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Pediatric Critical Care Medicine pp 343–361Cite as

Care of the Oncology Patient in the PICU

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Abstract

There are numerous malignant conditions that place the pediatric patient at great risk requiring the need of critical care services. Therefore, it is essential that the pediatric critical care provider possess a sound understanding of these conditions such that they may be anticipated, recognized and treated effectively. Of these conditions, perhaps none requires the prompt, well conceived care of a pediatric intensivist as much as a malignant mediastinal mass. A definitive diagnosis must be established balancing the likelihood of a definitive result with the risk of the diagnostic procedure and the associated sedation. A clear understanding of the findings that suggest a patient is at high risk for airway compromise is essential. Hyperleukocytosis is another malignant condition associated with significant morbidity and mortality as a result of leukostasis. Leukostasis is a clinical condition characterized by progressive and potentially severe neurologic or respiratory disease attributable to small vessel infiltration and occlusion by leukemic blasts. Hypercalcemia is another disorder that may be associated with a variety of malignant processes. Although relatively rare in children, it may result in a number of life-threatening conditions including cardiac dysrhythmias, neurologic impairment, and renal failure. Additionally, it is well-established that varying degrees of coagulopathy are present in most patients with advanced malignancy. Perhaps most notable, acute promyelocytic leukemia is associated with such a high incidence of death near the time of presentation secondary to intracranial and pulmonary hemorrhages that it is viewed as a medical emergency. Other forms of leukemia may be associated with other pathophysiological consequences that may also be life-threatening. For example, lactic acidosis resulting from a high rate of glycolysis is a very rare, but life-threatening complication of hematologic malignancies. A heightened sense of alertness for these rare conditions may result in earlier detection, more effective therapy, and better outcomes for these children.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA

    Robert J. Greiner MD

  2. Divisions of Pediatric Critical Care and Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA

    Stacey Peterson-Carmichael MD

  3. Department of Pediatrics, Duke University Medical Center, Durham, NC, USA

    Jennifer A. Rothman MD

  4. Department of General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Kenneth W. Gow MSc, MD, FRCSC, FACS

  5. Department of Pediatrics, Penn State Hershey Children’s Hospital, 500 University Drive, Hershey, PA, 17033, USA

    Robert F. Tamburro Jr. MD, MSc

  6. Department of Pediatric Hematology/Oncology, Duke University, Durham, NC, USA

    Raymond Barfield MD, PhD

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  1. Robert J. Greiner MD
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  2. Stacey Peterson-Carmichael MD
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  3. Jennifer A. Rothman MD
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  4. Kenneth W. Gow MSc, MD, FRCSC, FACS
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  5. Robert F. Tamburro Jr. MD, MSc
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  6. Raymond Barfield MD, PhD
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Correspondence to Robert F. Tamburro Jr. MD, MSc .

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Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. MICHR, University of Michigan Medical Scho, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Greiner, R.J., Peterson-Carmichael, S., Rothman, J.A., Gow, K.W., Tamburro, R.F., Barfield, R. (2014). Care of the Oncology Patient in the PICU. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6416-6_24

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