Pediatric Intensive Care Unit admission criteria for haematooncological patients: a basis for clinical guidelines implementation
Pediatric Intensive Care Unit admission criteria for haematooncological patients: a basis for clinical guidelines implementation
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DOI：
10.4081/pr.2011.e13
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发表时间：
2011-01-01
影响因子：
1.1
通讯作者：
Franceschi, Alessia
中科院分区：
文献类型：
--
作者：
Piastra, Marco;Fognani, Giuliana;Franceschi, Alessia
支持性治疗的最新进展以及化疗的开发和使用的进展极大地改善了许多恶性肿瘤儿童的预后，因此对重症监护入院和治疗的需求正在增加，在整个病程中，约40%的患者接受了重症监护入院和治疗。癌症仍然是儿童的主要死亡原因，尽管在过去的几十年里，结果已经有了很大的改善。预测儿科重症监护病房(PICU)癌症儿童的预后显然需要临床指南，而这些指南以及入院标准都没有很好的定义。负面结果的主要决定因素仍然是严重的脓毒症/感染性休克相关性和呼吸衰竭，值得对癌症儿童，特别是接受骨髓移植的儿童采取特殊的治疗方法。儿科重症医生和肿瘤学家应在全国范围内就需要入住重症监护病房(ICU)的临界值临床条件以及具体的重症监护方案达成共识。正如危重的非肿瘤性儿童所证明的那样，儿科恶性肿瘤患者可以进入成人重症监护病房似乎是不合理的。在全国范围内，应确定一批食疗机构，并尽早转诊至肿瘤科PICU。
Recent advances in supportive care and progress in the development and use of chemotherapy have considerably improved the prognosis of many children with malignancy, thus the need for intensive care admission and management is increasing, reaching about 40% of patients throughout the disease course. Cancer remains a major death cause in children, though outcomes have considerably improved over the past decades. Prediction of outcome for children with cancer in Pediatric Intensive Care Unit (PICU) obviously requires clinical guidelines, and these are not well defined, as well as admission criteria. Major determinants of negative outcomes remain severe sepsis/septic shock association and respiratory failure, deserving specific approach in children with cancer, particularly those receiving a bone marrow transplantation. A nationwide consensus should be achieved among pediatric intensivists and oncologists regarding the threshold clinical conditions requiring Intensive Care Unit (ICU) admission as well as specific critical care protocols. As demonstrated for the critically ill non-oncologic child, it appears unreasonable that pediatric patients with malignancy can be admitted to an adult Intensive Care Unit ICU. On a national basis a pool of refecence institutions should be identified and early referral to an oncologic PICU is warranted