Outcomes for paediatric acute leukaemia patients admitted to the paediatric intensive care unit

Caballero, Mireia Cantero; Faura, Anna; Margarit, Adriana; Pérez, Sandra Martínez; Catalá, Albert; Alonso‐Saladrigues, Anna; Conde, Núria; Balaguer, Mònica; Rives, Susana; Jordán, Iolanda

doi:10.1007/s00431-021-04292-9

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…1 Sepsis and acute respiratory failure remain the most common causes for admission to the PICU in children with oncologic disease. 3 10 11 12 13 14 The lower ICU mortality that has been found in adult patients with cancer over the last several decades had not been confirmed in pediatric patients. 1 15…”

Section: Discussionmentioning

confidence: 99%

“…1 Sepsis and acute respiratory failure remain the most common causes for admission to the PICU in children with oncologic disease. 3,[10][11][12][13][14] The lower ICU mortality that has been found in adult patients with cancer over the last several decades had not been confirmed in pediatric patients. 1,15 In our cohort, mortality was lower than in the recent systematic review of children with cancer admitted to a PICU (18.3% compared to 27.8% [95% confidence interval [CI] 23.7, 31.9]).…”

Section: Discussionmentioning

confidence: 99%

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Mortality in Patients with Leukemia and Lymphoma Urgently Admitted to the PICU: Secondary Analysis of Data from a Cluster Randomized Controlled Trial

Nostedt,

Sinha,

Joffe

et al. 2024

J Pediatr Intensive Care

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Objectives were to describe the severity of illness in patients with leukemia or lymphoma urgently admitted to pediatric intensive care and explores the risk factors for mortality. A secondary analysis was performed of prospectively collected data from a cluster-randomized controlled trial in 21 children's hospitals from 2011 to 2015. Eligible patients were urgently admitted to intensive care and had a diagnosis of leukemia or lymphoma. Associations with intensive care mortality (primary outcome) were determined with multivariable generalized estimating equation with a logit link, accounting for clustering by site. Associations with time to intensive care mortality (secondary outcome) were determined with multivariable proportional hazards models. A total of 109 patients were included, age 115 (interquartile range [IQR] 42, 168) months and intensive care length of stay was 3 (IQR 2, 6) days. During the first hour in intensive care 36 (33%) were ventilated, and during intensive care 45 (41.3%) had at least 1 technology day. Day 1 Pediatric Logistic Organ Dysfunction (PELOD) score was ≥ 20 in 37 (33.9%), Pediatric Index of Mortality 2 mortality risk was > 10% in 35 (32.1%), and Children's Resuscitation Intensity Scale (RISC) was ≥ 3 (late admission to intensive care) in 32 (31.7%). Intensive care mortality was 20/109 (18.3%); with intensive care stay ≥ 20 days mortality was 51%. Previous urgent pediatric intensive care unit (PICU) admission, mechanical ventilation, and day 1 PELOD score were associated with higher PICU mortality. Mechanical ventilation, day 1 PELOD score, and late admission to the PICU (RISC ≥ 2) were associated with time to death. Patients with leukemia and lymphoma urgently admitted to intensive care had mortality of 18.3%, an improvement from historical cohorts. Risk factors were not accurate enough to make individual patient care decisions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mortality in Patients with Leukemia and Lymphoma Urgently Admitted to the PICU: Secondary Analysis of Data from a Cluster Randomized Controlled Trial

Nostedt,

Sinha,

Joffe

et al. 2024

J Pediatr Intensive Care

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“…Kinderonkologische Patienten mit Fieber während der Granulozytopenie (FN) haben bei einem septischen Schock oder einer Sepsis mit Organdysfunktion ein erhöhtes Risiko für einen komplizierten Verlauf der Intensivtherapie (z. B. Liegedauer, Dauer der Katecholamingabe und der Beatmung, Notwendigkeit von Nierenersatzverfahren) und eine deutlich höhere Mortalität als Patienten ohne Granulozytopenie oder vormals gesunde Kinder und Jugendliche 1 2 3 4 5 6 . Daher werden kinderonkologische Patienten mit FN berechtigterweise als solche mit einer dringlichen Indikation für die Erstbeurteilung des Allgemeinzustandes mit Vitalzeichenkontrolle, für die ärztliche Anamneseerhebung, Untersuchung und auch für eine zeitnahe Verordnung von Antibiotika angesehen.…”

Section: Hintergrundunclassified

Time to Antibiotics (TTA) – Überlegungen der Arbeitsgruppe Fieber bei Granulozytopenie im Kindes- und Jugendalter (GPOH/DGPI) zu einer Neubewertung.

Simon,

Lehrnbecher,

Baltaci

et al. 2023

Klin Padiatr

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Zusammenfassung Hintergrund Die geltende Leitlinie für kinderonkologische Patienten mit febriler Granulozytopenie (FN) von 2016 empfiehlt eine Time-to-Antibiotics (TTA)<60 min. Methode Kritische Analyse verfügbarer Studien und Metaanalysen, Diskussion der Konsequenzen in der Arbeitsgruppe Fieber bei Granulozytopenie der Fachgesellschaften für pädiatrische Onkologie und Hämatologie und pädiatrische Infektiologie. Ergebnisse Die verfügbaren Studien können keinen klinisch signifikanten Vorteil einer TTA<60 min für alle kinderonkologischen Patienten mit FN darstellen. Studien, die einen solchen Zusammenhang nahelegen, sind mit einem Triage Bias und anderen methodischen Limitationen behaftet und nutzen unterschiedliche TTA Definitionen. Hingegen ist eine TTA<60 min elementarer Bestandteil des Einstunden-Maßnahme-Bündels bei septischem Schock oder Sepsis mit Organdysfunktion. Zusammenfassung Wenn alle kinderonkologischen Patienten mit neu aufgetretenem Fieber zeitnah durch gut ausgebildetes und trainiertes Fachpersonal eine strukturierte Anamnese und körperliche Untersuchung (inkl. Vitalzeichen) erhalten und unter der Voraussetzung, dass lokal eine Sepsis Triage und Management Bündel etabliert und implementiert wurde, ist eine TTA<3 h bei kinderonkologischen Patienten mit FN angemessen.

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“…These treatment protocols are however, associated with severe side effects. Infections and treatment-related toxicity conditions are leading causes for of mortality and morbidity in cancer patients that require treatment in the intensive care unit and 2% to 28% of the pediatric cancer patients have been shown to require admission to the PICU during their disease course (2)(3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Organizational characteristics of European pediatric onco-critical care: An international cross-sectional survey

et al. 2022

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BackgroundIntensified 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.MethodsA web-based survey was sent to PICU directors or representative physicians between February and June 2021.ResultsResponses 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%).ConclusionOur 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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Outcomes for paediatric acute leukaemia patients admitted to the paediatric intensive care unit

Cited by 6 publications

References 23 publications

Mortality in Patients with Leukemia and Lymphoma Urgently Admitted to the PICU: Secondary Analysis of Data from a Cluster Randomized Controlled Trial

Mortality in Patients with Leukemia and Lymphoma Urgently Admitted to the PICU: Secondary Analysis of Data from a Cluster Randomized Controlled Trial

Time to Antibiotics (TTA) – Überlegungen der Arbeitsgruppe Fieber bei Granulozytopenie im Kindes- und Jugendalter (GPOH/DGPI) zu einer Neubewertung.

Organizational characteristics of European pediatric onco-critical care: An international cross-sectional survey

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