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Efficacy and outcome of intensive care in pediatric oncologic patients

Heying, Ruth MD; Schneider, Dominik T. MD; Körholz, Dieter MD; Stannigel, Hans MD; Lemburg, Peter MD; Göbel, Ulrich MD

CLINICAL INVESTIGATIONS
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Objective  Because the long-term survival of children with cancer has dramatically improved because of multimodal treatment strategies, intensive care medicine has become more relevant for these patients. This study was performed to assess the efficacy of intensive care medicine in newly diagnosed pediatric oncologic patients and in patients under ongoing oncologic treatment.

Design  A retrospective analysis of children admitted to the pediatric intensive care unit (PICU) of the University Hospital Duesseldorf for life-threatening conditions between 1995 and 1999 was performed to identify those patients with an oncologic condition.

Setting  University hospital.

Patients  A total of 123 patients were identified. Children admitted for uncomplicated postoperative care and children admitted after bone marrow transplantation were excluded from this analysis. Forty-eight patients could be divided into two groups. Group A contained children admitted to the PICU at the time of cancer diagnosis and group B children receiving ongoing oncologic treatment.

Interventions  The evaluation included diagnosis, risk factors, complications leading to PICU admission, PICU therapy, and outcome. Statistical analysis included evaluation of Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) scores.

Measurements and Main Results  Respiratory insufficiency was the leading diagnosis for PICU admission, whereas in the remaining children cardiovascular insufficiency, renal failure, neurologic impairment, ileus, and tumor-associated complications led to PICU admission. The number of organ failures was correlated to outcome. All children but one of group A could be discharged from the PICU, whereas 12 of 35 children in group B died, despite intensive care treatment attempts. The PRISM and TISS scores at admission to the PICU were significantly higher in children who did not survive the period of intensive care treatment in group B. However, all patients with a PRISM score of >20 died.

Conclusions  Diagnosis of cancer does not exclude potential benefit from intensive care medicine in these children, although severe complications might affect the prognosis.

From the Departments of Pediatric Hematology and Oncology (RH, DTS, DK, UG) and Neonatology and Pediatric Intensive Care Medicine (HS, PL), Children’s Hospital, Heinrich-Heine University, Duesseldorf, Germany.

Supported, in part, by Elterninitiative Kinderkrebsklinik e.V., Duesseldorf.

In our study, children who were admitted to the pediatric intensive care unit at the time of cancer diagnosis benefited from supportive treatment.

© 2001 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins