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Acute Respiratory Failure and Management

  • Prakadeshwari RajapreyarEmail author
  • Whitney Kopp
  • Adrienne Randolph
Chapter

Abstract

Acute respiratory failure is a common reason for admission to the pediatric intensive care unit in oncology patients. Acute respiratory complications are also common after pediatric hematopoietic stem cell transplant (HSCT), accounting for a high proportion of HSCT-related morbidity and mortality. Evaluation of these patients requires a thorough workup that includes identification and treatment of infectious etiologies, and treatment for noninfectious causes once infectious causes are ruled out. These patients should be closely monitored for development of pediatric acute respiratory distress syndrome (PARDS) with early escalation of respiratory support. Patients undergoing a trial of noninvasive ventilation (NIV) should be continuously monitored to ensure they are responding. Prolonged delay of endotracheal intubation in patients who do not improve or worsen on NIV could worsen their outcome. Optimal treatment of immunocompromised patients with acute lung failure requires early and aggressive lung protective ventilation, prevention of fluid overload, and rapid diagnosis of underlying causes to facilitate prompt disease-directed therapy.

Keywords

Hematopoietic stem cell transplant Immunocompromised pediatric patients Invasive mechanical ventilation Noninvasive positive pressure ventilation Pediatric acute respiratory distress syndrome 

