Abstract
Background
Overall survival in paediatric cancer has improved significantly over the past 20 years. Treatment strategies have been intensified, and supportive care has made substantial advances. Historically, paediatric oncology patients admitted to an intensive care unit (ICU) have had extremely poor outcomes.
Methods
We conducted a retrospective cohort study over a 3-year period in a single centre to evaluate the outcomes for this particularly vulnerable group of patients admitted to a paediatric ICU.
Results
Fifty-five patients were admitted a total of 66 times to the ICU during the study period. The mortality rate of this group was 23% compared with an overall ICU mortality rate of 5%. 11/15 patients who died had an underlying haematological malignancy. Twenty-eight percent of children with organism-identified sepsis died.
Conclusions
While mortality rates for paediatric oncology patients admitted to a ICU have improved, they are still substantial. Those with a haematological malignancy or admitted with sepsis are most at risk.
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References
McGregor LM, Metzger ML, Sanders R et al (2007) Pediatric cancers in the new millennium: dramatic progress, new challenges. Oncology 21(7):809–820
Reiter A, Schrappe M, Ludwig WD et al (1994) Chemotherapy in 998 unselected childhood acute lymphoblastic leukaemia patients. Results and conclusions of the multicenter trial ALL-BFM 86. Blood 84(9):3122–3133
van Veen A, Karstens A, van der Hoek ACJ (1996) The prognosis of oncologic patients in the pediatric intensive care unit. Intensive Care Med 22:237–241
Rossi R, Kleta R, Ehrich JHH (1999) Renal involvement in children with malignancies. Pediatr Nephrol 13:153–162
Matthay KK, Villablanca JG, Seeger RC et al (1999) Treatment of high-risk neuroblastoma with intensive chemotherapy, radiotherapy, autologous bone marrow transplantation, and 13-cis retinoic acid. NEJM 341(16):1165–1173
Hallahan AR, Shaw PJ, Rowell G et al (2000) Improved outcomes of children with malignancy admitted to a pediatric intensive care unit. Crit Care Med 28(11):3718–3721
Keengwe IN, Stansfield F, Eden OB et al (1999) Paediatric oncology and intensive care treatments: changing trends. Arch Dis Child 80:553–555
Pound CM, Johnston DL, Armstrong R et al (2008) The morbidity and mortality of pediatric oncology patients presenting to the intensive care unit with septic shock. Pediatr Blood Cancer 51(5):584–588
Dalton HJ, Slonim AD, Pollack MM (2003) Multicenter outcome of pediatric oncology patients requiring intensive care. Pediatr Hematol Oncol 20:643–649
Shann F, Pearson G, Slater A, Wilkinson K (1997) Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med 23(2):201–207
Goldstein B, Giroir B, Randolph A (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6(1):2–8
Ellison LF, Pogany L, Mery LS (2007) Childhood and adolescent cancer survival: a period analysis of data from the Canadian Cancer Registry. Eur J Can 43(13):p1967–p1975
Pritchard-Jones K, Kaatsch P, Steliarova-Foucher E et al (2006) Cancer in children and adolescents in Europe: developments over 20 years and future challenges. Eur J Can 42(13):2183–2190
Butt W, Barker G, Walker C (1988) Outcome of children with hematologic malignancy who are admitted to an intensive care unit. Crit Care Med 16:761–764
Sivan Y, Schwartz PH, Schonfeld T et al (1991) Outcome of oncology patients in the pediatric intensive care unit. Intensive Care Med 17:11–15
Tsalik EL, Jones D, Nicholson B (2010) Multiplex PCR to diagnose bloodstream infections in patients admitted from the emergency department with sepsis. J Clin Microbiol 48(1):26–33
Louie RF, Tang Z, Albertson TE et al (2008) Multiplex polymerase chain reaction detection enhancement of bacteremia and fungemia. Crit Care Med 36(5):1487–1492
Mancini N, Clerici D, Diotti R et al (2008) Molecular diagnosis of sepsis in neutropenic patients with haematological malignancies. J Med Microbiol 57(Pt 5):601–604
Varani S, Stanzani M, Paolucci M et al (2009) Diagnosis of bloodstream infections in immunocompromised patients by real-time PCR. J Infect 58(5):346–351
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The authors disclose no financial or ethical conflicts of interest regarding the submission of this article.
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Owens, C., Mannion, D., O’Marcaigh, A. et al. Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU. Ir J Med Sci 180, 85–89 (2011). https://doi.org/10.1007/s11845-010-0634-8
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DOI: https://doi.org/10.1007/s11845-010-0634-8