title: Management of unstable pediatric hemato-oncology patient: results of a Web-based survey to pediatric oncologists in Spain.
abstract: The current management and monitoring of unstable pediatric hemato-oncology patient (UPHOP) in the oncology ward is not well defined. To evaluate this concept, an anonymous Web-based survey was sent to the 150 Spanish pediatric oncologists registered in the Spanish Society of Pediatric Hemato-Oncology. The response rate was 57 %, with the following main results: Pediatric intensive consulting was available for 97 %, and it was made in case of UPHOP by 37 % of oncologists, up to 65 % if hemodynamic instability. In case of inotropic support initiation, 32 % of respondents never consulted the intensivist. Dopamine is first chosen inotropic; 28 % of surveyed considered there is no limit in its dosage or it is superior to 20 μg/kg/min before an intensivist consulting. Pediatric intensive care admission was considered necessary in case of fever with hemodynamic instability by 15 % of respondents. Respiratory monitoring was mainly done by clinical signs (67 %). In case of respiratory insufficiency, the noninvasive respiratory support by high-flow ventilation with nasal cannula was applied by 57 % in the oncology ward. In case of acute kidney injury, diuretics were generally the initial therapy. The anticonvulsive drugs most frequently applied were valproic acid (93 %), diazepam (88 %), and phenytoin (81 %).
  
  
  CONCLUSIONS
  A consensus should be achieved among oncologists and intensivists. The creation and training of rapid response teams could be useful to improve the UPHOP management.
authors.affiliation: Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, Madrid, Spain. citopensis@yahoo.es
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Salido
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Iglesias-Bouzas
authors.forename: Montserrat
authors.initials: M
authors.lastname: Nieto-Moro
authors.forename: Alvaro
authors.initials: A
authors.lastname: Lassaleta-Atienza
authors.forename: Ana
authors.initials: A
authors.lastname: Serrano-González
authors.forename: Juan
authors.initials: J
authors.lastname: Casado-Flores
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D020407:Internet; D010820:Physicians; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires