RT Book, Section
A1 Pastores, Stephen M.
A1 Rosenzweig, Michael A.
A1 Jakubowski, Ann A.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Kress, John P.
SR Print(0)
ID 1107723012
T1 Hematopoietic Stem Cell Transplantation and Graft-Versus-Host Disease
T2 Principles of Critical Care, 4e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071738811
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1107723012
RD 2024/04/20
AB The  complications  of  hematopoietic  stem  cell  transplantation  generally  relate  to  the  consequences  of  the  cytoreductive  therapy,  infections,  and  in  the  case  of  allogeneic  transplants,  immunosuppression  and  development  of  graft-versus-host  disease.Graft-versus-host  disease  remains  one  of  the  most  important  complications  of  allogeneic  transplantation.Stem  cell  transplant  recipients  may  require  admission  to  the  intensive  care  unit  for  close  monitoring  for  volume  and  electrolyte  issues,  vasopressor  or  renal  support,  and  mechanical  ventilation.The  approach  to  the  diagnosis  and  management  of  infectious  disorders  in  the  stem  cell  transplant  recipient  is  dependent  on  the  underlying  disease  and  prior  therapy,  timing  of  the  infection  relative  to  the  transplant,  the  type  of  transplant,  the  patient's  immunologic  history  and  comorbidities.Pulmonary  complications  develop  in  up  to  60%  of  allogeneic  transplant  recipients  and  are  the  immediate  cause  of  death  in  approximately  half  of  the  cases.Major  noninfectious  pulmonary  complications  in  the  early  transplant  period  include  idiopathic  pneumonia  syndrome,  diffuse  alveolar  hemorrhage,  and  periengraftment  respiratory  distress  syndrome;  bronchiolitis  obliterans  syndrome  and  bronchiolitis  obliterans  organizing  pneumonia  occur  later.Despite  advances  in  supportive  care  in  the  intensive  care  unit,  the  mortality  rate  of  allogeneic  transplant  recipients  who  develop  respiratory  failure  and  multiple  organ  failure  remains  extremely  high.