Background

Up to 40% of pediatric cancer patients require admission to PICU during the course of their disease. However, scarce are available on the standard of care in critical care delivery for this patient group, nor are systematic multi-center outcome data.

Objectives

To obtain consensus on the top five research priorities in the field of pediatric cancer patient critical care.

Methods

We conducted a three-round modified Delphi consensus process among pediatric intensivists and pediatric oncologists in Europe. An anonymous questionnaire was distributed online via SurveyMonkey. POKER consortium members drafted ten candidate research topics. Participants rated these topics using a 4-point scale. Research questions that met a priori consensus thresholds for >80% high priority were included in round 2, complemented with additional research topics suggested by participants. Round 2 yielded consensus on high prioritiy topics, which were ranked by POKER member in round 3 to create a final top five .

Results

One-hundred seventy-four and 154 colleagues participated in rounds 1 and 2, respectively (Fig. 1). Five research topics were identified as top priorities: (1) Optimal timing of the use of life-sustaining therapies; (2) Development of specific early warning scores; (3) Role of non-invasive ventilation in acute respiratory insufficiency; (4) End-of-life care and ethical issues; (5) Sepsis.

Profession and country of residence of the participants.

Conclusion

Admissions of pediatric cancer patients contribute to a substantial proportion of critical care patient- and work-load. In particular, optimum use of critical care resources in this group is an area requiring urgent research.

Background

Acute respiratory failure is a major cause of pediatric intensive care unit (PICU) admission in pediatric cancer and hematopoietic stem cell transplant (HSCT) patients. The use of high-flow nasal cannula oxygen therapy (HFNC) is growing as an alternative to standard oxygen. However, its use in patients treated for malignancies including HSCT, is controversial.

Objectives

The aim of this study was to assess outcomes of pediatric cancer and HSCT patients (including non-malignant indications) with acute hypoxemic respiratory failure treated with high-flow nasal oxygen on the ward.

Methods

In this retrospective cohort study, pediatric cancer and (non)-cancer HSCT patients with acute hypoxemic respiratory failure treated with HFNC were included. Among 39 patients included in the study, 53 episodes of HFNC treatment were analyzed. Of these episodes, 18 (34%) failed and patients required subsequently PICU admission. A significant median higher CRP (175 (range (72-308) versus 80 (13.5-187.8) mg/dL, p = 0.006) and higher Bedside Pediatric Early Warning Score (PEWS) 1-4 hours after initiation of HFNC (10.1 ± 0.8 versus 7.1 ± 0.4, p=0.001) was found in the failure group compared to the non-failure group. Among the 18 patients admitted to PICU, 14 (78%) needed intubation. Five (28 %) patients died during their PICU admission. None of the patients died outside the PICU.

Conclusion

In this study, one third of the pediatric cancer and HSCT patients receiving HFNC on the ward, eventually required PICU admission. A significant higher CRP and a higher Bedside PEWS 1-4 hours after initiation of HFNC were associated with HFNC treatment failure.