Recent advances in supportive care and progress in the development and use of
chemotherapy have considerably improved the prognosis of many children with
malignancy, thus the need for
intensive care admission and management is increasing, reaching about 40% of patients throughout the disease course.
Cancer remains a major death cause in children, though outcomes have considerably improved over the past decades. Prediction of outcome for children with
cancer in Pediatric Intensive Care Unit (PICU) obviously requires clinical guidelines, and these are not well defined, as well as admission criteria. Major determinants of negative outcomes remain
severe sepsis/
septic shock association and
respiratory failure, deserving specific approach in children with
cancer, particularly those receiving a
bone marrow transplantation. A nationwide consensus should be achieved among pediatric intensivists and oncologists regarding the threshold clinical conditions requiring Intensive Care Unit (ICU) admission as well as specific
critical care protocols. As demonstrated for the
critically ill non-oncologic child, it appears unreasonable that pediatric patients with
malignancy can be admitted to an adult Intensive Care Unit ICU. On a national basis a pool of refecence institutions should be identified and early referral to an oncologic PICU is warranted.