Skip to main content

Advertisement

SpringerLink
Log in

Management of unstable pediatric hemato-oncology patient: results of a web-based survey to pediatric oncologists in Spain

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The current management and monitoring of unstable pediatric hemato-oncology patient (UPHOP) in the oncology ward is not well defined. To evaluate this concept, an anonymous Web-based survey was sent to the 150 Spanish pediatric oncologists registered in the Spanish Society of Pediatric Hemato-Oncology. The response rate was 57 %, with the following main results: Pediatric intensive consulting was available for 97 %, and it was made in case of UPHOP by 37 % of oncologists, up to 65 % if hemodynamic instability. In case of inotropic support initiation, 32 % of respondents never consulted the intensivist. Dopamine is first chosen inotropic; 28 % of surveyed considered there is no limit in its dosage or it is superior to 20 μg/kg/min before an intensivist consulting. Pediatric intensive care admission was considered necessary in case of fever with hemodynamic instability by 15 % of respondents. Respiratory monitoring was mainly done by clinical signs (67 %). In case of respiratory insufficiency, the noninvasive respiratory support by high-flow ventilation with nasal cannula was applied by 57 % in the oncology ward. In case of acute kidney injury, diuretics were generally the initial therapy. The anticonvulsive drugs most frequently applied were valproic acid (93 %), diazepam (88 %), and phenytoin (81 %). Conclusion: A consensus should be achieved among oncologists and intensivists. The creation and training of rapid response teams could be useful to improve the UPHOP management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

BMT:

Bone marrow transplantation

PICU:

Pediatric critical care unit

OC:

Oncology clinic

PHOP:

Pediatric hemato-oncology patient

MV:

Mechanical ventilation

AKI:

Acute kidney injury

OW:

Oncology ward

NRS:

Noninvasive respiratory support

CPAP:

Continuous positive airway pressure

BiPAP:

Bilevel positive airway pressure

SE:

Status epilepticus

TLS:

Tumor lysis syndrome

RRT:

Renal replacement therapy

CRRT:

Continuous renal replacement therapy

PD:

Peritoneal dialysis

References

  1. Agrawal A, Gupta A, Consul S, Shastri P (2011) Comparative study of dopamine and norepinephrine in the management of septic shock. Saudi J Anaesth 5(2):162–166. doi:10.4103/1658-354X.82784

    Article  PubMed  Google Scholar 

  2. Askenazi D (2010) Evaluation and management of critically ill children with acute kidney injury. Curr Opin Pediatr 23(2):201–207. doi:10.1097/MOP.0b013e328342ff37

    Article  Google Scholar 

  3. Avent Y, Johnson S, Henderson N, Wilder K, Cresswell J, Elbahlawan L (2010) Successful use of a rapid response team in the pediatric oncology outpatient setting. Jt Comm J Qual Patient Saf 36(1):43–45

    PubMed  Google Scholar 

  4. Basu RK, Devarajan P, Wong H, Wheeler DS (2010) An update and review of acute kidney injury in pediatrics. Pediatr Crit Care Med 12(3):339–347. doi:10.1097/PCC.0b013e3181fe2e0b

    Article  Google Scholar 

  5. Bercovitz RS, Greffe BS, Hunger SP (2009) Acute tumor lysis syndrome in a 7-month-old with hepatoblastoma. Curr Opin Pediatr 22(1):113–116. doi:10.1097/MOP.0b013e32833499e5

    Article  Google Scholar 

  6. Cairo MS, Coiffier B, Reiter A, Younes A (2010) Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol 149(4):578–586. doi:10.1111/j.1365-2141.2010.08143.x

    Article  PubMed  CAS  Google Scholar 

  7. Curley MA (2011) Respiratory research in the critically ill pediatric patient: why is it so difficult? Respir Care 56(9):1247–1254. doi:10.4187/respcare.01255, discussion 1254-1247

    Article  PubMed  Google Scholar 

  8. Darmon M, Guichard I, Vincent F (2010) Rasburicase and tumor lysis syndrome: lower dosage, consideration of indications, and hyperhydration. J Clin Oncol 29(3):e67–e68. doi:10.1200/JCO.2010.32.6751, author reply e69

    Article  PubMed  Google Scholar 

  9. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, Brasseur A, Defrance P, Gottignies P, Vincent JL (2010) Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 362(9):779–789. doi:10.1056/NEJMoa0907118

