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.