.jpg "Ariella Barhen, MD photo")
Ariella Barhen, MD
Pediatric Critical Care Fellow
Nicklaus Childrens Hospital
Miami, Florida
Disclosure information not submitted.
Prithvi Raj Sendi, MD
Nicklaus Children's Hospital
Miami, Florida
Disclosure information not submitted.
Paul Martinez, MD
Assistant Professor
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM
Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Title: Invasive mechanical ventilation in pediatric hematopoietic stem cell transplant from 1997-2016.
Introduction: Hematopoietic stem cell transplantation (HSCT) is a life-saving therapy in children. Respiratory failure requiring invasive mechanical ventilation (IMV) after HSCT is associated with high mortality. Our primary objective was to describe the trends in IMV in children after HSCT.
Methods: A retrospective analysis using the Healthcare Cost and Utilization Project’s Kids’ Inpatient database from 1997-2016 was performed. Any child, 28 days to 20 years of age, who underwent HSCT was identified using ICD-9 or ICD-10 codes. Trend analysis (StatCalc, CDC) was performed to evaluate the trends in prevalence of HSCT and use of IMV in HSCT and mortality in ventilated children from 1997 to 2016. Binary regression analysis was performed to evaluate mortality risk factors.
Results: Out of 25,072,776 non-neonatal discharges from 1997-2016, 16,389 children underwent HSCT (0.6 per 1000 discharges). The most common indications for HSCT included leukemia (34.6%), solid tumors (25.7%), and immune disorders (9.3%). IMV was used in 6.5% children and more in the cord blood transplant group compared to others (12.4% vs 3.3% in autologous and 7.8% in allogeneic). The median time to IMV from HSCT was higher in cord blood and allogeneic transplants with 18 days (IQR 11-38 and IQR 9-34 respectively) compared to autologous (p < 0.001). The overall mortality rate in children after HSCT was 6.7%, and 60.6% in those that required IMV (p < 0.001). Trend analysis demonstrated an increase in the prevalence of HSCT procedure (p < 0.001), while respiratory failure and the use of IMV among HSCT recipients decreased over time (p=0.047). The mortality trend in those receiving IMV decreased (p=0.01). In multivariable regression analysis, leukemia as an indication for HSCT (OR 2.9; CI 2.0-4.1), cord blood transplantation (OR 2.7; 2.0-3.7), and use of IMV (OR 31.1; CI 26.3-36.8) or hemodialysis (OR 14; CI 10.1-19.4) were associated with increased mortality.
Conclusion: In this large, national cohort study, we report an increase in prevalence trend of HSCT, a decrease in use of IMV among children with HSCT, and a decrease in mortality for those children with HSCT who received IMV from 1997 to 2016. Increased mortality is associated with children who received HSCT for leukemia or cord blood transplantation, or who required IMV or hemodialysis.