PICU mortality of children with cancer admitted to pediatric intensive care unit a systematic review and meta-analysis

Asperen, Roelie M. Wösten–van; Gestel, Josephus P. J. van; Grotel, Martine van; Tschiedel, Eva; Dohna-Schwake, Christian; Valla, Frédéric V.; Willems, Jef; Nielsen, Jeppe Sylvest Angaard; Krause, Martín; Potratz, Jenny; Heuvel‐Eibrink, Marry M. van den; Brierley, Joe

doi:10.1016/j.critrevonc.2019.07.014

Cited by 61 publications

(104 citation statements)

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“…This has led to many providers electing to limit the extent of care for these patients. However, with advancing intensive care therapies such as early intervention for sepsis, lung‐protective ventilation strategies, and new oncological therapies, the overall survival and cure rate of malignancies have improved 9 . For example, mortality rates for acute myeloid leukemia decreased from 80.0% in the 1970s to 40.0‐60.0% currently 10 .…”

Section: Introductionsupporting

confidence: 88%

“…After excluding elective admissions, the mortality was 28.7%. These findings are in keeping with a recent systematic review and meta‐analysis 9 of 31 mostly retrospective studies on PICU mortality ( n = 16 853) by the PICU Oncology Kids in Europe Research (POKER) Group with overall mortality of 27.8% (95% CI: 23.7, 31.9). After excluding postsurgical patients, the pooled mortality was 33.5% (95% CI: 27.0, 40.0).…”

Section: Discussionmentioning

confidence: 99%

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Critical illness epidemiology and mortality risk in pediatric oncology

Pravin

Tan

Sultana

et al. 2020

Pediatric Blood & Cancer

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Objective: Pediatric oncology patients admitted to the pediatric intensive care unit (PICU) are at high risk of mortality. This study aims to describe the epidemiology of and the risk factors for mortality in these patients. Study design:This is a retrospective cohort study including all consecutive PICU oncology admissions from 2011 to 2017. Demographic and clinical risk factors between survivors and nonsurvivors were compared. Both univariate and multivariate Cox proportional hazard regression models were used to quantify the association between 60-day mortality and admission categories, accounting for other covariates (Pediatric Risk Of Mortality [PRISM] III score and previous bacteremia). Main outcome measures:The primary outcome was 60-day mortality. Results:The median (interquartile range) age and PRISM III scores of pediatric oncology patients admitted to the PICU were 7 (3, 12) years and 3 (0, 5), respectively. The most common underlying oncological diagnoses were brain tumors (73/200 [36.5%]) and acute lymphoblastic leukemia (36/200 [18.0%]). Emergency admissions accounted for approximately half of all admissions (108/200 [54.0%]), including cardiovascular (24/108 [22.2%]), neurology (24/108 [22.2%]), respiratory (22/108 [20.4%]), and "other" indications (38/108 [35.2%]). The overall 60-day mortality was 35 of 200 (17.5%). Independent risk factors for mortality were emergency respiratory and neurology categories of admission (adjusted hazard ratio[aHR]: 5.62, 95% confidence interval [95% CI]: 1. 57, 20.19; P = .008 and aHR: 6.96, 95% CI: 2.04, 23.75; P = .002, respectively) and previous bacteremia (aHR: 3.37, 95% CI: 1.57, 7.20; P = .002). Conclusion:Emergency respiratory and neurology admissions and previous bacteremia were independent risk factors for 60-day mortality for pediatric oncological patients admitted to the PICU. K E Y W O R D Sepidemiology, intensive care,

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Section: Introductionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Critical illness epidemiology and mortality risk in pediatric oncology

Pravin

Tan

Sultana

et al. 2020

Pediatric Blood & Cancer

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“…Hospitalized pediatric hematology-oncology and posthematopoietic cell transplant (HCT) patients are a unique patient population with more frequent deterioration and lower survival than other pediatric patients (7,8,10,11). As in adults, there is evidence that delays in PICU transfer for these patients results in higher mortality (12).…”

