RESUMEN
BACKGROUND: Children with leukemia are at risk of developing life-threatening opportunistic pulmonary infections. The role of bronchoalveolar lavage (BAL) and lung biopsy (BX) in the management of these patients is controversial. In this study, we evaluate the yield and safety of BAL and BX in children with leukemia. PROCEDURE: We reviewed the records of all children with leukemia who underwent either BAL or BX between 1997 and 2007 at the St Jude Children's Research Hospital. RESULTS: A total of 64 patients were included, of whom 35 (55%) had BX and 29 (45%) had BAL. Positive results were obtained in 69% of BAL cohort and in 46% of BX cohort. Both procedures resulted in change in antimicrobial coverage (77% in BX, 83% in BAL). Pulmonary hemorrhage occurred in 2 patients, and transient hypoxia was the most frequent complication. All resolved without negatively impacting the clinical course. CONCLUSIONS: Both BAL and BX are safe and useful in the management of children with leukemia and pulmonary disease.
Asunto(s)
Antiinfecciosos/uso terapéutico , Lavado Broncoalveolar , Leucemia/complicaciones , Enfermedades Pulmonares/diagnóstico , Pulmón/patología , Biopsia , Niño , Manejo de la Enfermedad , Femenino , Hemorragia , Humanos , Hipoxia , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/etiología , Masculino , Estudios RetrospectivosRESUMEN
Neutrophil recovery has been implicated in deterioration of oxygenation and exacerbation of lung injury in pediatric oncology patients. Our objectives were to determine the impact of neutrophil recovery on oxygenation in pediatric oncology patients with acute hypoxemic respiratory failure (AHRF) and to identify risk factors that result in oxygenation worsening. A cohort of 24 neutropenic pediatric oncology patients with AHRF in whom neutrophil recovery occurred during a course of mechanical ventilation was evaluated. Oxygenation index (OI) and PaO(2)/FiO(2) ratio showed a trend of improvement after neutrophil recovery. Mean PaO(2)/FiO(2) pre-recovery was 205±48.67 versus 225±72.24 postrecovery (P=0.08), whereas mean pre-recovery OI was 9.39±0.96 compared with 8.31±1.1 postrecovery (P=0.078). Seven episodes (24% of the total episodes) of recovery were characterized by worsening of oxygenation. Tripling absolute neutrophil count on Day+2 compared with Day+1 postrecovery was associated with 28-fold increase in risk of oxygenation worsening. In conclusion, resolution of neutropenia lead to significant deterioration of oxygenation in 24% of episodes of neutrophil recovery in a pediatric oncology cohort with AHRF. Our findings suggest that a faster ANC increment in the 2 days after recovery is associated with an increased risk of oxygenation worsening.
Asunto(s)
Neutropenia/sangre , Neutrófilos/fisiología , Oxígeno/sangre , Insuficiencia Respiratoria/sangre , Enfermedad Aguda , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Neutropenia/complicaciones , Neutropenia/diagnóstico , Insuficiencia Respiratoria/complicaciones , Insuficiencia Respiratoria/diagnóstico , Factores de RiesgoRESUMEN
OBJECTIVE: To report 6 children who had severe systemic reaction after spider bites requiring pediatric intensive care unit admission and to describe their clinical presentation, hospital course, and outcome. METHODS: A retrospective analysis was done to identify patients presenting with brown recluse spider bites. Charts of children admitted to the intensive care unit were reviewed. RESULTS: Six previously healthy African-American children, aged 3 to 15 years, with brown recluse spider bites were admitted to the pediatric intensive care unit. All had fever, jaundice, and evidence of hemolytic anemia. Four of 6 children had hypotension. One child developed mental status changes, acute renal failure secondary to rhabdomyolysis, and hyperkalemia and required emergent hemodialysis. All children fully recovered. CONCLUSION: Although most cases of brown recluse spider bites are benign requiring no intervention, severe systemic reactions may occur in the pediatric population resulting in admission to the pediatric intensive care unit. These systemic reactions may include hemolytic anemia, hypotension, and renal failure.