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.

Background: Children with neuromuscular diseases (NMDs) often display altered vital functions mainly respiratory muscle weakness which increase the risk of postoperative pulmonary complications after general anesthesia or sedation. Non-invasive ventilation (NIV) associated with cough assistance can successfully reduce these complications. The aim of this study was to report our experience with a peri-operative protocol that consists in using NIV combined with mechanical insufflation-exsufflation (MI-E) to improve the postoperative outcome of children with NMD. Methods: To this end, we conducted a multicenter, observational study on consecutive pediatric patients with NMDs undergoing anesthesia or sedation for surgical and diagnostic procedures from December 2015 to December 2018 in 13 Italian hospitals. Results: We found that 89% of the 167 children included in the study (mean age 8 y), were at risk of respiratory complications, due to the presence of at least one respiratory risk factor. In particular, 51% of them had preoperative technology dependence, while 25% displayed severe dysphagia. Average hospital length of stay (LOS) was 12 (±17) days. Despite the complexity of these children, only 26 patients developed intraoperative surgical complications, whereas 14 developed postoperative respiratory complications. No patient needed tracheostomy. The occurrence of long-term mechanical ventilation (MV), severe scoliosis or dysphagia in the preoperative period and the use of cough assistance or invasive MV (IMV) longer than 24 h in the postoperative period were all associated with prolonged hospital LOS. Conclusion: A carefully planned, multidisciplinary approach for the perioperative management of pediatric NMD patients can help prevent and resolve postoperative complications.