References

  1. 1.
    Sivan Y, Schwrtz PH, Schonfeld T, et al. Outcome of oncology patients in the pediatric intensive care unit. Intensive Care Med. 1991;17:11–5.CrossRefGoogle Scholar
  2. 2.
    Eikenberry M, Bartakova H, Defor T, et al. Natural history of pulmonary complications in children after bone marrow transplantation. Biol Blood Marrow Transplant. 2005;11:56–64.CrossRefGoogle Scholar
  3. 3.
    Elbahlawan L, Srinivasan A, Morrison RR. A critical care and transplant-based approach to acute respiratory failure after hematopoietic stem cell transplantation in children. Biol Bood Marrow Transplant. 2016;22(4):617–26.CrossRefGoogle Scholar
  4. 4.
    Crawford SW, Hackman RC. Clinical course of idiopathic pneumonia after bone marrow transplantation. Am Rev Resp Dis. 1993;147:1393–400.CrossRefGoogle Scholar
  5. 5.
    Clark JG, Madtes DK, Martin TR, et al. Idiopathic pneumonia after bone marrow transplantation: cytokine activation and lipopolysaccharide amplification in the bronchoalveolar compartment. Crit Care Med. 1999;27:1800–6.CrossRefGoogle Scholar
  6. 6.
    Tamburro RF, Barfield RC, Shaffer ML, et al. Changes in out- comes (1996–2004) for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation. Pediatr Crit Care Med. 2008;9(3):270–7.CrossRefGoogle Scholar
  7. 7.
    van Gestel JPJ, Bollen CW, Bierings MB, et al. Survival in a recent cohort of mechanically ven- tilated allogeneic hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant. 2008;14(12):1385–93.CrossRefGoogle Scholar
  8. 8.
    Aspesberro F, Guthrie KA, Woolfrey AE, et al. Outcome of pediatric stem cell transplant recipients requiring mechanical ventilation. J Intensive Care Med. 2014;29(1):31–7.CrossRefGoogle Scholar
  9. 9.
    Rowan CM, Smith LS, Loomis A, et al. Pediatric acute respiratory distress syndrome in pediatric allogeneic hematopoietic stem cell transplants: a multicenter study. Pediatr Crit Care Med. 2017;18:304–9.CrossRefGoogle Scholar
  10. 10.
    The Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med. 2015;16(5):428–39.CrossRefGoogle Scholar
  11. 11.
    Schwartz C, Hobbie WL, Constine LS, Ruccione K. Chapter 11: Pulmonary effects of antineoplastic therapy. In:Survivors of childhood and adolescent cancer: a multidisciplinary approach. 3rd ed. New York: Springer International Publishing; 2015. p. 201–27.CrossRefGoogle Scholar
  12. 12.
    Huang TT, Hudson MM, Stokes DC, Krasin MJ, Spunt SL, Ness KK. Pulmonary outcomes in survivors of childhood cancer a systematic review. Chest. 2011;140(4):881–901.CrossRefGoogle Scholar
  13. 13.
    Fuhrmann BP, Zimmerman J. Chapter 38: Critical illness involving children undergoing hematopoietic progenitor cell transplantation. In:Pediatric critical care. 5th ed. Philadelphia: Elsevier Inc; 2016. p.1325–42.Google Scholar
  14. 14.
    Panoskaltsis-Mortari A, Griese M, Madtes DK, et al. An official American Thoracic Society research statement: noninfectious lung injury after hematopoietic stem cell transplantation: idiopathic pneumonia syndrome. Am J Respir Crit Care Med. 2011;183:1262–79.CrossRefGoogle Scholar
  15. 15.
    Triebwasser M, Duvall A, Hoffman T, et al. Impact of broncho-alveolar lavage on the diagnosis and management of pulmonary complications following hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2018;24(3):s98.CrossRefGoogle Scholar
  16. 16.
    Clark JG, Hertz MI, Parkman R, et al. Idiopathic pneumonia syndrome after bone marrow transplantation. Am Rev Respir Dis. 1993;147:1601–6.CrossRefGoogle Scholar
  17. 17.
    Yanik GA, Grupp SA, Pulsipher MA, et al. TNF-receptor inhibitor therapy for the treatment of children with idiopathic pneumonia syndrome. A joint pediatric blood and marrow transplant consortium and children’s oncology group study (ASCT0521). Biol Blood Marrow Transplant. 2015;21:67–73.CrossRefGoogle Scholar
  18. 18.
    Spitzer TR. Engraftment syndrome following hematopoietic stem cell transplantation. Bone Marrow Transplant. 2001;27:893–8.CrossRefGoogle Scholar
  19. 19.
    Chang L, Frame D, Braun T, et al. Engraftment syndrome following allogeneic hematopoietic cell transplantation predicts poor outcomes. Biol Blood Marrow Transplant. 2014;20:1407–17.CrossRefGoogle Scholar
  20. 20.
    Majhail NS, Parks K, Defor TE, et al. Diffuse alveolar hemorrhage and infection- associated alveolar hemorrhage following hematopoietic stem cell transplantation: related and high-risk clinical syndromes. Biol Blood Marrow Transplant. 2006;12:1038–46.CrossRefGoogle Scholar
  21. 21.
    Rathi NK, Tanner AR, Dinh A, et al. Low-, medium-and high dose steroids with or without aminocaproic acid in adult hematopoietic SCT patients with diffuse alveolar hemorrhage. Bone Marrow Transplant. 2015;50:420–6.CrossRefGoogle Scholar
  22. 22.
    Wanko SO, Broadwater G, Folz RJ, et al. Diffuse alveolar hemorrhage: retrospective review of clinical outcome in allogeneic transplant recipients treated with aminocaproic acid. Biol Blood Marrow Transplant. 2006;12:949–53.CrossRefGoogle Scholar
  23. 23.