Section: Introductionmentioning

confidence: 99%

Abnormal Vital Signs Predict Critical Deterioration in Hospitalized Pediatric Hematology-Oncology and Post-hematopoietic Cell Transplant Patients

et al. 2020

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Introduction: Hospitalized pediatric hematology-oncology and post-hematopoietic cell transplant (HCT) patients have frequent deterioration requiring Pediatric Intensive Care Unit (PICU) care. Critical deterioration (CD), defined as unplanned PICU transfer requiring life-sustaining interventions within 12 h, is a pragmatic metric to evaluate emergency response systems (ERS) in pediatrics, however, it has not been investigated in these patients. The goal of this study was to evaluate if CD is an appropriate metric to assess effectiveness of ERS in pediatric hematology-oncology and post-HCT patients and if it is preceded by an actionable period of vital sign changes. Methods: A retrospective review of all unplanned PICU transfers and floor cardiopulmonary arrests in a dedicated pediatric hematology-oncology hospital between August 2014 and July 2016. Vital signs and physical exam findings 48 h prior to events were converted to Pediatric Early Warning System-Like Scores (PEWS-LS) using cardiovascular, respiratory, and neurologic criteria. Results: There were 220 deterioration events, with 107 (48.6%) meeting criteria for CD, representing a rate of 2.98 per 1,000-inpatient-days. Using the first event per hospitalization (n = 184), patients with CD had higher mortality (17.4 vs. 7.6%, p = 0.045), fewer median ICU-free-days (21 vs. 24, p = 0.011), ventilator-free-days (25 vs. 28, p < 0.001), and vasoactive-free-days (27 vs. 28, p < 0.001). Using vital sign data 48 h prior to deterioration events, those with CD had higher PEWS-LS on PICU admission (p < 0.001), spent more time with elevated PEWS-LS prior to PICU transfer (p = 0.008 to 0.023) and had a longer time from first abnormal PEWS-LS (p = 0.007 to 0.043). Significant difference between the two groups was observed as early as 4 h prior to the event (p = 0.047). Conclusion: Hospitalized pediatric hematology-oncology and post-HCT patients have frequent deterioration resulting in a high mortality. In these patients, CD is over 13 times Agulnik et al. Critical Deterioration in Pediatric Oncology more common than floor cardiopulmonary arrests and associated with higher mortality and fewer event-free days, making it a useful metric in these patients. CD is preceded by a long duration of abnormal vital signs, making it potentially preventable through earlier recognition.

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“…Survivorship for children with malignancies has significantly improved in recent decades as a result of improved understanding of cancer genomics and immunology, diagnostic modalities, risk stratification, targeted therapies, and early recognition and treatment of complications (1)(2)(3)(4)(5). However, up to 40% of these children still require critical care therapies for factors specific to their oncologic disease (6). These factors include immunosuppression and a dysregulated inflammatory response secondary to malignant bone marrow infiltration and chronic glucocorticoid use, infection from long-term indwelling central venous catheters, and acute and chronic organ toxicity from chemotherapy agents (7).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, patients who undergo hematopoietic cell transplant (HCT) are subject to unique complications such as graft-versus-host disease, idiopathic pneumonia syndrome, diffuse alveolar hemorrhage, and sinusoidal obstruction syndrome, which further increases critical care utilization, intensive care unit (ICU) morbidity, and mortality in these patients (7)(8)(9)(10)(11)(12). Furthermore, post-HCT patients and those with underlying malignancies who require critical care have higher rates of resource utilization, such as invasive mechanical ventilation, vasoactive infusions, and continuous renal replacement therapy, as well as higher mortality, when compared to the general inpatient pediatric population (6).…”

Section: Introductionmentioning

confidence: 99%

Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit

et al. 2021

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IntroductionChildren with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population.MethodsWe describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission.ResultsBetween January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff.ConclusionsOur experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.

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PICU mortality of children with cancer admitted to pediatric intensive care unit a systematic review and meta-analysis

Cited by 61 publications

References 58 publications

Critical illness epidemiology and mortality risk in pediatric oncology

Critical illness epidemiology and mortality risk in pediatric oncology

Abnormal Vital Signs Predict Critical Deterioration in Hospitalized Pediatric Hematology-Oncology and Post-hematopoietic Cell Transplant Patients

Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit

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