INTRODUCTION
Pediatric cancer patients admitted to a pediatric intensive care unit (PICU) form a unique patient population with specific critical care needs due to their underlying malignancy and treatment-related toxicities. Development of intensified and new treatment protocols have revolutionized oncology in the past decade and pediatric 5-year all-cancer survival currently stands at almost 80%.1These treatment protocols are however, associated with severe side effects. Infections and treatment-related toxicity conditions are leading causes for of mortality and morbidity in cancer patients that require treatment in the intensive care unit and 2% to 28% of the pediatric cancer patients have been shown to require admission to the PICU during their disease course.2-8
As cancer therapies improve and options evolve rapidly the knowledge, prompt recognition, and management of potentially life-threatening disease- and treatment-related complications is of utmost importance and requires close collaboration between the oncologists and PICU physicians. It has been shown in adult cancer patients that differences in ICU structure, organization, and collaboration between oncologists and the ICU team affects the quality of care and patient outcomes.9-11 The presence of clinical pharmacist in the ICU, presence of ICU protocols, and daily meetings between oncologists and intensivists were associated with lower hospital mortality even after adjustment for volume of exposure.11 In addition, implementation of protocols and daily meetings between ICU physicians and oncologists were also associated with more efficient ICU resource utilization. So far, no studies have addressed the organizational aspects of critical care for children with cancer. Comprehensive information on the organization of pediatric onco-critical care and the differences between PICUs is needed to further study the effects on outcomes, to harmonize care across units and to design future multicenter studies. To address these knowledge gaps, we aimed to describe the structure, organization, and delivery of critical care to children with cancer in Europe.