Management of the Critically Ill Marrow Transplant Patient

摘要

The management of the immunosuppressed patient is of increasing importance for intensivists. The average length of hospitalization for marrow transplantation is 4-6 weeks, and approx. 25% of patients will spend one month in an intensive care unit. Optimal care of the patient during marrow transplantation requires the skills of oncologists, infectious disease specialists, and often, input from intensivists is required, most commonly to assist in the management of renal and pulmonary complications. Marrow transplantation represents a curative attempt at the treatment of malignant diseases of hematopoietic and non-hematopoietic origin, to correct marrow failure of diverse causes, and to treat a variety of genetic disorders (Table 45.1). In this chapter, we will focus on (a) the drugs that are commonly given during the course of marrow transplantation, and that are otherwise not commonly used in the ICU, (b) management of the immunosuppressed patient, and (c) acute complications such as graft-versus-host disease (GVHD) and hepatic venoocclusive disease (VOD) that are relatively specific to marrow transplantation. Various aspects of marrow transplantation have been reviewed in recent years. Reprints. (kt)