Management of Oncology Patients Admitted to the Paediatric Intensive Care Unit of a General Children's Hospital – A Single Center Analysis

Abstract

Background: The improving prognosis of children with cancer has partially been attributed to the increasing importance of pediatric intensive care units (PICU). We analyze whether outcome of these patients on a PICU improved during the last decade and which factors may influence the outcome in our hospital.

Patients and methods: The charts of all oncology patients admitted to the PICU between 1998 and 2009 have been reviewed retrospectively. The survival of patients admitted for life threatening complications has been correlated with basic data, organ failure and the PRISM score. The results of 2 consecutive treatment periods (1998–2003 and 2004–2009) were compared.

Results: 644 admissions of 226 patients were recorded. 79 admissions were performed because of potentially life threatening complications (Group A), 236 for monitoring (B) and 329 admissions for interventions (C). 62% of Group A patients and all Group B and C patients were discharged alive. Poor outcome was associated with admission >28 days after initial diagnosis, PRISM >10, organ failure >2 organs, sepsis, allogeneic stem cell transplantation, need for mechanical ventilation or for catecholamines. The PICU survival rate of Group A patients admitted between 2004 and 2009 (78%) was higher than in the period between 1998 and 2003 (48%).

Conclusions: PICU provides essential services to support the pediatric oncology ward. Although children with cancer may have had benefit from advances in pediatric intensive care over the past decade, specific scoring systems for early identification of children with cancer needing PICU treatment are required. These systems might further improve PICU outcome in critical ill pediatric cancer patients.

Zusammenfassung

Hintergrund: Im Rahmen der verbesserten Prognose krebskranker Kinder gewinnen pädiatrische Intensivstationen zunehmende Bedeutung. Wir untersuchen, ob sich die Prognose krebskranker Patienten unserer Klinik im letzten Jahrzehnt verbessert hat bzw. welche Faktoren das Überleben dieser Patienten beeinflussen.

Patienten und Methoden: Unizentrische, retrospektive Analyse der 1998–2009 intensivmedizinisch behandelten Kinder mit Krebs. Für vital bedrohte Patienten wurde das Überleben mit Patientengrunddaten, Organversagen und dem PRISM-Score korreliert. Die Ergebnisse der Behandlungszeiträume 1998–2003 und 2004–2009 wurden verglichen.

Ergebnisse: 644 Aufnahmen von 226 Patienten wurden registriert. 79 Aufnahmen erfolgten aus vitaler Indikation (Gruppe A), 236 zum intensivmedizinischen Monitoring (B) und 329 zur Durchführung von Interventionen (C). 62% der Patienten in Gruppe A und alle Patienten der Gruppe B/C konnten lebend verlegt werden. Bis zum Ende des Beobachtungszeitraumes verstarben 55% der Gruppe-A-Patienten. Aufnahme >28 Tage nach Erstdiagnose, Sepsis, Zustand nach allogener Stammzelltransplantation, PRISM >10, Versagen von >2 Organen, Katecholamin- und Beatmungsbedürftigkeit waren mit einer höheren Sterblichkeit assoziiert. Die Intensivüberlebensrate der 2004–2009 aufgenommenen Patienten betrug 78%, die der 1998–2003 aufgenommenen Patienten 48%.

Schlussfolgerungen: Pädiatrische Intensivstationen können die pädiatrische Onkologie unterstützen. Ein spezifischer Score, der die besonderen Risikofaktoren der krebskranken Kinder und Jugendlichen wie z. B. die vorangehende Belastung durch die Krebsbehandlung berücksichtigt, könnte zu weiteren Prognoseverbesserungen führen.

Key words

pediatric intensive care unit - pediatric oncology - organ failure - PRISM-score

Schlüsselwörter

Kinderintensivstation - pädiatrische Onkologie - Organversagen - PRISM-Score

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