    Elinoff JM, Bagci U, Moriyama B, et al. Recombinant human factor VIIa for aleveolar hemorrhage following allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2014;20:969–78.CrossRefGoogle Scholar
  24. 24.
    Troussard X, Bernaudin JF, Cordonnier C, et al. Pulmonary veno-occlusive disease after bone marrow transplantation. Thorax. 1984;39:956–7.CrossRefGoogle Scholar
  25. 25.
    Woodard JP, Gulbahce E, Shreve M, et al. Pulmonary cytolytic thrombi: a newly recognized complication of stem cell transplantation. Bone Marrow Transplant. 2000;25:293–300.CrossRefGoogle Scholar
  26. 26.
    Boeckh M, Murphy WJ, Peggs KS. Recent advances in cytomegalovirus: an update on pharmacologic and cellular therapies. Biol Blood Marrow Transplant. 2015;21:24–9.CrossRefGoogle Scholar
  27. 27.
    Hiwarkar P, Amrolia P, Sivaprakasam P, et al. Brincidofovir is highly efficacious in controlling adenoviremia in pediatric recipients of hematopoietic cell transplant. Blood. 2017;129:2033–7.CrossRefGoogle Scholar
  28. 28.
    Khanna N, Widmer AF, Decker M, et al. Respiratory syncytial virus infection in patients with hematological diseases: single center study and review of literature. Clin Infect Dis. 1999;29:1210–9.CrossRefGoogle Scholar
  29. 29.
    Rowan CM, Gertz SJ, Zinter MS, et al. A multicenter investigation of respiratory syncytial viral infection in children with hematopietic cell transplantation. Transpl Infect Dis. 2018; doi: https://doi.org/10.1111/tid.12882 (epub ahead of print).
  30. 30.
    Abbasi S, Shenep JL, Hughes WT, et al. Aspergillosis in children with cancer: a 34-year experience. Clin Infect Dis. 1999;29:1210–9.CrossRefGoogle Scholar
  31. 31.
    Alsharif M, Cameron SEH, Young JAH, et al. Time trends in fungal infections as a cause of death in hematopoietic stem cell transplant recipients. Am J Clin Pathol. 2009;132:746–55.CrossRefGoogle Scholar
  32. 32.
    van Burik JH, Leisenring W, Myerson D, et al. The effect of prophylactic fluconazole on the clinical spectrum of fungal disease in bone marrow transplant recipients with special attention to hepatic candidiasis. An autopsy study of 355 patients. Medicine. 1998;77:246–54.CrossRefGoogle Scholar
  33. 33.
    Maron GM, Hayden RT, Rodriguez A, et al. Voriconazole prophylaxis in children with cancer: changing outcomes and epidemiology of fungal infections. Pediatr Infect Dis J. 2013;32:e451–5.CrossRefGoogle Scholar
  34. 34.
    Levy ER, Musick L, Zinter MS, et al. Safe and effective prophylaxis with bimonthly pentamidine in the pediatric hematopoietic stem cell transplant population. Pediatr Infect Dis J. 2016;35:135–41.CrossRefGoogle Scholar
  35. 35.
    Williams KM, Cheng GS, Pusic I, Jagasia M, Burns L, Ho VT, Pidala J, Palmer J, Johnston L, Mayer S, Chien JW, Jacobsohn DA, Pavletic SZ, Martin PJ, Storer BE, Inamoto Y, Chai X, Flowers MED, Lee SJ. FAM treatment for new onset bronchiolitis obliterans syndrome after hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2016;22(4):710–6.CrossRefGoogle Scholar
  36. 36.
    Venkataraman S. Noninvasive ventilation: concepts and practice. In: Pediatric critical care. Elsevier, Inc: Philadelphia; 2017. p. 770–84.Google Scholar
  37. 37.
    Pancera CF, Hayashi M, Fregnani JH, et al. Noninvasive ventilation in immunocompromised pediatric patients: eight years of experience in a pediatric oncology intensive care unit. J Pediatr Hematol Oncol. 2008;30(7):533–8.CrossRefGoogle Scholar
  38. 38.
    Fuhrmann BP, Zimmerman J. Airway management. In: Pediatric critical care. 5th. Elsevier Inc: Philadelphia; 2016.Google Scholar
  39. 39.
    Bello G, De Pascale G, Antonelli M. Noninvasive ventilation for the immunocompromised patient: always appropriate? Curr Opin Crit Care. 2012;18(1):54–60.CrossRefGoogle Scholar
  40. 40.
    Popat B, Jones AT. Invasive and non-invasive mechanical ventilation. Medicine. 2012;40(6):298–304.CrossRefGoogle Scholar
  41. 41.
    Yanez LJ, Yunge M, Emilfork M, et al. A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med. 2008;9(5):484–9.CrossRefGoogle Scholar
  42. 42.
    Mayordomo-Colunga J, Pons M, Lopez Y, et al. Predicting non-invasive ventilation failure in children from the SpO2/FiO2 (SF) ratio. Intensive Care Med. 2013;39(6):1095–103.CrossRefGoogle Scholar
  43. 43.
    Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med. 2001;163(2):540–77.CrossRefGoogle Scholar
  44. 44.
    Carron M. A new horizon for the use of non-invasive ventilation in patients with acute respiratory distress syndrome. Ann Transl Med. 2016;4(18):348.CrossRefGoogle Scholar
  45. 45.
    Wang T, Zhang L, Luo K, et al. Noninvasive versus invasive mechanical ventilation for immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. BMC Pulm Med. 2016;16(1):129.CrossRefGoogle Scholar
  46. 46.
    Azoulay E, Alberti C, Bronstain C, et al. Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med. 2001;29(3):519–25.CrossRefGoogle Scholar
  47. 47.
    Piastra M, De Luca D, Pietrini D, et al. Noninvasive pressure-support ventilation in immunocompromised children with ARDS: a feasibility study. Intensive Care Med. 2009;35(8):1420–7.CrossRefGoogle Scholar
