EFFICIENCY AND OUTCOME OF INTENSIVE CARE IN PEDIATRIC

ONCOLOGIC PATIENTS

R. Heying. D.Schneider, D. Körholz, H. Stannigel, P. Lemburg, U. Göbel

Department of Pediatric Hematology/Oncology and Neonatology/Intensive Care Medicine, Childrens University Hospital, Moorenstrasse 5, 40225 Duesseldorf, Germany

OBJECTIVE: Since the longtime survival of children with cancer has dramatically improved by multimodal treatment strategies, intensive care medicine becomes more relevant in these patients. The study was performed to assess the efficiency of intensive care medicine in newly diagnosed pediatric oncologic patients and patients under ongoing oncologic treatment.

METHODS: A retrospective analysis of 43 children who were admitted to the intensive care unit of the University Hospital Duesseldorf for life-threatening conditions between 1995 and 1998 was performed.

The patients were divided into group A with children admitted to the PICU (pediatric intensive care unit) at the time of cancer diagnosis and group B with children receiving ongoing oncologic treatment. The evaluation included diagnosis, risk factors, complications leading to PICU admission, PICU therapy and outcome. Therefore the values of the PRISM, P-TISS and TISS score were analysed.

RESULTS: Most of the patients (n=24) were admitted for respiratory insufficiency. In the other patients cardiovascular insufficiency (n=4), renal failure (n=3), neurological impairment (n=5), ileus (n=2) and tumor associated complications (n=5) led to PICU admission. A severe infection on admission was seen in 34 children. Therapeutic intervention consisted of mechanical ventilation in 22 children, inotropic support for cardiovascular insufficiency in 15 children and dialysis in 2 patients. Two patients were resuscitated. Thirty-four of the 43 children survived the period of intensive care treatment. All children who developed a multiple system organ failure of ³ 3 organ systems died. All children of group A could be discharged from PICU whereas 9/27 children of group B died in spite of intensive care treatment. The PRISM, P-TISS and TISS score was significantly higher in children who did not survive the period of intensive care treatment. However there was no cut off value to differentiate between survivors and non-survivors.

CONCLUSION: Diagnosis of cancer does not exclude intensive care medicine in these children, although severe complications might influence the prognosis.