    Article  PubMed  Google Scholar 

  10. de Oliveira CF (2010) Early goal-directed therapy in treatment of pediatric septic shock. Shock 34(Suppl 1):44–47. doi:10.1097/SHK.0b013e3181e7e6d5

    Article  PubMed  Google Scholar 

  11. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36(1):296–327. doi:10.1097/01.CCM.0000298158.12101.41

    Article  PubMed  Google Scholar 

  12. Diaz MA, Vicent MG, Prudencio M, Rodriguez F, Marin C, Serrano A, Sevilla J, Casado J, Madero L (2002) Predicting factors for admission to an intensive care unit and clinical outcome in pediatric patients receiving hematopoietic stem cell transplantation. Haematologica 87(3):292–298

    PubMed  Google Scholar 

  13. Dursun O, Hazar V, Karasu GT, Uygun V, Tosun O, Yesilipek A (2009) Prognostic factors in pediatric cancer patients admitted to the pediatric intensive care unit. J Pediatr Hematol Oncol 31(7):481–484. doi:10.1097/MPH.0b013e3181a330ef

    Article  PubMed  Google Scholar 

  14. Duzova A, Bakkaloglu A, Kalyoncu M, Poyrazoglu H, Delibas A, Ozkaya O, Peru H, Alpay H, Soylemezoglu O, Gur-Guven A, Bak M, Bircan Z, Cengiz N, Akil I, Ozcakar B, Uncu N, Karabay-Bayazit A, Sonmez F (2010) Etiology and outcome of acute kidney injury in children. Pediatr Nephrol 25(8):1453–1461. doi:10.1007/s00467-010-1541-y

    Article  PubMed  Google Scholar 

  15. Elbahlawan L, Gaur AH, Furman W, Jeha S, Woods T, Norris A, Morrison RR (2011) Severe H1N1-associated acute respiratory failure in immunocompromised children. Pediatr Blood Cancer 57(4):625–628. doi:10.1002/pbc.22973

    Article  PubMed  Google Scholar 

  16. Fleming S, Thompson M, Stevens R, Heneghan C, Pluddemann A, Maconochie I, Tarassenko L, Mant D (2011) Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 377(9770):1011–1018. doi:10.1016/S0140-6736(10)62226-X

    Article  PubMed  Google Scholar 

  17. Goldstein SL (2010) Continuous renal replacement therapy: mechanism of clearance, fluid removal, indications and outcomes. Curr Opin Pediatr 23(2):181–185. doi:10.1097/MOP.0b013e328342fe67

    Article  Google Scholar 

  18. Goldstein SL, Devarajan P (2010) Acute kidney injury in childhood: should we be worried about progression to CKD? Pediatr Nephrol 26(4):509–522. doi:10.1007/s00467-010-1653-4

    Article  PubMed  Google Scholar 

  19. Gregoretti C, Pelosi P, Chidini G, Bignamini E, Calderini E (2010) Non-invasive ventilation in pediatric intensive care. Minerva Pediatr 62(5):437–458

    PubMed  CAS  Google Scholar 

  20. Haase R, Lieser U, Kramm C, Stiefel M, Vilser C, Bernig T, Merkel N, Mauz-Korholz C, Korholz D (2011) Management of oncology patients admitted to the paediatric intensive care unit of a general children's hospital—a single center analysis. Klin Padiatr 223(3):142–146. doi:10.1055/s-0031-1275291

    Article  PubMed  CAS  Google Scholar 

  21. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344(7):481–487. doi:10.1056/NEJM200102153440703

    Article  PubMed  CAS  Google Scholar 

  22. Holme H, Nanduri V (2010) Superior vena cava obstruction: dangers of a missed diagnosis. J Paediatr Child Health 47(3):150–151. doi:10.1111/j.1440-1754.2010.01741.x

    Article  Google Scholar 

  23. Jawaid W, Solari V, Howell L, Jesudason E (2011) Excision of extensive metastatic dysgerminoma to control refractory hypercalcaemia in a child at high risk for tumour-lysis syndrome. J Pediatr Surg 46(1):e13–e19. doi:10.1016/j.jpedsurg.2010.08.060

    Article  PubMed  Google Scholar 

  24. Kissoon N, Orr RA, Carcillo JA (2010) Updated American College of Critical Care Medicine—pediatric advanced life support guidelines for management of pediatric and neonatal septic shock: relevance to the emergency care clinician. Pediatr Emerg Care 26(11):867–869. doi:10.1097/PEC.0b013e3181fb0dc0

