Background: Survival rates from mechanical ventilation
(MV) in allogeneic bone marrow transplantation are poor, but little is
known about the need for and outcomes from MV in patients who undergo
autologous hematopoietic stem cell transplantation (AHSCT).
Study objective: To determine the frequency of and risk
factors for the use of MV in recipients of AHSCT and to identify
predictors of survival in mechanically ventilated AHSCT patients.
Design: Retrospective, cohort analysis
Setting: Tertiary-care, university-affiliated medical
Patients: One hundred fifty-nine consecutive
patients who underwent AHSCT.
surveillance and data collection.
results: The primary outcome measure was the need for MV, and the
secondary end point was survival after MV. Of 159 patients, 17 required
MV (10.7%). Three variables were associated with the need for MV:
increasing age, use of total body irradiation in the conditioning
regimen, and treatment with amphotericin B. As a screening test to
predict the need for MV, no risk factor had a sensitivity or
specificity > 82%. Three of the 17 mechanically ventilated patients
(17.6%) survived to discharge. Only the mean APACHE (acute physiology
and chronic health evaluation) II score separated survivors from
nonsurvivors (21.7 vs 31.4; p = 0.029). Both the duration of MV and
the length of stay in the ICU were similar in survivors and
Conclusions: We conclude that MV is
infrequently needed following AHSCT. Although survival after MV in
these patients is limited, clinical variables do not reliably allow
clinicians to prospectively identify patients destined to