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Outcomes for paediatric acute leukaemia patients admitted to the paediatric intensive care unit. Eur J Pediatr 2022; 181:1037-1045. [PMID: 34694507 DOI: 10.1007/s00431-021-04292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
Children with acute leukaemia (AL) are a high-risk population for infections and life-threatening conditions requiring paediatric intensive care unit (PICU) admission, presenting an increased mortality rate. A few literature exists about PICU outcomes in this kind of patients, especially with haematopoietic stem cell transplant (HSCT) background. We investigated the clinical and epidemiological characteristics of these patients as well as their outcomes. A retrospective, single-centre analytical/observational study was conducted from January 2011 to December 2018 in the PICU of a tertiary care hospital. AL patients from 28 days to 18 years old admitted to the PICU were included, excluding those with histories of HSCT or CAR T-cell therapy. We collected epidemiological and clinical characteristics, laboratory and microbiology results and outcomes. Forty-three patients with AL required urgent admission (35 lymphoblastic and 8 myeloblastic) for 63 different episodes. The main reasons were sepsis (21, 33.3%), hyperleukocytosis (12, 19%), respiratory failure (11, 17.5%) and seizures (8, 12.7%). Nineteen (30.2%) required inotropic support, and fifteen (23.8%) required mechanical ventilation. Three patients died at the hospital (3/43, 6.9%). Sixty-day mortality was 9.3%, and 1-year mortality was 13.9%. There was no differences regarding the type of AL and 60-day mortality (log-rank 2.652, p = 0.103).Conclusion: In our study, the main cause of admission for AL patients was infection, which was associated to more severity and longer hospital admission. What is Known: • Acute leukaemia is the most common childhood cancer. Admission to a paediatric intensive care unit is required in 30% of children with acute leukaemia. • Regarding the outcomes of children with acute leukaemia that require admission to the intensive care unit data are scarce. What is New: • Mortality in acute leukaemia patients admitted to the paediatric intensive care unit is lower than that of patients with a history of stem cell therapy but higher than that of patients with solid tumours. • The main reason for admission was sepsis, which is related in literature to more severity and long length of stay.
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Nielsen JSA, Agbeko R, Bate J, Jordan I, Dohna-Schwake C, Potratz J, Moscatelli A, Bottari G, Pappachan J, Witt V, Crazzolara R, Amigoni A, Mizia-Malarz A, Sánchez Martín M, Willems J, van den Heuvel-Eibrink MM, Schlapbach LJ, Wösten-van Asperen RM. Organizational characteristics of European pediatric onco-critical care: An international cross-sectional survey. Front Pediatr 2022; 10:1024273. [PMID: 36533247 PMCID: PMC9751627 DOI: 10.3389/fped.2022.1024273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Intensified treatment protocols have improved survival of pediatric oncology patients. However, these treatment protocols are associated with increased treatment-related morbidity requiring admission to pediatric intensive care unit (PICU). We aimed to describe the organizational characteristics and processes of care for this patient group across PICUs in Europe. METHODS A web-based survey was sent to PICU directors or representative physicians between February and June 2021. RESULTS Responses were obtained from 77 PICUs of 12 European countries. Organizational characteristics were similar across the different countries of Europe. The median number of PICU beds was 12 (IQR 8-16). The majority of the PICUs was staffed by pediatric intensivists and had a 24/7 intensivist coverage. Most PICUs had a nurse-to-patient ratio of 1:1 or 1:2. The median numbers of yearly planned and unplanned PICU admissions of pediatric cancer patients were 20 (IQR 10-45) and 10 (IQR 10-30, respectively. Oncology specific practices within PICU were less common in participating centres. This included implementation of oncology protocols in PICU (30%), daily rounds of PICU physicians on the wards (13%), joint mortality and morbidity meetings or complex patients' discussions (30% and 40%, respectively) and participation of parents during clinical rounds (40%). CONCLUSION Our survey provides an overview on the delivery of critical care for oncology patients in PICU across European countries. Multidisciplinary care for these vulnerable and challenging patients remains complex and challenging. Future studies need to determine the effects of differences in PICU organization and processes of care on patients' outcome.
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Affiliation(s)
- Jeppe S A Nielsen
- Department of Neonatal and Pediatric Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Rachel Agbeko
- Department of Pediatric Intensive Care Unit, Great North Children's Hospital & Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Jessica Bate
- Department of Pediatric Oncology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Iolanda Jordan
- Department of Pediatric Intensive Care, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | | | - Jenny Potratz
- Department of General Pediatrics-Intensive Care Medicine, University Children's Hospital Münster, Münster, Germany
| | - Andrea Moscatelli
- Department of Pediatric Intensive Care, Gaslini Hospital, Genova, Italy
| | - Gabriella Bottari
- Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù, IRCC, Rome, Italy
| | - John Pappachan
- Department of Pediatric Intensive Care, Southampton Children's Hospital, Southamptom, United Kingdom
| | - Volker Witt
- Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Southamptom, Austria
| | - Roman Crazzolara
- Department of Pediatrics, Pediatric Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Angela Amigoni
- Department of Pediatric Intensive Care, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
| | - Agniezka Mizia-Malarz
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Katowice, Poland
| | - Mariá Sánchez Martín
- Department of Pediatric Intensive Care, Hospital Universitario La Paz, Madrid, Spain
| | - Jef Willems
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
| | | | - Luregn J Schlapbach
- Department of Intensive Care and Neonatology, and Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Roelie M Wösten-van Asperen
- Department of Pediatric Intensive Care, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Utrecht, Netherlands
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