Paediatric oncology and intensive care treatments: changing trends
Isaac N Keengwea, Francesca Stansfielda, Osborn B Edenb, Nicholas D Nelhansa, Oliver R Dearlovec, Andrew Sharplesa
a Department of
Intensive Care, Manchester Children's Hospital, Pendlebury, Manchester
M27 4HA, UK, b Department of
Oncology, Manchester Children's Hospital, c Department of Anaesthesia, Manchester
Children's Hospital
Correspondence to: Dr Keengwe.
Accepted 3 February
1999
OBJECTIVES
To review
the outcome of patients with childhood malignancy requiring intensive
care treatment and to assess whether there is any secular trend for
improved outcome.
DESIGNRetrospective
chart reviews of 74 consecutive admissions to a paediatric intensive
care unit from a regional paediatric oncology centre between 1990 and
1997. During the same period there were 6419 admissions to the oncology
unit, 814 of whom were new cases.
RESULTSThe overall
survival at discharge from the intensive care unit was 49 of 74. Patients with either systemic or respiratory infection requiring
ventilation had the poorest survival (13 of 31) whereas postoperative
patients had the best survival (15 of 15). However, patients with
respiratory or systemic infection who required inotropic support with
more than three agents all died compared with about one quarter of
those needing no inotrope. All patients with systemic or respiratory
infective illness were neutropenic and positive microbiological
identification was possible in 13 of 21 and five of 18, respectively.
Non-survivors had a higher mean acute physiology and chronic health
evaluation system (APACHE-II) score than survivors (24.2 v 15.94, respectively) but no patient with a
score of > 27 survived.
CONCLUSIONCompared
with previous series, there has been a great improvement in survival of
oncology patients admitted to the intensive care unit especially those
with either systemic or respiratory infection needing ventilation. Full
intensive care treatment should be provided for these patients.
Keywords: intensive care; oncology; haematology; infection; ventilation; inotropes; survival
© 1999 by Archives of Disease in Childhood
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