European Journal of Pediatrics

, Volume 172, Issue 1, pp 51–58

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

  • Alberto García-Salido
  • María Isabel Iglesias-Bouzas
  • Montserrat Nieto-Moro
  • Álvaro Lassaleta-Atienza
  • Ana Serrano-González
  • Juan Casado-Flores
Original Article

DOI: 10.1007/s00431-012-1840-3

Cite this article as:
García-Salido, A., Iglesias-Bouzas, M.I., Nieto-Moro, M. et al. Eur J Pediatr (2013) 172: 51. doi:10.1007/s00431-012-1840-3

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.

Keywords

PediatricsPediatric hematology/oncologyIntensive careHealth care survey

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

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Alberto García-Salido
    • 1
  • María Isabel Iglesias-Bouzas
    • 1
  • Montserrat Nieto-Moro
    • 1
  • Álvaro Lassaleta-Atienza
    • 2
  • Ana Serrano-González
    • 1
  • Juan Casado-Flores
    • 1
  1. 1.Pediatric Critical Care UnitHospital Infantil Universitario Niño JesúsMadridSpain
  2. 2.Hemato-oncology UnitHospital Infantil Universitario Niño JesúsMadridSpain