3.3 | Patterns of ICU transfer
A total of 44 patients were transferred to the ICU within 100 days after transplant. Of these 44 patients, 34 exhibited elevated pediatric early warning signs (PEWS). These signs refer to clinical changes in a patient’s respiratory, cardiovascular, and/or neurological state indicative of the potential for rapid deterioration.25In this study, the following symptoms were classified as elevating a patient’s PEWS score: tachypnea, tachycardia, blood pressure instability (hypotension or hypertension), increased work of breathing, desaturations, hypoxia, apnea, and altered mental status. Of these 34 patients, 19 patients exhibited an elevated PEWS score for respiratory symptoms (tachypnea, increased work of breathing, desaturations, and apnea) alone. The most common causes of ICU transfer were tachypnea, tachycardia, blood pressure instability, fluid overload, and altered mental status. Indications for ICU transfer with a statistically significant increase between RVI+ and RVI- groups included fluid overload (p=0.025) and blood pressure instability (p=0.034). (Table 3)
Overall, increased requirement for ICU transfer was found to be statistically associated with positive pre-transplant RVI PCR results. While in the first 25 days post-transplant ICU transfer remained comparable between the RVI- and RVI+ groups, afterward the disparity between the two greatly increased up to 100 days after HSCT. (Fig. 2)