Optimism and no longer foolishness? Haematology/oncology and the PICU

Peters, Mark; Agbeko, Rachel

doi:10.1007/s00134-014-3478-2

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…Observational data show consistently worse outcomes for these children especially in the context of acute respiratory failure -for example, in paediatric acute respiratory distress syndrome, overall mortality is around 20%(1) but in the context of impaired immunity this approaches 50%. (2,3) The association of invasive mechanical ventilation with death in adults with impaired immunity prompted a number of studies to determine if non-invasive ventilation could avoid endotracheal intubation and reduce mortality. Three small randomised clinical trials (RCTs) of adults with acute respiratory failure and impaired immunity suggest that using continuous positive airways pressure (CPAP), via facemask or helmet, before it is required to maintain gas exchange, reduces the risk of death by around 60%.…”

Section: Introductionmentioning

confidence: 99%

Randomized Study of Early Continuous Positive Airways Pressure in Acute Respiratory Failure in Children With Impaired Immunity (SCARF) ISRCTN82853500*

Peters

Agbeko

Davis

et al. 2018

Pediatric Critical Care Medicine

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Section: Introductionmentioning

confidence: 99%

Randomized Study of Early Continuous Positive Airways Pressure in Acute Respiratory Failure in Children With Impaired Immunity (SCARF) ISRCTN82853500*

Peters

Agbeko

Davis

et al. 2018

Pediatric Critical Care Medicine

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“…This exemplifies the fact that despite risk factors, many children with cancer who experience critical illness can recover with adequate supportive care. This finding is an important divergence from the common belief that many of these patients will not survive critical illness in resource-limited settings, leading to inadequate resource and ultimately poor outcomes (8). Our center's relatively low mortality in critically ill children with cancer compared to other resource-limited settings is likely due to a combination of factors and practices that may improve outcomes in these patients.…”

Section: Discussionmentioning

confidence: 73%

Outcomes for critical illness in children with cancer: Analysis of risk factors for adverse outcome and resource utilization from a specialized center in Mexico

et al. 2022

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IntroductionChildren with cancer have a higher risk of adverse outcomes during critical illness than general pediatric populations. In Low- and middle-income countries, lack of resources can further negatively impact outcomes in critically ill children with cancer.MethodsIn this study, we describe the outcomes of a large cohort of children with cancer including mortality and resource utilization. We performed a retrospective review of all patients admitted to our PICU between December 12th, 2013 and December 31st, 2019. Outcomes were defined as recovery or death and resource utilization was described via use of critical care interventions, Length of stay as well as PICU- and Mechanical Ventilation- free days.ResultsOverall mortality was 6.9% while mortality in the unplanned admissions was 9.1%. This remained lower than expected mortality based on PIM2 scoring. Type of PICU admission, Neurological Deterioration as a cause of PICU admission, and PIM2 were significant as risk factors in univariate analysis, but only PIM2 remained significant in the multivariate analysis.DiscussionOur Study shows that high survival rates are achievable for children with cancer with critical illness in resource-limited settings with provision of high-quality critical care. Organizational and clinical practice facilitating quality improvement and early identification and management of critical illness may attenuate the impact of known risk factors for mortality in this population.

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“…Тенденция смертности с течением времени дает важную информацию о состоянии медицинской помощи для конкретного заболевания или группы пациентов [12]. M. Peters и R. Agbeko показали, что прогнозируемый риск смертности детей с лейкемией или лимфомой за пределами первой ремиссии, поступивших в ОРИТ из-за синдрома полиорганной дисфункции, вызванной сепсисом или острым респираторным дистресс-синдромом, снизился за последние десятилетия [25]. Тем не менее результаты исследования показывают лишь незначительное снижение уровня смертности с течением времени, когда послеоперационные пациенты не включаются в анализ.…”

Section: таблицаunclassified

Causes of transfer and mortality in children with oncohematological diseases admitted to the intensive care unit

Алиева¹,

Мулдахметов²,

Нурмагамбетова³

2021

Voprosy gematologii/onkologii i immunopatologii v pediatrii

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The last few decades survival rates of children with hematologic malignancies have improved significantly, due to a potentially curative chemotherapy protocols, the expansion of biological knowledge and innovative methods of therapy. However oncohematological pediatric patients are at high risk for rapid clinical deterioration due to numerous factors such as the severity of the underlying condition, interventions toxicity and associated immunosuppression. Using aggressive tactics of therapy with oncohematological diseases in children is also associated with complications and life-threatening events that lead to admission to the pediatric intensive care unit. Historically, these children have been considered as poor candidates for intensive care. Discussions around the transfer of children with hematological malignancies to intensive care units and also the expected prognosis raised complicate and delicate questions, especially from an ethical point of view. Despite the general tendency of improved survival rate, mortality in the intensive care unit on hematological malignancies children, unfortunately, is still high and, in comparison to adults, has remained relatively invariable over the past decades. These findings highlight the necessity for research in this group of patients.

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Optimism and no longer foolishness? Haematology/oncology and the PICU

Cited by 11 publications

References 18 publications

Randomized Study of Early Continuous Positive Airways Pressure in Acute Respiratory Failure in Children With Impaired Immunity (SCARF) ISRCTN82853500*

Randomized Study of Early Continuous Positive Airways Pressure in Acute Respiratory Failure in Children With Impaired Immunity (SCARF) ISRCTN82853500*

Outcomes for critical illness in children with cancer: Analysis of risk factors for adverse outcome and resource utilization from a specialized center in Mexico

Causes of transfer and mortality in children with oncohematological diseases admitted to the intensive care unit

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