Organizational Characteristics of European Pediatric Onco-Critical Care:
An International Cross-Sectional Survey.
Abstract
Background: Intensified treatment protocols have improved
survival of pediatric oncology patients. However, these treatment
protocols are associated with increased treatment-related morbidity
requiring admission to pediatric intensive care unit (PICU). We aimed to
describe the organizational characteristics and processes of care for
this patient group across PICUs in Europe. Methods: A web-based
survey was sent to PICU directors or representative physicians between
February and June 2021. Results: Responses were obtained from
77 PICUs of 12 European countries. Organizational characteristics were
similar across the different countries of Europe. The median number of
PICU beds was 12 (IQR 8-16). The majority of the PICUs was staffed by
pediatric intensivists and had a 24/7 intensivist coverage. Most PICUs
had a nurse-to-patient ratio of 1:1 or 1:2. The median numbers of yearly
planned and unplanned PICU admissions of pediatric cancer patients were
20 (IQR 10-45) and 10 (IQR 10-30, respectively. Oncology specific
practices within PICU were less common in participating centres. This
included implementation of oncology protocols in PICU (30%), daily
rounds of PICU physicians on the wards (13%), joint mortality and
morbidity meetings or complex patients’ discussions (30% and 40%,
respectively) and participation of parents during clinical rounds
(40%). Conclusion: Our survey provides an overview on the
delivery of critical care for oncology patients in PICU across European
countries. Multidisciplinary care for these vulnerable and challenging
patients remains complex and challenging. Future studies need to
determine the effects of differences in PICU organization and processes
of care on patients’ outcome.