The Changing Landscape of the Critical Care of Pediatric Immunocompromised Hematology and Oncology Patients

Abstract

Immunocompromised children and adolescent patients who have hematologic or oncologic diseases represent a small percentage of patients treated in pediatric intensive care units (PICUs) but have a disproportionately high mortality rate. A single-center study of 1278 patients admitted to a pediatric hematology-oncology service over an 11-year period found an admission rate of 4.2% with an overall PICU mortality rate of 38.9% (Faraci et al. J Pediatr Hematol Oncol 36(7): e403-9, 2014). Risk factors for PICU admission included older age, diagnosis of nonmalignant disease, and treatment with HCT. A more recent retrospective multicenter cohort analysis of almost 250,000 consecutive PICU admissions using the Virtual PICU Systems database identified 10,365 patients diagnosed with a malignancy who were admitted to PICUs for reasons other than perioperative admissions during the study period (Zinter et al. Intensive Care Med 40(10): 1536-44, 2014). Children with any cancer accounted for 11.4% of all PICU deaths and had mortality of 6.8% (43% in those who were mechanically ventilated) compared to 2.4% in patients without malignancy.