Nelson Mandela Children's Hospital.
Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa.
J Pediatr Hematol Oncol. 2022 Apr 1;44(3):89-97. doi: 10.1097/MPH.0000000000002345.
Improved survival and intensified treatment protocols in pediatric oncology have resulted in an increased need for intensive care. However, in resource-constrained settings, the higher morbidity and mortality of these patients raises sensitive issues around the optimal use of limited critical care resources.
Single-center, 10-year retrospective review of pediatric oncology patients admitted to the pediatric intensive care unit (PICU).
Of the 117 admissions, 70.1% had solid tumors, 61.5% were admitted electively, and 76.1% were admitted for noninfective indications. PICU mortality of oncology patients was 18.8% relative to the PICU mortality of all patients in the same period of 10.5%. In a multivariable analysis, factors shown to be independently associated with PICU mortality were infective indications for admission (relative risk=3.83, confidence interval: 1.16; 12.6, P=0.028) and vasoactive support (relative risk=7.50, confidence interval: 1.72; 32.8, P=0.0074).
The increased mortality associated with sepsis, organ dysfunction and need for organ support underscores the need for earlier recognition of and intervention in pediatric oncology patients requiring intensive care. Further prospective studies are needed to identify the most critical areas for improvement in the referral of these children to PICU, to optimize care and improve outcomes.
儿科肿瘤学中生存的改善和强化治疗方案导致对重症监护的需求增加。然而，在资源有限的环境中，这些患者更高的发病率和死亡率引发了有关最佳利用有限重症监护资源的敏感问题。
对儿科重症监护病房（PICU）收治的儿科肿瘤患者进行了为期 10 年的单中心回顾性研究。
在 117 例住院患者中，70.1%为实体瘤，61.5%为择期住院，76.1%为非感染性原因住院。与同期所有患者的 PICU 死亡率（10.5%）相比，肿瘤患者的 PICU 死亡率为 18.8%。多变量分析显示，与 PICU 死亡率相关的独立因素为感染性住院指征（相对风险=3.83，置信区间：1.16；12.6，P=0.028）和血管活性药物支持（相对风险=7.50，置信区间：1.72；32.8，P=0.0074）。
与脓毒症、器官功能障碍和器官支持需求相关的死亡率增加，强调了需要更早识别和干预需要重症监护的儿科肿瘤患者。需要进一步的前瞻性研究来确定这些儿童转至 PICU 的最关键的改进领域，以优化护理并改善结局。