    Article  PubMed  Google Scholar 

  25. Kravljanac R, Jovic N, Djuric M, Jankovic B, Pekmezovic T (2011) Outcome of status epilepticus in children treated in the intensive care unit: a study of 302 cases. Epilepsia 52(2):358–363. doi:10.1111/j.1528-1167.2010.02943.x

    PubMed  Google Scholar 

  26. Larsen GY, Mecham N, Greenberg R (2011) An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics 127(6):e1585–e1592. doi:10.1542/peds.2010-3513

    Article  PubMed  Google Scholar 

  27. Ledet DS, Wheless JW, Rubnitz JE, Brannon Morris E (2009) Levetiracetam as monotherapy for seizures in a neonate with acute lymphoblastic leukemia. Eur J Paediatr Neurol 14(1):78–79. doi:10.1016/j.ejpn.2008.12.007

    Article  PubMed  Google Scholar 

  28. Lopez-Herce J, Santiago MJ, Solana MJ, Urbano J, del Castillo J, Carrillo A, Bellon JM (2009) Clinical course of children requiring prolonged continuous renal replacement therapy. Pediatr Nephrol 25(3):523–528. doi:10.1007/s00467-009-1378-4

    Article  PubMed  Google Scholar 

  29. McGrath S, Chatterjee F, Whiteley C, Ostermann M (2010) ICU and 6-month outcome of oncology patients in the intensive care unit. QJM 103(6):397–403. doi:10.1093/qjmed/hcq032

    Article  PubMed  CAS  Google Scholar 

  30. Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, Bellamy SL, Christie JD (2009) Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 37(5):1670–1677. doi:10.1097/CCM.0b013e31819fcf68

    Article  PubMed  CAS  Google Scholar 

  31. Nguyen HB, Loomba M, Yang JJ, Jacobsen G, Shah K, Otero RM, Suarez A, Parekh H, Jaehne A, Rivers EP (2010) Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock. J Inflamm (Lond) 7:6. doi:10.1186/1476-9255-7-6

    Article  Google Scholar 

  32. Nichol AD, Egi M, Pettila V, Bellomo R, French C, Hart G, Davies A, Stachowski E, Reade MC, Bailey M, Cooper DJ (2010) Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care 14(1):R25. doi:10.1186/cc8888

    Article  PubMed  Google Scholar 

  33. Piastra M, Fognani G, Franceschi A (2011) Pediatric Intensive Care Unit admission criteria for haemato-oncological patients: a basis for clinical guidelines implementation. Pediatr Rep 3(2):e13. doi:10.4081/pr.2011.e13

    PubMed  Google Scholar 

  34. Peris-Bonet SF-G R, Fuentes-García G, Navarro-Jordán EP-R R, Tamarit-Giménez C (2009) Cáncer infantil en España, Estadísticas 1980-2009. Paper presented at the III Congreso de la SEHOP, Almeria

  35. Raaijmakers R, Schroder CH, Gajjar P, Argent A, Nourse P (2010) Continuous flow peritoneal dialysis: first experience in children with acute renal failure. Clin J Am Soc Nephrol 6(2):311–318. doi:10.2215/CJN.00330110

    Article  PubMed  Google Scholar 

  36. Reiter PD, Huff AD, Knupp KG, Valuck RJ (2010) Intravenous levetiracetam in the management of acute seizures in children. Pediatr Neurol 43(2):117–121. doi:10.1016/j.pediatrneurol.2010.03.017

    Article  PubMed  Google Scholar 

  37. Salido AG, Moro MN, Flores JC (2011) [Breathing difficulties in children subjected to bone marrow transplantation]. Med Intensiva 35(9):569–577. doi:10.1016/j.medin.2011.06.006

    Article  Google Scholar 

  38. Salido AG, Moro MN, Flores JC (2011) [Breathing difficulties in children with cancer]. Med Intensiva 35(9):562–568. doi:10.1016/j.medin.2011.06.005

    Article  Google Scholar 

  39. Saz EU, Karapinar B, Ozcetin M, Polat M, Tosun A, Serdaroglu G, Gokben S, Tekgul H (2011) Convulsive status epilepticus in children: etiology, treatment protocol and outcome. Seizure 20(2):115–118. doi:10.1016/j.seizure.2010.10.034

    Article  PubMed  Google Scholar 

  40. Schiller O, Schonfeld T, Yaniv I, Stein J, Kadmon G, Nahum E (2009) Bi-level positive airway pressure ventilation in pediatric oncology patients with acute respiratory failure. J Intensive Care Med 24(6):383–388. doi:10.1177/0885066609344956

