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Predicting Death in Mechanically Ventilated Recipients of Bone Marrow Transplants
- Brian J. Hennessy, MB;
- Mary White, MB; and
- Gerard M. Crotty, MB
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TO THE EDITOR:
Rubenfeld and Crawford [1] describe the experience of Seattle's 865 bone marrow transplant recipients who required mechanical ventilation. They propose the introduction of evidence-based guidelines for ventilatory support after transplantation. Their study sample represents the largest cohort to date, and their study consolidates the findings of previous studies. The guidelines represent a reasonable and logical approach to patients with an extremely low survival rate.
In the past 7 years, 141 patients received allogeneic bone marrow transplantation in our center. Fifteen percent (n = 21) of patients required mechanical ventilation for lung injury; all 21 of these patients died. The rate of transfer to the intensive care unit from the transplantation unit (15%) compares favorably with the rates in other series: 25% [1], 33% [2], and 40% [3]. The duration of stay in the intensive care unit ranged from 1 to 44 days (median, 12 days). Rubenfeld and Crawford point out that their study was limited to patients who were followed for no more than 100 days after bone marrow transplantation. However, we studied patients for as long as 17 months after transplantation (median, 3 months) and found no evidence of an improved survival rate in patients who had had transplantation more than 100 days previously.
We welcome the guidelines that predict outcome in the first 4 days in the intensive care unit. Adherence to guidelines may spare unnecessary prolongation of suffering for both patients and relatives, with consequent saving of valuable resources. In view of the variation in transfer rates among centers, we suggest that guidelines for initial transfer to the intensive care unit would be a valuable addition to the above.
Brian J. Hennessy, MB
Mary White, MB
Gerard M. Crotty, MB
St. James's Hospital; Dublin 8, Ireland
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
