the critically-ill pediatric hemato-oncology patient epidemiology, management, and strategy of transfer to the pediatric intensive care unit小儿hemato-oncology重病患者流行病学、管理和战略转移的儿科重症监护室.pdf

Demaret et al. Annals of Intensive Care 2012, 2:14 /content/2/1/14 REVIEW Open Access The critically-ill pediatric hemato-oncology patient: epidemiology, management, and strategy of transfer to the pediatric intensive care unit 1* 1 2 3 1 Pierre Demaret , Geraldine Pettersen , Philippe Hubert , Pierre Teira and Guillaume Emeriaud Abstract Cancer is a leading cause of death in children. In the past decades, there has been a marked increase in overall survival of children with cancer. However, children whose treatment includes hematopoietic stem cell transplantation still represent a subpopulation with a higher risk of mortality. These improvements in mortality are accompanied by an increase in complications, such as respiratory and cardiovascular insufficiencies as well as neurological problems that may require an admission to the pediatric intensive care unit where most supportive therapies can be provided. It has been shown that ventilatory and cardiovascular support along with renal replacement therapy can benefit pediatric hemato-oncology patients if promptly established. Even if admissions of these patients are not considered futile anymore, they still raise sensitive questions, including ethical issues. To support the discussion and potentially facilitate the decision-making process, we propose an algorithm that takes into account the reason for admission (surgical versus medical) and the hemato-oncological prognosis. The algorithm then leads to different types of admission: full-support admission, “pediatric intensive care unit trial” admission, intensive care with adapted level of support, and palliative intensive care. Throughout the process, maintaining a dialogue betwe