    Article  PubMed  Google Scholar 

  41. Schneider J, Khemani R, Grushkin C, Bart R (2010) Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 38(3):933–939. doi:10.1097/CCM.0b013e3181cd12e1

    Article  PubMed  CAS  Google Scholar 

  42. Shearer P, Riviello J (2010) Generalized convulsive status epilepticus in adults and children: treatment guidelines and protocols. Emerg Med Clin North Am 29(1):51–64. doi:10.1016/j.emc.2010.08.005

    Article  Google Scholar 

  43. Simpson JN, Teach SJ (2011) Pediatric rapid fluid resuscitation. Curr Opin Pediatr 23(3):286–292. doi:10.1097/MOP.0b013e3283460599

    Article  PubMed  Google Scholar 

  44. Sreenath TG, Gupta P, Sharma KK, Krishnamurthy S (2009) Lorazepam versus diazepam-phenytoin combination in the treatment of convulsive status epilepticus in children: a randomized controlled trial. Eur J Paediatr Neurol 14(2):162–168. doi:10.1016/j.ejpn.2009.02.004

    Article  PubMed  Google Scholar 

  45. Standage SW, Wong HR (2010) Biomarkers for pediatric sepsis and septic shock. Expert Rev Anti-Infect Ther 9(1):71–79. doi:10.1586/eri.10.154

    Article  Google Scholar 

  46. Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, Hackbarth R, Somers MJ, Baum M, Symons JM, Flores FX, Benfield M, Askenazi D, Chand D, Fortenberry JD, Mahan JD, McBryde K, Blowey D, Goldstein SL (2010) Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 55(2):316–325. doi:10.1053/j.ajkd.2009.10.048

    Article  PubMed  Google Scholar 

  47. Tamburro RF, Barfield RC, Shaffer ML, Rajasekaran S, Woodard P, Morrison RR, Howard SC, Fiser RT, Schmidt JE, Sillos EM (2008) Changes in outcomes (1996–2004) for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation. Pediatr Crit Care Med 9(3):270–277. doi:10.1097/PCC.0b013e31816c7260

    Article  PubMed  Google Scholar 

  48. Ten Bruggencate MJ, Kremer LC, Caron HN, Knops AM, van Dalen EC (2009) Pediatric oncologists and evidence-based medicine: a postal survey in The Netherlands. Pediatr Blood Cancer 52(2):231–236. doi:10.1002/pbc.21844

    Article  PubMed  Google Scholar 

  49. Turner DA, Cheifetz IM (2011) Pediatric acute respiratory failure: areas of debate in the pediatric critical care setting. Expert Rev Respir Med 5(1):65–73. doi:10.1586/ers.10.93

    Article  PubMed  Google Scholar 

  50. Zhongheng Z, Xiao X, Hongyang Z (2010) Intensive- vs less-intensive-dose continuous renal replacement therapy for the intensive care unit-related acute kidney injury: a meta-analysis and systematic review. J Crit Care 25(4):595–600. doi:10.1016/j.jcrc.2010.05.030

    Article  Google Scholar 

Download references

Acknowledgments

Thanks to Manuel Ramírez-Orellana Ph.D., M.D. and Eduardo Salete-Casino Ph.D. Thanks to the Spanish Society of Pediatric Hemato-Oncologist.

Conflict of interest statement

There is no potential conflict of interest. There are no sources or financial assistance. This survey was not funded.

Author information

Authors and Affiliations

  1. Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, Madrid, Spain

    Alberto García-Salido, María Isabel Iglesias-Bouzas, Montserrat Nieto-Moro, Ana Serrano-González & Juan Casado-Flores

  2. Hemato-oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain

    Álvaro Lassaleta-Atienza

Authors
  1. Alberto García-Salido
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. María Isabel Iglesias-Bouzas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Montserrat Nieto-Moro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Álvaro Lassaleta-Atienza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ana Serrano-González
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Juan Casado-Flores
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto García-Salido.

Rights and permissions

Reprints and permissions

About this article

Cite this article

García-Salido, A., Iglesias-Bouzas, M.I., Nieto-Moro, M. et al. Management of unstable pediatric hemato-oncology patient: results of a web-based survey to pediatric oncologists in Spain. Eur J Pediatr 172, 51–58 (2013). https://doi.org/10.1007/s00431-012-1840-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-012-1840-3

Keywords

Search

Navigation