Abstract
The authors discuss in this article one of the complications of oncological treatment in children requiring intensive care. This complication is acute respiratory distress syndrome caused by the pneumotoxic effect of cytostatic drugs, such as cyclophosfamide, methotrexate and nitrosourea derivatives.
The risk of ARDS increases with the cumulative dose of administered cytostatic drugs. A group of 51 children in the age bracket of 1 - 18 years was treated in 1996 - 1999 at the University Hospital Motol Prague.
Indication for treatment was in 17 children progress of the basic disease and in 34 children complications of oncological treatment. ARDS was noticed as a complication of treatment in 18 children.
From this group 8 patients survived, 10 died. The period of mechanical ventilation in surviving patients was 2 - 48 days (median 8.5 days), in the non-surviving patients 1 - 78 days (median 4 days).
Cumulative doses of cytostatic drugs were: cyclophosfamide 1800 - 3545 mg/m2 (median 2345 mg/m2), methotrexate 8.6 - 19.4 g/m2 (median 11.4 g/m2), nitrosourea derivatives 80 - 180 mg/m2 (median 111 mg/m2). Administration of cytostatic drugs was in all cases discontinued.
The mortality rate of this complication was in our group 55.6 per cent. The authors recommend in case of developing symmetrical shadows on X-ray of the lungs during administration of cytostatic drugs to start intensive care, already at the time of development of clinical signs of respiratory failure.