Paciente crítico oncohematológico, ¿hacemos lo que deberíamos hacer?

espanolObjetivo Objetivo primario, definir el tratamiento y la monitorizacion del nino critico con enfermedad hemato-oncologica en las unidades de cuidados intensivos espanolas. El objetivo secundario fue, tras una revision de la literatura, contextualizar el enfoque obtenido y detectar posibles puntos de mejora. Material y metodos Estudio observacional, descriptivo y transversal. Se envio en el periodo abril del 2011-mayo del 2011 una encuesta online a 324 intensivistas y adjuntos de pediatria registrados en la Sociedad Espanola de Cuidados Intensivos Pediatricos. Resultados Se obtienen 105 respuestas globales, 59/105 indicaron acordar el tratamiento con el oncologo. Ante hipotension, taquicardia y requerimiento de inotropicos, 85/105 realizan siempre monitorizacion no invasiva de presion arterial asociando ademas medicion intraarterial (85/105) y casi siempre presion venosa central (70/105). Ante dificultad respiratoria, se instaura siempre (36/105) o frecuentemente (60/105) ventilacion no invasiva. De forma previa a iniciar ventilacion mecanica convencional, 72/105 consideran el pronostico global del paciente. Ante fallo renal agudo oligurico, las tecnicas de depuracion extrarrenal son ampliamente utilizadas (74/105). En caso de mal pronostico, la adecuacion del tratamiento es considerada de forma frecuente (75/103) y conjunta con el oncologo (91/103) y la familia (81/103). Conclusiones Se observa gran similitud en las respuestas a pesar de que el manejo de este tipo de pacientes no esta estandarizado. En caso de dificultad respiratoria, el uso de ventilacion no invasiva como primera asistencia esta ampliamente extendido. El desarrollo de futuros estudios observacionales prospectivos y multicentricos permitiria conocer los resultados derivados de este enfoque. EnglishObjective Primary objective, to describe the management and monitorization of critically ill pediatric hemato-oncology patient (CIPHO) in the Spanish pediatric intensive care units (PICU). Secondary objective, through a literature review, to identify possible areas of improvement. Material and methods Observational transversal descriptive study. An anonymous web-based survey was sent to 324 Spanish pediatric intensivists from April 2011 to May 2011. None of them were pediatric residents. Results The survey was answered by 105 intensivists, 59/105 always agreed their treatment with the oncologist. In case of hemodynamic instability, non-invasive blood pressure monitoring is always done by 85/105 and almost always optimized by intra-arterial measuring (85/105) and central venous pressure (70/105). If respiratory failure the use of non-invasive ventilation (NIPPV) is always (36/105) or frequently (60/105) established prior to conventional mechanical ventilation. To replace or withdraw non-invasive ventilation only 44/96 of the respondents to this question use a clinical protocol. Before the instauration of conventional mechanical ventilation the oncological prognosis is considered by 72/105. In case of acute oliguric renal failure the renal replacement techniques are widely used (74/105). The withdrawal of sustaining life support is frequently discussed (75/103) and agreed with the oncologist (91/103) and caregivers (81/103). Conclusions In our study, despite there is not a defined standard-of-care, the respondents showed similar therapeutics and monitorization choices. The use of NIPPV as first respiratory assistance is extended. Prospective, observational and multicenter studies should be developed to establish the results of this management in this population.