[Severe sepsis and septic shock in children with cancer].
BACKGROUND
This report describes the clinical characteristics of children and adolescents bearers of oncological disease who were admitted to PICU with severe sepsis and septic shock. The predicting factors for mortality and for need of pulmonary mechanical ventilation were also determined.


METHODS
Thirty-three children diagnosed with severe sepsis and septic shock were evaluated prospectively at the PICU of Hospital do Câncer between June and December of 2001.


RESULTS
Thirty-three admissions were analyzed during this period; ages ranged from 1 to 23 years; 16 (48%) were boys and 17 (52%) were girls. Twenty patients had leukemia/lymphoma and 13 patients had solid tumors. Twenty-eight patients had a diagnosis of infectious diseases. In 73% of the patients, infection germs were isolated and gram negative organisms were responsible for 67% of the samples. Respiratory support was necessary for 18 patients (54%), inotropic support for 22 (67%) and dialysis for four patients. The mortality rate was of 41% for patients who needed inotropic support, of 69% for those requiring respiratory support and of 100% for those with an indication for dialysis. The overall mortality rate was of 27%.


CONCLUSIONS
This research suggests that early intensive treatment for children with cancer exhibiting severe sepsis and/or septic shock could be an important factor to influence the mortality rate of these patients. Moreover, that noninvasive ventilation could be an option to reduce endotracheal intubation and invasive ventilation.
Pancera
Christiane Finardi
CF
Hospital do Câncer, São Paulo, SP.
Costa
Cecília M L da
CM
Hayashi
Massami
M
Lamelas
Raul Gutierrez Y
RG
Camargo
Beatriz de
Bd
D000293:Adolescent; D000328:Adult; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007938:Leukemia / Q000150:complications / Q000188:drug therapy; D008223:Lymphoma / Q000150:complications / Q000188:drug therapy; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018805:Sepsis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality / Q000628:therapy
D002316:Cardiotonic Agents