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.