Acute respiratory failure and the kinetics of neutrophil recovery in pediatric hematopoietic cell transplantation: a multicenter study.

Journal Article (Journal Article;Multicenter Study)

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.

Full Text

Duke Authors

Cited Authors

  • Moffet, JR; Mahadeo, KM; McArthur, J; Hsing, DD; Gertz, SJ; Smith, LS; Loomis, A; Fitzgerald, JC; Nitu, ME; Duncan, CN; Hall, MW; Pinos, EL; Tamburro, RF; Simmons, RA; Troy, J; Cheifetz, IM; Rowan, CM; Investigators of the Pediatric Acute Lung Injury and Sepsis Network,

Published Date

  • February 2020

Published In

Volume / Issue

  • 55 / 2

Start / End Page

  • 341 - 348

PubMed ID

  • 31527817

Pubmed Central ID

  • PMC7091821

Electronic International Standard Serial Number (EISSN)

  • 1476-5365

Digital Object Identifier (DOI)

  • 10.1038/s41409-019-0649-3

Language

  • eng

Conference Location

  • England