of patients required mechanical ventilation for lung injury; all 21 of these patients died. The rate of transfer to the intensive care unit from the transplantation unit (15%) compares favorably with the rates in other series: 25% [1], 33% [2], and 40% [3]. The duration of stay in the intensive care unit ranged from 1 to 44 days (median, 12 days). Rubenfeld and Crawford point out that their study was limited to patients who were followed for no more than 100 days after bone marrow transplantation. However, we studied patients for as long as 17 months after transplantation (median, 3 months) and found no evidence of an improved survival rate in patients who had had transplantation more than 100 days previously.
We welcome the guidelines that predict outcome in the first 4 days in the intensive care unit. Adherence to guidelines may spare unnecessary prolongation of suffering for both patients and relatives, with consequent saving of valuable resources. In view of the variation in transfer rates among centers, we suggest that guidelines for initial transfer to the intensive care unit would be a valuable addition to the above.
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Author and Article Information
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St. James's Hospital; Dublin 8, Ireland
1. Rubenfeld GD, Crawford SW. Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines. Ann Intern Med. 1996; 125:625-33.
2. Denardo SJ, Oye RK, Bellamy PE. Efficacy of intensive care for bone marrow transplant patients with respiratory failure. Crit Care Med. 1989; 17:4-6.
3. Torrecelia C, Cortes JL, Chamorro C, Rubio JJ, Dominquez de Villota E. Prognostic assessment of the acute complications of bone marrow transplantation requiring intensive therapy. Intens Care Med. 1988; 14:393-8.
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