Aggressive Disease, Aggressive Treatment: The Adult Hematopoietic Stem Cell Transplant Patient in the Intensive Care Unit

Hematopoietic stem cell transplant is associated with high morbidity and mortality. Transplant is often the only curative therapy for cancers such as leukemia, lymphoma, and multiple myeloma. Between 40% and 80% of patients who receive transplant become long-term survivors, and intensive care unit (ICU) admission rates are between 24% and 44% during the peritransplant period. The aggressive nature of hematopoietic stem cell transplant has a drastic impact on the physical and emotional state of the patient and family. From the day of diagnosis of any blood cancer, patients and families are faced with decisions and challenges ranging from quality of life and mortality to insurance coverage and financial concerns. The purpose of this article is to provide the experienced ICU nurse with background on the hematopoietic stem cell transplant process as a basis for interventions that can improve patient- and family-centered care, to provide tools that improve the transitions between the transplant and ICU teams, and to support communication between nursing teams for patients who survive the ICU stay and for those at the end of life. Collaboration between 2 separate nursing units can result in exceptional care for this complex patient population.