The risks of the new morbidities acquired during pediatric onco-critical care and their life-shortening effects

Abstract Objective: The authors investigated the functional status at ICU admission and at hospital discharge, and the impact of dysfunctions on survivors' lifespan. Method: Single-center retrospective cohort. The FSS (Functional Status Scale) was calculated at ICU admission and at hospital discharge. A new morbidity was defined as an increase in FSS ≥ 3. Results: Among 1002 patients, there were 855 survivors. Of these, 194 (22.6%) had died by the end of the study; 45 (5.3%) had a new morbidity. Means in the motor domain at admission and discharge were 1.37 (SD: 0.82) and 1.53 (SD 0.95, p = 0.002). In the feeding domain, the means were 1.19 (SD 0.63) and 1.30 (SD 0.76), p = 0.002; global means were 6.93 (SD 2.45) and 7.2 (SD 2.94), p = 0.007. Acute respiratory failure requiring mechanical ventilation, the score PRISM IV, age < 5 years, and central nervous system tumors were independent predictors of new morbidity. New morbidity correlated with lower odds of survival after hospital discharge, considering all causes of death (p = 0.014), and was independently predictive of death (Cox hazard ratio = 1.98). In Weibull models, shortening in the life span of 14.2% (p = 0.014) was estimated as a new morbidity. Conclusions: New morbidities are related to age, disease severity at admission, and SNC tumors. New morbidities, in turn, correlate with lower probabilities of survival and shortening of the remaining life span. Physical rehabilitation interventions in this population of children may have the potential to provide an increase in lifespan.

Pulmonary Function in Long-Term Survivors of Childhood and Adolescence Osteosarcoma: Case Report / Função Pulmonar em Sobreviventes de Osteossarcoma da Infância e Adolescência: Relato de Caso / Función Pulmonar en Sobrevivientes de Osteosarcoma en la Infancia y la Adolescencia: Relato de Caso

Introduction: Chemotherapy used in osteosarcoma have the potential to cause lung damage. The objectives were to analyze lung volumes and capacities, and respiratory muscle strength of patients treated with chemotherapy and surgery for osteosarcoma. The study was designed as a prospective case-series of patients, through the analysis of spirometry,impulse, oscillometry, and manovacuometry tests. Case report: In twenty-one patients, the median age at diagnosis was 15 years, and at inclusion, 30 years. The median disease-free survival time was 10 years. Eight different chemotherapeutic agents were used: cisplatin, doxorubicin, methotrexate, carboplatin, ifophosphamide, epidoxorubicin, cyclophosphamide and etoposide. There were test abnormalities in 14 patients (66.6%), with mild obstructive disorders on spirometry in three patients (14.3%), and obstructive patterns on oscillometry in seven patients (33.3%). On spirometry, the mean ± standard deviation (SD) values of forced vital capacity (FVC) were 91.9%±12.2; for forced expiratory volume in one second (FEV1) were 87.4%±12.2 and FEV1/FVC ratios, 95.4%±7.9. On oscillometry, mean ± SD values for resistance at 5 Hz were 126.2%±36.2; for resistance at 20 Hz, 128.4%±32.4; reactance at 5 Hz, -0.75±0.68 kPa/L/s; for resonant frequency, 15.6±4.2 Hz. Nine patients (42.8%) had reduced maximum pressures on the manovacuometry: Maximum Expiratory Pressure (MEP) were reduced in eight patients, and inspiratory (MIP) in three. The mean ± SD MIP was 89.4±29.5; MEP, 88±37.7. Conclusion: Mild abnormalities in pulmonary function tests in this series of patients were observed years after treatment for osteosarcoma

Introdução: A quimioterapia usada no osteossarcoma tem potencial para causar danos aos pulmões. Os objetivos deste trabalho foram analisar os volumes e capacidades pulmonares e a força respiratória de pacientes tratados com quimioterapia e cirurgia para osteossarcoma, em uma série prospectiva de casos, em um hospital pediátrico oncológico, por meio da análise de espirometria, oscilometria de impulso e manovacuometria. Relato de caso: Em 21 pacientes, a mediana de idade ao diagnóstico foi de 15 anos e na inclusão de 30 anos. O tempo médio de sobrevida livre de doença foi de dez anos. Houve alterações nos exames em 14 pacientes (66,6%), com distúrbios obstrutivos leves na espirometria em três pacientes (14,3%) e padrões obstrutivos na oscilometria em sete pacientes (33,3%). Na espirometria, os valores de média ± desvio padrão (DP) da capacidade vital forçada (CVF) foram 91,9%±12,2; para o volume expiratório forçado no primeiro segundo (VEF1) foram 87,4%±12,2 e as relações VEF1/CVF, 95,4%±7,9. Na oscilometria, os valores médios ± DP para resistência em 5 Hz foram 126,2%±36,2; para resistência a 20 Hz, 128,4% ± 32,4; reatância a 5 Hz, -0,75 ± 0,68 kPa/L/s; para frequência de ressonância, 15,6±4,2 Hz. Na manovacuometria, nove pacientes (42,8%) apresentaram redução nas pressões: as pressões expiratórias máximas (PEmáx) foram reduzidas em oito pacientes e as inspiratórias (PImáx) em três. A média ± DP da PImáx foi 89,4±29,5; PEmáx, 88±37,7. Conclusão: Observaram-se alterações leves nos testes de função pulmonar anos após o tratamento do osteossarcoma

Introducción: La quimioterapia utilizada en osteosarcoma puede causar daño a los pulmones. Los objetivos de este trabajo fueron analizar los volúmenes y capacidades pulmonares y la fuerza respiratoria en pacientes tratados para osteosarcoma, en una serie prospectiva de casos, en un hospital de oncología pediátrica, mediante el análisis de espirometría, oscilometría de impulsos y manuvacuometría. Relato de caso: En 21 pacientes, la mediana de edad al diagnóstico fue de 15 años y en la inclusión de 30 años. La supervivência media libre de enfermedad fue de diez años. Hubo alteraciones en los exámenes en 14 pacientes (66,6%), con alteraciones obstructivas leves en la espirometría en tres (14,3%), y obstrucción en la oscilometría en siete (33,3%). En espirometría, las medias ± desviación estándar (DE) de la capacidad vital forzada (CVF) fueron 91,9%±12,2; para el volumen espiratorio forzado en el primer segundo (VEF1) fue 87,4%±12,2 y el cociente VEF1/CVF fue 95,4%±7,9. En oscilometría, los valores medios ± DE para la resistencia a 5 Hz fueron 126,2%±36,2; para resistencia a 20 Hz, 128,4%±32,4; reactancia a 5 Hz, -0,75±0,68 kPa/L/s; para la frecuencia de resonancia, 15,6±4,2 Hz. En manuvacuometría, nueve pacientes (42,8%) mostraron una reducción de las presiones: las presiones espiratorias máximas (PEmáx) se redujeron en ocho pacientes y las presiones inspiratorias (PImáx) en tres. La media ± DE del PImáx fue 89,4 ± 29,5; PEmáx, 88±37,7. Conclusión: Se observaron ligeros cambios en las pruebas de función pulmonar años después del tratamiento del osteosarcoma