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Respiratory Failure in Children With Hemato-oncological Diseases Admitted to the PICU: A Single-center Experience
Alberto García-Salido1, Ignacio Mastro-Martínez, Beatriz Cabeza-Martín
1Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Insights
Respiratory failure in children with cancer often requires intensive care. Initial non-invasive support like high-flow nasal cannula or non-invasive ventilation is common, but mechanical ventilation is linked to higher mortality.
Area of Science:
- Pediatric critical care medicine
- Hematology-oncology
- Respiratory medicine
Background:
- Respiratory failure (RF) is a significant cause for pediatric intensive care unit (PICU) admission in pediatric hemato-oncological patients.
- Understanding RF management and outcomes in this vulnerable population is crucial.
Purpose of the Study:
- To characterize pediatric hemato-oncological patients admitted to the PICU for RF.
- To describe their respiratory management strategies.
- To identify factors associated with mechanical ventilation (MV) and mortality.
Main Methods:
- Retrospective chart review of children admitted to the PICU for RF between January 2006 and December 2010.
- Analysis of demographic and clinical characteristics, respiratory support, and outcomes.
- Statistical analysis to identify factors associated with MV and mortality.
Main Results:
- Hypoxemic RF was the predominant type (55/88 episodes).
- High-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) were frequently used as initial respiratory support.
- Mechanical ventilation (MV) was required in 47/88 episodes, often after initial HFNC or NIV, and was associated with higher mortality (P=0.001).
Conclusions:
- Hypoxemic RF is a major reason for PICU admission in pediatric hemato-oncological patients.
- Initial respiratory support often involves HFNC or NIV.
- The use of MV is associated with increased mortality, suggesting a need for further research into early and effective non-invasive strategies.
Abstract:
Respiratory failure (RF) is a main cause of pediatric intensive care unit (PICU) admission in children with hemato-oncological diseases. We present a retrospective chart review of children admitted to our PICU because of RF (January 2006 to December 2010). The aims of this study are the following: (1) to describe the demographical and clinical characteristics and respiratory management of these children; and (2) to identify the factors associated with mechanical ventilation (MV) and mortality. A total of 69 patients, encompassing 88 episodes, were included (55/88 cases were hypoxemic RF). The first respiratory support at PICU admission was, in decreasing order of frequency, high-flow oxygen nasal cannula (HFNC; 50/88), noninvasive ventilation (NIV; 13/88), and oxygen nasal cannula (16/88). MV was necessary in 47/88 episodes, 38/47 after another respiratory support. In 18/28 children with initial NIV, MV was required later. MV was associated with O-PRISM score, NIV requirement, suspected respiratory infection, and days of PICU treatment. Patients without MV showed an increased survival rate (P=0.001). In summary, the hypoxemic RF was the main cause of PICU admission, and HFNC or NIV was almost always the first respiratory support. The use of MV was associated with a higher mortality rate. The utility of precocious HFNC or NIV should be investigated in larger clinical studies.
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