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Outcomes of hematopoietic cell transplant recipients requiring invasive mechanical ventilation: a two-centre retrospective cohort study

  • Mohammad Hamidi
  • Kira L. Gossack-Keenan
  • Bruno L. Ferreyro
  • Federico Angriman
  • Bram Rochwerg
  • Sangeeta MehtaEmail author
Reports of Original Investigations

Abstract

Purpose

Outcomes of critically ill, hematopoietic cell transplant patients who require prolonged mechanical ventilation are not well studied. We describe the baseline characteristics, critical care management, and outcomes of this population and explore potential predictors of mortality.

Methods

We performed a retrospective cohort study in two critical care units in Ontario. We included adult intensive care unit patients who required invasive mechanical ventilation within 90 days of receiving a hematopoietic cell transplant. The primary outcome was mortality at 90 days. Using logistic regression, we explored predictors of mortality including type of transplant (allogeneic vs autologous), severity of illness (assessed using the Sequential Organ Failure Assessment [SOFA] score), and baseline characteristics (such as age and sex).

Results

We included 70 patients from two study sites. Ninety-day mortality was 73% (n = 51) in the entire cohort, 58% (15/26) in patients post-autologous transplant, and 82% (36/44) in those post-allogeneic transplant. Ninety-one percent (10/11) of patients who required invasive mechanical ventilation for more than 21 days died. Independent predictors of all-cause mortality included allogeneic transplant, higher SOFA score, the presence of acute hypoxemic respiratory failure, and a longer interval between receiving the transplant and initiation of mechanical ventilation.

Conclusions

Our study shows high rates of mortality among hematopoietic cell transplant recipients that require invasive mechanical ventilation, particularly in those post-allogeneic transplant and in those who require prolonged ventilation for more than 21 days.

Pronostics des récipiendaires de transplantations de cellules hématopoïétiques nécessitant une ventilation mécanique invasive : une étude de cohorte rétrospective dans deux centres

Résumé

Objectif

Les pronostics des patients en état critique recevant une transplantation de cellules hématopoïétiques et nécessitant une ventilation mécanique prolongée sont peu étudiés. Nous décrivons les caractéristiques de base, la prise en charge de soins critiques et les pronostics de cette population et explorons des prédicteurs potentiels de mortalité.

Méthode

Nous avons réalisé une étude de cohorte rétrospective dans deux unités de soins critiques en Ontario. Nous avons inclus les patients adultes de l’unité de soins intensifs nécessitant une ventilation mécanique invasive dans les 90 jours suivant la transplantation de cellules hématopoïétiques. Le critère d’évaluation principal était la mortalité à 90 jours. À l’aide d’une analyse de régression logistique, nous avons exploré les prédicteurs de mortalité, y compris le type de greffe (allogénique ou autologue), la gravité de la maladie (évaluée à l’aide du score SOFA - Sequential Organ Failure Assessment), et les caractéristiques de base (telles que l’âge et le sexe).

Résultats

Nous avons inclus 70 patients provenant de nos deux sites d’étude. La mortalité à 90 jours était de 73 % (n = 51) dans la cohorte entière, 58 % (15/26) chez les patients ayant reçu une greffe autologue, et 82 % (36/44) chez les patients ayant reçu une greffe allogénique. Quatre-vingt-onze pour cent (10/11) des patients nécessitant une ventilation mécanique invasive pendant plus de 21 jours sont décédés. Les prédicteurs indépendants de mortalité toutes causes confondues comprenaient la greffe allogénique, un score SOFA plus élevé, la présence d’une insuffisance respiratoire hypoxémique aiguë, et un intervalle plus long entre la greffe et le début de la ventilation mécanique.

Conclusion

Notre étude montre des taux de mortalité élevés chez les récipiendaires de greffes de cellules hématopoïétiques nécessitant une ventilation mécanique invasive, particulièrement chez les patients ayant reçu une greffe allogénique et chez ceux nécessitant une ventilation prolongée de plus de 21 jours.

Notes

Conflicts of interest

The authors declare no potential conflicts of interest.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Mohammad Hamidi and Bruno L. Ferreyro were involved in study conception and design, analysis and interpretation of data, and drafting of the manuscript. Federico Angriman was involved in data analysis and interpretation, and drafting of the manuscript. Kira L. Gossack-Keenan and Bram Rochwerg were involved in study conception and design, data acquisition, and critical revision of manuscript. Sangeeta Mehta was involved in study conception and design, analysis and interpretation of the data, and drafting of manuscript. All authors have read and approved the final version of this manuscript.

Financial source

None.

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Intensive Care UnitWestmead HospitalSydneyAustralia
  2. 2.Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonCanada
  3. 3.Department of MedicineSinai Health SystemTorontoCanada
  4. 4.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  5. 5.Institute for Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  6. 6.Sunnybrook Health Sciences CenterTorontoCanada
  7. 7.Department of Medicine, Division of Critical CareMcMaster UniversityHamiltonCanada
  8. 8.Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonCanada

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