ORIGINAL ARTICLE   

Minerva Anestesiologica 2023 October;89(10):850-8

DOI: 10.23736/S0375-9393.23.17329-9

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Italian pediatric intensive care units admitting critically ill cancer children: results from a national survey

Matteo MARTINATO ^{1, 2}, Rosanna I. COMORETTO ^{1, 3}, Paolo BIBAN ⁴, Elisa ZANONATO ⁵, Alessandro SIMONINI ⁶, Alessia MONTAGUTI ⁷, Eloisa GITTO ⁸, Fabio CARAMELLI ⁹, Stefania FERRARIO ¹⁰, Raffaella SAGREDINI ¹¹, Nicola ALAIMO ¹², Geremia ZITO MARINOSCI ¹³, Emanuele ROSSETTI ¹⁴, Corrado CECCHETTI ¹⁵, Manuela L’ERARIO ¹⁶, Beatrice VASILE ¹⁷, Giorgio IVANI ¹⁸, Ezio BONANOMI ¹⁹, Marinella ASTUTO ²⁰, Dario GREGORI ¹, Maria C. MONDARDINI ⁹, Angela AMIGONI ²¹ ✉, OncoTIPnet Study Group 

¹ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy; ² Giuseppe Parenti Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy; ³ Department of Sciences of Public Health and Pediatrics, University of Turin, Turin, Italy; ⁴ University Hospital of Verona, Verona, Italy; ⁵ S. Bortolo Hospital, Vicenza, Italy; ⁶ Salesi Hospital, Ancona, Italy; ⁷ IRCCS Giannina Gaslini Children Hospital, Genoa, Italy; ⁸ University Hospital of Messina, Messina, Italy; ⁹ S. Orsola-Malpighi IRCCS University Hospital, Bologna, Italy; ¹⁰ Buzzi Children’s Hospital, Milan, Italy; ¹¹ IRCCS Burlo Garofalo Hospital, Trieste, Italy; ¹² Di Cristina Children’s Hospital, Palermo, Italy; ¹³ Santobono Hospital, Naples, Italy; ¹⁴ ARCO Unit, Bambino Gesù Children’s Hospital, Rome, Italy; ¹⁵ DEA Unit, Bambino Gesù Children’s Hospital, Rome, Italy; ¹⁶ Meyer Children’s Hospital of Florence, Florence, Italy; ¹⁷ Spedali Civili, Brescia, Italy; ¹⁸ AOU Città della Salute e della Scienza, Turin, Italy; ¹⁹ Papa Giovanni XXXIII Hospital, Bergamo, Italy; ²⁰ Policlinico University Hospital of Catania, Catania, Italy; ²¹ University Hospital of Padua, Padua, Italy

BACKGROUND: Pediatric patients affected by oncologic disease have a significant risk of clinical deterioration that requires admission to the intensive care unit. This study reported the results of a national survey describing the characteristics of Italian onco-hematological units (OHUs) and pediatric intensive care units (PICUs) that admit pediatric patients, focusing on the high-complexity treatments available before PICU admission, and evaluating the approach to the end-of-life (EOL) when cared in a PICU setting.
METHODS: A web-based electronic survey has been performed in April 2021, involving all Italian PICUs admitting pediatric patients with cancer participating in the study.
RESULTS: Eighteen PICUs participated, with a median number of admissions per year of 350 (IQR 248-495). Availability of Extracorporeal Membrane Oxygenation therapy and the presence of intermediate care unit are the only statistically different characteristics between large or small PICUs. Different high-level treatments and protocols are performed in OHUs, non depending on the volume of PICU. Palliative sedation is mainly performed in the OHUs (78%), however, in 72% it is also performed in the PICU. In most centers protocols that address EOL comfort care and treatment algorithms are missing, non depending on PICU or OHU volume.
CONCLUSIONS: A non-homogeneous availability of high-level treatments and in OHUs is described. Moreover, protocols addressing EOL comfort care and treatment algorithms in palliative care are lacking in many centers.

KEY WORDS: Intensive care units, pediatric; Terminal care; Pediatrics; Oncology service, hospital; Palliative care