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

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.

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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

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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

Correspondence to Alberto García-Salido.

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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

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Keywords

  • Pediatrics
  • Pediatric hematology/oncology
  • Intensive care
  • Health care survey