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
Interpretation:
• 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.
Limitations:
• 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.
