How to ventilate critically ill children with cancer?: a narrative review

Abstract

The management of respiratory failure and hypoxemia in children with cancer presents a critical challenge. Choosing between invasive and noninvasive mechanical ventilation can profoundly impact mortality rates, especially in resource-limited settings. Choosing between invasive and noninvasive mechanical ventilation can impact mortality rates, particularly in resource-limited settings. Extensive clinical studies are imperative to thoroughly evaluate the efficacy of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) during the early stages of treatment. Further research is crucial to determine the most optimal therapeutic approach. Early implementation of IMV or NIV could significantly reduce mortality rates in these patients.^[1] Additionally, this article examines the admission of children with terminal cancer, evaluating their use of invasive and noninvasive ventilatory support versus palliative care. The interdisciplinary medical team, in collaboration with the family, must carefully consider the benefits and risks of these interventions, whether in the early or terminal stages of the disease. Furthermore, the article delves into the controversies surrounding the utilization of ventilation in critically ill children with cancer.

Keywords

Child / Mechanical ventilation / Pediatric oncology / Pediatric intensive care unit

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

All authors assisted in study conceptualization and design, analysis, and interpretation, and drafted and critically revised the manu-script. Authorship requirements have been met and the final manu-script was approved by all authors.

Funding

None.

Ethical approval of studies and informed consent

None.

Acknowledgments

We would like to thank all the critical oncology committee of the Latin American Society of Pediatric Intensive Care Medicine.

References

[1] García-Salido A, Mastro-Martínez I, Cabeza-Martín B, et al. Respira-tory failure in children with hemato-oncological diseases admitted to the PICU: a single-center experience. J Pediatr Hematol Oncol. 2015; 37(6):449-454. doi:10.1097/MPH.0000000000000377

[2] Xu Z, Li P, Zhang C, Ma D. Effect of heated humidified high-flow nasal cannula (HFNC) oxygen therapy in dyspnea patients with advanced cancer, a randomized controlled clinical trial. Support Care Cancer. 2022; 30(11):9093-9100. doi:10.1007/s00520-022-07330-w

[3] Demaret P, Pettersen G, Hubert P, Teira P, Emeriaud G. The critically-ill pediatric hemato-oncology patient: epidemiology, management, and strategy of transfer to the pediatric intensive care unit. Ann Intensive Care. 2012; 2(1):14. doi:10.1186/2110-5820-2-14

[4] Fuchs H, Rossmann N, Schmid MB, et al. Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: a single-center experience. PLoS One. 2017; 12(6):e0179974. doi:10.1371/journal.pone.0179974

[5] Pelosi P, Ball L, Barbas CSV, et al. Personalized mechanical ventilation in acute respiratory distress syndrome. Crit Care. 2021; 25(1):250. doi: 10.1186/s13054-021-03686-3

[6] Emeriaud G, López-Fernández YM, Iyer NP, et al. Executive summary of the second international guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PALICC-2). Pediatr Crit Care Med. 2023; 24(2):143-168. doi:10.1097/PCC.0000000000003147

[7] Fuchs H, Schoss J, Mendler MR, et al. The cause of acute respiratory failure predicts the outcome of noninvasive ventilation in immuno-compromised children. Klin Padiatr. 2015; 227(6-7):322-328. doi: 10.1055/s-0034-1395692

[8] Piastra M, De Luca D, Pietrini D, et al. Non-invasive pressure support ventilation in immunocompromised children with ARDS: a feasibility study. Intensive Care Med. 2009; 35(8):1420-1427. doi:10.1007/s00134-009-1558-5

[9] Schiller O, Schonfeld T, Yaniv I, Stein J, Kadmon G, Nahum E. Bi-level positive airway pressure ventilation in pediatric oncology patients with acute respiratory failure. J Intensive Care Med. 2009; 24(6):383-388. doi:10.1177/0885066609344956

[10] Yilmaz S, Yıldızdaş R, Dursun O. Noninvasive ventilation in cancer children with acute respiratory failure. J Acute Dis. 2017; 6(1):23-27. doi:10.12980/jad.6.2017JOAD_2016_46

[11] García-Salido A, Nieto Moro M, Casado Flores J. Breathing difficulties in children with cancer. Med Intensiva. 2011; 35(9):562-568. doi:10. 1016/j.medin.2011.06.005

[12] Mayordomo-Colunga J, Medina A, Rey C, et al. Predictive factors of non-invasive ventilation failure in critically ill children: a prospective epidemiological study. Intensive Care Med. 2009; 35(3):527-536. doi: 10.1007/s00134-008-1346-7

[13] Pancera CF, Hayashi M, Fregnani JH, Negri EM, Deheinzelin D, de Camargo B. Noninvasive ventilation in immunocompromised pediatric patients: eight years of experience in a pediatric oncology intensive care unit. J Pediatr Hematol Oncol. 2008; 30(7):533-538. doi:10.1097/MPH.0b013e3181754198

[14] Torres MF, Porfírio GJ, Carvalho AP, Riera R. Non-invasive positive pressure ventilation for prevention of complications after pulmonary resection in lung cancer patients. Cochrane Database Syst Rev. 2019; 2019(3):CD010355. doi:10.1002/14651858.CD010355.pub3

[15] Luo F, Annane D, Orlikowski D, et al. Invasive versus noninvasive ventilation for acute respiratory failure in neuromuscular diseases and chest wall disorders. Cochrane Database Syst Rev. 2017; 12(12): CD008380. doi:10.1002/14651858.CD008380.pub2

[16] Theodoulou D. Invasive mechanical ventilation: when and to whom?Indications and complications of invasive mechanical ventilation. Pneumonologie. 2020; 33(1):13-24.

[17] Bhosale SJ, Joshi M, Patil VP, et al. Epidemiology and predictors of hospital outcomes in critically ill pediatric oncology patients: a retro-spective study. Indian J Crit Care Med. 2021; 25(10):1183-1188. doi: 10.5005/jp-journals-10071-23984

[18] Ali AM, Sayed HA, Mohammed MM. The outcome of critically ill pediatric cancer patients admitted to the pediatric intensive care unit of a tertiary university oncology center in a developing country: a 5-year experience. J Pediatr Hematol Oncol. 2016; 38(5):355-359. doi: 10.1097/MPH.00000000000000523

[19] Belenguer-Muncharaz A, Albert-Rodrigo L, Ferrandiz-Sellés A, Cebrián-Graullera G. Ten-year evolution of mechanical ventilation in acute respiratory failure in hematological patients admitted to the intensive care unit. Med Intensiva. 2013; 37(7):452-460. doi:10.1016/j.medin.2012.12.011

[20] Salins N, Hughes S, Preston N. Palliative care in paediatric oncology: an update. Curr Oncol Rep. 2022; 24(2):175-186. doi:10.1007/s11912-021-01170-3