Trends in Childhood Oncology Admissions to ICUs in Australia and New Zealand.

OBJECTIVES: There are few robust, national-level reports of contemporary trends in pediatric oncology admissions, resource use, and mortality. We aimed to describe national-level data on trends in intensive care admissions, interventions, and survival for children with cancer. DESIGN: Cohort study using a binational pediatric intensive care registry. SETTING: Australia and New Zealand. PATIENTS: Patients younger than 16 years, admitted to an ICU in Australia or New Zealand with an oncology diagnosis between January 1, 2003, and December 31, 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We examined trends in oncology admissions, ICU interventions, and both crude and risk-adjusted patient-level mortality. Eight thousand four hundred ninety admissions were identified for 5,747 patients, accounting for 5.8% of PICU admissions. Absolute and population-indexed oncology admissions increased from 2003 to 2018, and median length of stay increased from 23.2 hours (interquartile range [IQR], 16.8-62 hr) to 38.8 hours (IQR, 20.9-81.1 hr) ( p < 0.001). Three hundred fifty-seven of 5,747 patients died (6.2%). There was a 45% reduction in risk-adjusted ICU mortality, which reduced from 3.3% (95% CI, 2.1-4.4) in 2003-2004 to 1.8% (95% CI, 1.1-2.5%) in 2017-2018 ( p trend = 0.02). The greatest reduction in mortality seen in hematological cancers and in nonelective admissions. Mechanical ventilation rates were unchanged from 2003 to 2018, while the use of high-flow nasal prong oxygen increased (incidence rate ratio, 2.43; 95% CI, 1.61-3.67 per 2 yr). CONCLUSIONS: In Australian and New Zealand PICUs, pediatric oncology admissions are increasing steadily and such admissions are staying longer, representing a considerable proportion of ICU activity. The mortality of children with cancer who are admitted to ICU is low and falling.

High-flow nasal cannula use in a paediatric intensive care unit over 3 years.

OBJECTIVE: High-flow nasal cannula (HFNC) therapy is increasingly used in paediatric intensive care unit (PICU) patients, despite a paucity of studies. We describe its use over the 3 years since its implementation in our tertiary intensive care unit. DESIGN: The clinical database was used to identify PICU patients on HFNC therapy from 2011 to 2013. Patients were assessed for risk factors, underlying diagnosis, viral test results and cardiorespiratory parameters before and after HFNC therapy. RESULTS: Fifty-four children were included with a median age of 3.5 months (interquartile range [IQR], 1-10 months) and 59% were females. The commonest diagnosis was bronchiolitis (79%). HFNC therapy was successful in 78% of patients and failed for 12 (seven patients went on to CPAP treatment and five were intubated). The median time to HFNC therapy failure was 5.5 hours (IQR, 3.6-9 hours), with 75% of patients experiencing therapy failure by 8.25 hours. The failure rate was 50% in children with a primary diagnosis of congenital heart disease. There was a statistically significant difference between the mean respiratory rate at 1 hour in the success and failure groups (P = 0.037), despite similar respiratory rates at onset. HFNC therapy failure was associated with a longer PICU LOS (P = 0.04). CONCLUSION: HFNC therapy was successful in most patients. Most failures occurred within 8.25 hours. Use of HFNC for heart disease was associated with a high therapy failure rate (50%).