Respiratory Failure as a Result of ARDS as a High Risk Complication of Treatment of Acute Leukaemia and Myelodysplastic Syndrome in Children

Overview

The authors report on respiratory failure as a results of acute respiratory distress syndrome (ARDS) as a complication of treatment of acute leukaemia and myelodysplastic syndrome in children. A group of 24 haematooncologic patients in age bracket of 1 - 18 years was treated in PICU for complications of haematooncologic treatment. This group account for 1.84 per cent of all admitted children in this PICU. The group included as a basic diagnosis myelodysplastic syndrome (MDS, 1 patient), acute lymphoblastic leukaemia (ALL, 14 patients) and acute myelocytic leukaemia (AML, 9 patients). In 12 children ARDS was the reason for admission to PICU, 10 children from this groups died and 2 survived (2 x ALL). The period of mechanical ventilation in surviving patients was 5 - 13 days (median 9 dyas), in non-surviving patients 1 - 68 days (median 4 days). For induction chemotherapy cytosinarabinosid (ara-C) was used, from 100 mg/qm/24 h in continual infusion to a dose of 3 g/qm/12 h. Administration of chemotherapy was at the time of admission to PICU, except 3 cases, disconnected. Mortality for complication of haematooncologic treatment in this observed group was 70.8 per cent, mortality of ARDS in this group was 83.3 per cent. The group with ARDS and AML has higher risk than group with ARDS and ALL. In a similar group of children with solid tumours treated at the same time and in the same PICU the mortality was 55.6 per cent. The authors recommend not to wait with intensive care including mechanical ventilation for the development of all criteria of ARDS and to start early with this treatment at the time of the first clinical signs of respiratory failure and first pathologic changes on the X-ray picture or the lungs.

Key words:
ARDS, AML, ALL, chemotherapy, intensive care, children