Hayes et al identified predictors of a poor outcome for pediatric patients admitted to the intensive care unit (ICU) following a bone marrow transplant. These can help identify a patient for whom continued intensive care may be futile. The authors are from the Bristol Royal Hospital for Sick Children.


Patient selection: age <= 17 years following bone marrow transplantation


Predictors of poor outcome:

(1) proven viral pneumonia with acute respiratory failure

(2) need for mechanical ventilation > 2 days

(3) presence of lung injury in a patient requiring mechanical ventilation


Additional conditions with a "trend" towards a poor outcome:

(1) presence of lung injury and hepatic failure


Lung injury was defined as one or both of the following:

(1) positive end expiratory pressure (PEEP) > 6 cm water for > 24 hours

(2) requirement for FIO2 > 60% for > 24 hours



• A patient at risk for a poor outcome will usually not benefit from continued intensive care.

• The decision to discontinue intensive care is complex and needs to be individualized. This is a particularly difficult decision when it involves a child. However, there is little benefit to continue care if further care is futile.



• Most of the patients in the study were admitted to the ICU with acute respiratory failure. Some patients admitted to the ICU may have a poor outcome without developing respiratory failure.


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