Abstract P-281: SIGNIFICANT REDUCTION IN MORTALITY IN CHILDREN ADMITTED TO PICU AFTER HAEMATOPOIETIC STEM CELL TRANSPLANT (HSCT)

Abstract

Aims & Objectives: A previously published study of HSCT patients admitted to our Paediatric Intensive Care Unit (PICU) from 2002 to 2010 reported survival of 62.5% to PICU discharge with a further 33% mortality within 6 months of discharge. This audit aims to evaluate the survival of the cohort from 2011 to 2017 and compare between these two populations. Methods A retrospective chart review was conducted of all HSCT patients who required PICU admission from January 2011 to Dec 2017. Main outcome measures were that of survival to PICU discharge and survival at 6 months after initial PICU admission. Results Sixty-nine patients underwent HSCT at our institution during this time period. Of this, 26.1% (18/69) required PICU admission within 1 year of transplant with a total of 22 admissions. Survival to PICU discharge was 95.4%, significantly different from the previous cohort (p=0.006). We also showed higher survival rate of our population within 6 months after PICU admission (94.4% versus 50%; p=0.002). Median age of both cohorts was similar. 38.9% and 11.1% of patients required inotropic support and mechanical ventilation respectively. No patient required dialysis. The main indication for PICU admission in our cohort was septic shock (59%), differing from the previous cohort, whose main indication was respiratory distress (46%). Conclusions Changes in HSCT protocols and improved ward management have resulted in a shift in the spectrum of HSCT patients admitted to the PICU. Sepsis is the main indication for PICU admission. Prompt ward treatment of sepsis has translated into drastically reduced mortality rates.