• Courtney M Rowan, Jennifer McArthur, Deyin D Hsing, Shira J Gertz, Lincoln S Smith, Ashley Loomis, Julie C Fitzgerald, Mara E Nitu, Moser Elizabeth A S EAS Department of Biostatistics, Indiana University, Indianapolis, IN., Christine N Duncan, Kris M Mahadeo, Jerelyn Moffet, Mark W Hall, Emily L Pinos, Robert F Tamburro, Ira M Cheifetz, and Investigators of the Pediatric Acute Lung Injury and Sepsis Network.
• Department of Pediatrics, Division of Critical Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
• Crit. Care Med. 2018 Oct 1; 46 (10): e967-e974.

ObjectivesAcute respiratory failure is common in pediatric hematopoietic cell transplant recipients and has a high mortality. However, respiratory prognostic markers have not been adequately evaluated for this population. Our objectives are to assess respiratory support strategies and indices of oxygenation and ventilation in pediatric allogeneic hematopoietic cell transplant patients receiving invasive mechanical ventilation and investigate how these strategies are associated with mortality.DesignRetrospective, multicenter investigation.SettingTwelve U.S. pediatric centers.PatientsPediatric allogeneic hematopoietic cell transplant recipients with respiratory failure.InterventionsNone.Measurements And Main ResultsTwo-hundred twenty-two subjects were identified. PICU mortality was 60.4%. Nonsurvivors had higher peak oxygenation index (38.3 [21.3-57.6] vs 15.0 [7.0-30.7]; p < 0.0001) and oxygen saturation index (24.7 [13.8-38.7] vs 10.3 [4.6-21.6]; p < 0.0001), greater days with FIO2 greater than or equal to 0.6 (2.4 [1.0-8.5] vs 0.8 [0.3-1.6]; p < 0.0001), and more days with oxygenation index greater than 18 (1.4 [0-6.0] vs 0 [0-0.3]; p < 0.0001) and oxygen saturation index greater than 11 (2.0 [0.5-8.8] vs 0 [0-1.0]; p < 0.0001). Nonsurvivors had higher maximum peak inspiratory pressures (36.0 cm H2O [32.0-41.0 cm H2O] vs 30.0 cm H2O [27.0-35.0 cm H2O]; p < 0.0001) and more days with peak inspiratory pressure greater than 31 cm H2O (1.0 d [0-4.0 d] vs 0 d [0-1.0 d]; p < 0.0001). Tidal volume per kilogram was not different between survivors and nonsurvivors.ConclusionsIn this cohort of pediatric hematopoietic cell transplant recipients with respiratory failure in the PICU, impaired oxygenation and use of elevated ventilator pressures were common and associated with increased mortality.

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