  48. 48.
    Bernet V, Hug MI, Frey B. Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med. 2005;6(6):660–4.CrossRefGoogle Scholar
  49. 49.
    Munoz-Bonet JI, Flor-Macian EM, Brines J, et al. Predictive factors for the outcome of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med. 2010;11(6):675–80.CrossRefGoogle Scholar
  50. 50.
    Piastra M, De Luca D, Marzano L, et al. The number of failing organs predicts non-invasive ventilation failure in children with ALI/ARDS. Intensive Care Med. 2011;37(9):1510–6.CrossRefGoogle Scholar
  51. 51.
    Nava S, Ferrer M, Esquinas A, et al. Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: a randomised feasibility trial. Lancet Oncol. 2013;14(3):219–27.CrossRefGoogle Scholar
  52. 52.
    Rowan CM, Gertz SJ, McArthur J, et al. Invasive mechanical ventilation and mortality in pediatric hematopoietic stem cell transplantation: a muticenter study. Pediatr Crit Care Med. 2016;17(4):294–302.CrossRefGoogle Scholar
  53. 53.
    Aspesberro F, Guthrie KA, Woolfrey AE, et al. Outcome of pediatric hematopoietic stem cell transplant recipients requiring mechanical ventilation. J Intensive Care Med. 2014;29(1):31–7.CrossRefGoogle Scholar
  54. 54.
    Sarnaik AP, Meert KL, Pappas MD, et al. Predicting outcome in children with severe acute respiratory failure treated with high-frequency ventilation. Crit Care Med. 1996;24(8):1396–402.CrossRefGoogle Scholar
  55. 55.
    Rowan CM, Hege KM, Speicher RH, et al. Oxygenation index predicts mortality in pediatric stem cell transplant recipients requiring mechanical ventilation. Pediatr Transplant. 2012;16(6):645–50.CrossRefGoogle Scholar
  56. 56.
    Yehya N, Topjian AA, Lin R, et al. High frequency oscillation and airway pressure release ventilation in pediatric respiratory failure. Pediatr Pulmonol. 2014;49(7):707–15.CrossRefGoogle Scholar
  57. 57.
    Rowan CM, Loomis A, McArthur J, et al. High-frequency oscillatory ventilation use and severe PARDS in the pediatric hematopoietic stem cell transplant recipient. Respir Care. 2018;63(4):404–11.CrossRefGoogle Scholar
  58. 58.
    Yehya N, Topijan AA, Thomas NJ, et al. Improved oxygenation 24 hours after transition to airway pressure release ventilation or high-frequency oscillatory ventilation accurately discriminated survival in immunocompromised pediatric patients with acute respiratory distress syndrome. Pediatr Crit Care Med. 2014;15:e147–56.CrossRefGoogle Scholar
  59. 59.
    Schmidt M, Bailey M, Sheldrake J, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure: the Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med. 2014;189:1374–82.CrossRefGoogle Scholar
  60. 60.
    Gow KW, Wulkan ML, Heiss KF, et al. Extracorporeal membrane oxygenation for support of children after hematopoietic stem cell transplantation: the extracorporeal life support Oragnization experience. J Pediatr Surg. 2006;41:662–7.CrossRefGoogle Scholar
  61. 61.
    Mehta RL, Pasual MT, Soroko S, et al. PICARD study group: diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288:2547–53.CrossRefGoogle Scholar
  62. 62.
    Flynn JT. Choice of dialysis modality for management of pediatric acute renal failure. Pediatr Nephrol. 2002;17:61–9.CrossRefGoogle Scholar
  63. 63.
    Smoyer WE, McAdams C, Kaplan BS, et al. Determinants of survival in pediatric continuous hemofiltration. J Am Soc Nephrol. 1995;6:1401–9.PubMedGoogle Scholar
  64. 64.
    Klee KM, Greenleaf K, Fouser L, et al. Continuous venovenous hemofiltration with and without dialysis in pediatric patients. ANNA J. 1996;23:35–9.PubMedGoogle Scholar
  65. 65.
    Foland JA, Fortenberry JD, Warshaw BL, et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Pediatr Crit Care. 2001;32(8):1771–6.Google Scholar
  66. 66.
    Michael M, Kuehnle I, Goldstein SL. Fluid overload and acute renal failure in pediatric stem cell transplant patients. Pediatr Nephrol. 2004;19:91–5.CrossRefGoogle Scholar
  67. 67.
    Elbahlawan L, West NK, Avent Y, et al. Impact of continuous renal replacement therapy on oxygenation in children with acute lung injury after allogeneic hematopoietic stem cell transplantation. Pediatr Blood Cancer. 2010;55:540–5.CrossRefGoogle Scholar
  68. 68.
    Tamburro RF, Thomas NJ, Pon S, et al. Pediatric acute lung injury and sepsis investigators (PALISI) network. Post hoc analysis of calfactant use in immunocompromised children with acute lung injury: impact and feasibility of further clinical trials. Pediatr Crit Care Med. 2008;9:459–64.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2019

Authors and Affiliations

  • Prakadeshwari Rajapreyar
    • 1
    Email author
  • Whitney Kopp
    • 1
  • Adrienne Randolph
    • 2
    • 3
  1. 1.Division of Pediatric Critical Care MedicineMedical College of Wisconsin/Children’s Hospital of WisconsinMilwaukeeUSA
  2. 2.Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain MedicineBoston Children’s HospitalBostonUSA
  3. 3.Departments of Anesthesia and PediatricsHarvard Medical SchoolBostonUSA

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