Outcome of pediatric oncologic patients in the respiratory intensive care unit : Siriraj Hospital

Abstract

Objectives: To review the characteristics and outcome of patients with childhood malignancy requiring respiratory intensive care treatment and to assess the outcome of these patients. Design: Retrospective review of 22 oncological patients admitted to the pediatric respiratory intensive care unit between January 1, 1996 and December 31, 1998 (total 3 years.) Results: The overall survival at discharge from the intensive care unit was 10 out of 22 (45%). The mean age of the patients was 4 years 5 months old (range 1 month to 14 years ). Male : Female ratio was 1.2 : 1. 21 patients had fever. All patients with a systemic or respiratory infective illness were neutropenic with a positive hemoculture in 17 out of 21 (81%) and 10 out of 20 (50%), respectively. The most common organisms detected were coagulase negative Staphylococcal aureus and Escherichia Coli. Sputum culture in the respiratory failure group was positive in 3 out of 7 patients, all of them grew Pseudomonas aeruginosa. Antibiotics were given to all oncological patients presenting with fever. The most common antibiotics administered were Ceftazidime, Amikacin and Imipenem. Fourteen patients needed mechanical ventilation. 11 of these 14 patients had respiratory tract infections, 1 patient had acute respiratory distress syndrome and the remainder were in a coma as a result of brain metastasis. Only 2 of them survived. The mean duration of stay in the respiratory intensive care unit was 10.9 days. Conclusions: There has been an improvement in the survival of oncology patients admitted to the intensive care unit especially for those with either a systemic or respiratory infection. Early and full intensive care treatment should be provided for these patients in order to improve the outcome.