Gordon D. Rubenfeld, MD, MSc; Stephen W. Crawford, MD
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Rubenfeld G., Crawford S.; Predicting Death in Mechanically Ventilated Recipients of Bone Marrow Transplants. Ann Intern Med. 1997;127:88. doi: 10.7326/0003-4819-127-1-199707010-00019
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Published: Ann Intern Med. 1997;127(1):88.
Hennessy and colleagues' experience of no survivors out of 21 mechanically ventilated patients is consistent with our findings and those reported in the literature. We note that the upper bound of the 95% CI in this small sample allows for a 16% survival rate in mechanically ventilated patients. It would be problematic to draw conclusions about the relation (or lack of a relation) between timing of respiratory failure after bone marrow transplantation and survival in a sample of 21 patients.
In our report we proposed guidelines for limiting life support in selected bone marrow transplant recipients on the basis of three principles: 1) prognostic indicators with high specificity and narrow CIs; 2) a process through which patients and their surrogates are informed of the risks of respiratory complications, the outcomes of mechanical ventilation, and the decision-making guidelines; and 3) an ongoing educational and quality improvement process to evaluate end-of-life decisions.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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