The intensive care unit in paediatric oncology.
There were 70 admissions from a regional paediatric oncology centre to the intensive care unit over a six and a half year period. Patients were divided into those with systemic infections (n = 19), respiratory infections (n = 15), metabolic effects (n = 9), tumour mass effects (n = 10), neurological complications (n = 8), and others (n = 9). The overall survival was 51%. Patients admitted with metabolic or tumour mass related effects had the best prognosis with a survival of 84%. If dialysis is required in this group of patients then continuous arteriovenous haemofiltration is recommended. Patients with systemic or respiratory infections comprised the main poor prognosis group with a survival of 26%. For patients with a systemic infection who required ventilation, the mortality was 100%. The outlook for patients with a generalised encephalopathy was also poor, with no neurologically intact survivors. The median APACHE-II (acute physiology and chronic health evaluation) score for patients who died was 27 and for survivors was 16. There is a need for close cooperation between staff of intensive care and paediatric oncology units. Alternative treatments should be considered for patients with systemic infections who require ventilation.
Heney
D
D
Department of Paediatrics, St James' University Hospital, Leeds.
Lewis
I J
IJ
Lockwood
L
L
Cohen
A T
AT
Bailey
C C
CC
D000293:Adolescent; D001424:Bacterial Infections / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality*; D008297:Male; D008659:Metabolic Diseases / Q000401:mortality; D009422:Nervous System Diseases / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality*; D011379:Prognosis; D012120:Respiration Disorders / Q000401:mortality; D012141:Respiratory Tract Infections / Q000401:mortality; D014777:Virus Diseases / Q000401:mortality