Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 22, No 14S (July 15 Supplement), 2004: 8567
© 2004 American Society of Clinical Oncology

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Abstract

Pediatric oncology admission to pediatric intensive care unit (PICU). A 4-year experience at King Khalid National Guard Hospital (KKNGH), Jeddah, Saudi Arabia

King Khalid National Guard Hospital, Jeddah, Saudi Arabia

8567

Background: Cardiorespiratory decompensation is an ominous complication in the immune compromised pediatric cancer patient. Methods: A retrospective review of all PICU admissions from the KKNGH pediatric oncology unit between 6/1997 and 8/2001. To analyse pediatric oncology patients admitted to PICU with respect to cancer type, indication for admission, cardio-respiratory support required and overall outcome. Results: Over this 50 month period, 40% (79/196) of the newly diagnosed pediatric oncology patients were admitted to PICU. Cancers included ALL (50), AML (7), NHL (8), NBL (4), RMS (3), Wilms (2) and EWS, HBL, HD, CML and Abd. mass (1 each). They were divided into 2 groups based on the precipitating event: respiratory compromise or cardiovascular decompensation. Group I (n=38). 66% (25/38) required ventilation for a median of 3 days (0.25 to 14 days). 12/38 ( 32 % ) required inotropic support and 8/12 >one inotrop. Mortality in the ventilated group was 67% vs. 27% in the non-ventilated cohort. Overall mortality was 55% (21/38) and 8 deaths (38%) were relapsed / resistant disease. Group II, (n=41). 61% (25/41) required inotropic support, 14/25 > one inotrop. 5/41 (12% ) required ventilatory support. Overall mortality in this group was 32% (13/41) and in 11 of the deaths (85%) resistant/relapsed disease was present. The overall mortality for the entire cohort was 43% (34/79) and resistant/relapsed disease was a contributing factor in 56% (19/34) of these deaths. Conclusions: Over a 50 mo. period 40% of ped.oncology patients required PICU admission for ventilatory and/or inotropic support at sometime during their therapy. Infection with or without shock was the major precipitating factor. Early recognition of sepsis with aggressive management of cardio-respiratory function including early ventilatory support may reduce the high mortality rate.

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