Care for the critically ill pediatric oncology patients
Sixty-eight centers (91%) had general PICU protocols for sepsis and
infection prevention, and 51 centers (68%) had strategies for
ventilation (Table 3). However, only 25 centers (33%) had specific PICU
protocols for patients with cancer. Administration of chemotherapy
during critical illness was possible in almost all centers (99%).
Overall, 41% of the centers had implemented a Pediatric Early Warning
Score (PEWS), whereas in the UK all centers used a PEWS. In 10 centers
(13%) there were daily rounds of PICU physicians on the oncology and
HSCT wards. In contrast, in 70 centers (93%) there were daily rounds of
oncologists in the PICU when oncology patients were admitted.
Twenty-three centers (31%) hold joint oncology and intensivist
mortality meetings, 29 centers (39%) joint complication meetings, and
37 centers (49%) hold joint complex-patient discussions. Most of the
centers had a rapid response team or a cardiac arrest team, 77% and
83% respectively.
One third of the oncology units on the ward delivered more than low flow
oxygen as respiratory support with 27 centers (36%) using high-flow
nasal cannula, 6 centers (8%) non-invasive continuous positive airway
pressure/bilevel positive airway pressure (NIV CPAP/BiPAP), and seven
centers (9%) established long term ventilation on tracheotomies.
Inotropic support was possible in 13 % (10 centers) of the oncology
units while in 17 % of the centers renal replacement therapy (RRT) was
possible on the ward.
Palliation, pain, and psychological services were available at almost
all hospitals, however psychology service for staff was only available
in 63% of the participating units. Changes in goals of care towards
palliation mainly took place both at the oncology ward and PICU in 48
center (64%). In 45 centers (60%) PICU consultants were involved in
these discussions.