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


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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Bone marrow transplantation


Pediatric critical care unit


Oncology clinic


Pediatric hemato-oncology patient


Mechanical ventilation


Acute kidney injury


Oncology ward


Noninvasive respiratory support


Continuous positive airway pressure


Bilevel positive airway pressure


Status epilepticus


Tumor lysis syndrome


Renal replacement therapy


Continuous renal replacement therapy


Peritoneal dialysis


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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.

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