[Management of septic shock and acquired respiratory distress syndrome in pediatric cancer patients].
Septic shock occurs in 6 % of paediatric cancer patients with neutropenia and fever. The mortality of the septic shock is 40 % in BMT patients and 5 % in others. One third of paediatric ARDS cases affect immunocompromised individuals with a total mortality of 45 % and 80 % after BMT. Septic shock is caused by gram-negative bacteria in more than 75 %. ARDS is due to pneumonia in more than 50 %, sepsis in about 25 %. This article provides the recommendations of the Infectious Diseases Working Party of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Hematology/Oncology (GPOH) for treatment of septic shock and ARDS. Therapy of septic shock includes early antibiotic therapy and volume expansion (> or = 40 ml/kg initially). Refractory shock requires vasopressors (noradrenaline), followed by a judicious circulatory management. Hydrocortisone is indicated in patients with high probability of adrenal insufficiency. Mainstay of ARDS therapy is ventilation with sufficient end-expiratory pressure (PEEP) to prevent loss of functional residual capacity and with limited tidal volumes (< or = 6 ml/kg) and limited inspiratory pressure (< 35 cm H(2)O) respectively, to minimize ventilator induced lung injury. Volume therapy consists of maintenance of sufficient preload to counteract the impaired venous return, induced by positive pressure ventilation. Diuretics and eventually veno-venous haemofiltration are used to reduce free lung water. Surfactant application may be considered in severe cases. Steroids are indicated in pneumocystis carinii pneumonia and in engraftment pneumonitis.
Bindl
L
L
Univ.-Klinik für Kinderkardiologie, Aachen. lbindl@ukaachen.de
Nicolai
T
T
D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003422:Critical Care; D004359:Drug Therapy, Combination; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D009503:Neutropenia / Q000150:complications* / Q000209:etiology / Q000401:mortality; D009894:Opportunistic Infections / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012772:Shock, Septic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*