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      Dificultad respiratoria en el niño con cáncer Translated title: Breathing difficulties in children with cancer

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          Abstract

          La dificultad respiratoria es un fenómeno común en el niño con cáncer y supone la causa más frecuente de ingreso en la unidad de cuidados intensivos pediátricos (UCIP) en este grupo de pacientes. Su etiología es múltiple y requiere un tratamiento adecuado y precoz. En esta revisión se describen los cuadros más frecuentes de dificultad respiratoria en el niño con cáncer no sometido a trasplante de médula ósea comentando su clínica, diagnóstico y tratamiento.

          Translated abstract

          Respiratory distress is a common phenomenon in children with cancer. It is the most frequent cause of admission to the pediatric intensive care unit (PICU) in this group of patients. Its etiology is varied, and early and appropriate treatment is required. This review describes the most prevalent forms of respiratory distress in children with cancer without bone marrow transplantation. The symptoms, diagnosis and treatment are commented.

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          Etiology and clinical course of febrile neutropenia in children with cancer.

          A Gaur, G Flynn, D. Srivastava … (2009)
          The etiology, clinical course, and outcome of fever and neutropenia (FN) in children with cancer using the current FN guidelines and diagnostic resources in the United States have not been well described. Medical records of a randomly selected FN episode per patient during 2004-2005 at a pediatric oncology center were reviewed. Patients were managed as per institutional FN guidelines and blood cultures collected in continuously read BACTEC bottles. Of 337 FN episodes, infection was proven in 86 (25%) and probable in 75 (22%). In all, 177 episodes (53%) were judged fever of unknown origin (FUO). Bacteremia accounted for most (41) of the proven bacterial episodes, with viridans streptococci (13), Pseudomonas spp. (6) and Escherichia coli (6) the most frequently isolated organisms. The median time to positivity of blood cultures was 12 hours (range, 5.4-143.7) with 93% positive within 24 hours of incubation. Viral pathogens were identified in 29 (34%) episodes. Compared with other patients, those with FUO had shorter median duration of fever (0.5 vs. 2.0 d; P<0.0001) and hospitalization (3 vs. 6 d; P<0.0001), longer median duration since last chemotherapy (6.0 vs. 4.0 d; P=0.01), and were less likely to have a diagnosis of acute myelogenous leukemia (11% vs. 22%; P=0.009) or develop a clinical complication (5.1% vs. 24.4%; P<0.0001). Despite currently available diagnostic resources, the majority of patients with FN have FUO marked by a low rate of clinical complications and no infection-related mortality. Emergence of viridans streptococci as the most common blood isolate has affected FN treatment recommendations. Study findings will help further development of strategies for risk stratified management of fever with neutropenia in pediatric patients.
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            Radiation-induced and chemotherapy-induced pulmonary injury.

            Syed H. Abid, Vikas Malhotra, Michael Perry (2001)
            The management of cancer has continued to advance with the development of new chemotherapeutic agents and improved techniques of radiation therapy. Although new therapeutic approaches have improved survival in cancer patients, each form of intervention has the potential to produce adverse effects on normal host tissues. Some of these toxicities may be accentuated with combined modality therapy. The use of chemotherapy and radiation therapy, alone or combined, can be associated with clinically significant pulmonary toxicity. The pulmonary toxic effects of chemotherapy can be divided into (1) early onset, resulting in interstitial lung injury, and (2) late onset, with pulmonary fibrosis as a sequela. These toxic effects are frequently dose related but may be enhanced by radiation therapy. Similar to chemotherapy, radiation can produce acute or chronic lung injury depending on dose rate, duration, preexisting lung disease, and concomitant steroid use. Acute radiation injury typically occurs 2 weeks to 3 months after treatment and is usually limited to the irradiated field. Mild injury often resolves without treatment, whereas more serious injury results in fibrosis 6 to 12 months after treatment. Histopathologic evaluation of acute lung injury is no different from drug-induced injury, and damage to vascular endothelial cells and alveolar lining cells is seen. This article reviews and provides an update on the clinically important chemotherapy and radiation-induced pulmonary injuries, the pathologic mechanisms, where known, and the treatment advances that have occurred in this field.
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              Noninvasive ventilation in immunocompromised pediatric patients: eight years of experience in a pediatric oncology intensive care unit.

              José Humberto T G Fregnani, Priscila C. L. B. Camargo, M Hayashi … (2008)
              The experience of noninvasive positive pressure ventilation (NPPV) in the pediatric setting is limited. The aim of the present study is to retrospectively evaluate the effectiveness of NPPV in pediatric immunocompromised patient admitted in our PICU (Pediatric Intensive Care Unit) for acute respiratory failure. Retrospective cohort study of children admitted to the PICU of Hospital do Cancer between June 1997 and May 2005 requiring ventilatory support. A total of 239 admissions were included. The first mechanical ventilation (MV) technique used was NPPV in 120 (50.2%) patients [noninvasive ventilation (NIV) group] and conventional MV in 119 (49.8%) [invasive ventilation (IV) group]; 25.8% of the patients from the NIV group subsequently required intubation. Patients in the IV group were more likely to be in a severe clinical status. Characteristics associated with severe clinical status were median value for therapeutic intervention scoring system score (37.5 points IV vs. 29 points NIV, P 2 organs failure (63.6% IV vs. 36.4% NIV, P or=40 points (P=0.018). Our results encourage the use of NPPV as a first-line treatment in children with malignancies who develops acute respiratory failure, except in those with severe hemodynamic status.
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                Author and article information

                Contributors
                A. García Salido: Role: ND
                M. Nieto Moro: Role: ND
                J. Casado Flores: Role: ND
                Journal
                Journal ID (publisher-id): medinte
                Title: Medicina Intensiva
                Abbreviated Title: Med. Intensiva
                Publisher: Elsevier España, S.L. (, , Spain )
                ISSN (Print): 0210-5691
                Publication date (Print and electronic): December 2011
                Volume: 35
                Issue: 9
                Pages: 562-568
                Affiliations
                [01] Madrid orgnameHospital Infantil Universitario Niño Jesús orgdiv1Servicio de Cuidados Intensivos Pediátricos España
                Article
                Publisher ID: S0210-56912011000900005
                SO-VID: 0855074d-c96a-4fe9-b775-9df85f7d234e
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Date accepted : 09 June 2011
                Date received : 07 May 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 50, Pages: 7
                Product

                SciELO Spain


                Keywords: Oncología,Dificultad respiratoria,Cuidados intensivos pediátricos,Pediatrics,Oncology,Respiratory distress,Pediatric critical care,Pediatría
                Data availability:
                Keywords: Oncología, Dificultad respiratoria, Cuidados intensivos pediátricos, Pediatrics, Oncology, Respiratory distress, Pediatric critical care, Pediatría

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