title: [Critically ill pediatric hemato-oncology patient: What we do is what we should do?].
abstract: OBJECTIVE
  Primary objective, to describe the management and monitorization of critically ill pediatric hemato-oncology patient (CIPHO) in the Spanish pediatric intensive care units (PICU). Secondary objective, through a literature review, to identify possible areas of improvement.
  
  
  METHODS
  Observational transversal descriptive study. An anonymous web-based survey was sent to 324 Spanish pediatric intensivists from April 2011 to May 2011. None of them were pediatric residents.
  
  
  RESULTS
  The survey was answered by 105 intensivists, 59/105 always agreed their treatment with the oncologist. In case of hemodynamic instability, non-invasive blood pressure monitoring is always done by 85/105 and almost always optimized by intra-arterial measuring (85/105) and central venous pressure (70/105). If respiratory failure the use of non-invasive ventilation (NIPPV) is always (36/105) or frequently (60/105) established prior to conventional mechanical ventilation. To replace or withdraw non-invasive ventilation only 44/96 of the respondents to this question use a clinical protocol. Before the instauration of conventional mechanical ventilation the oncological prognosis is considered by 72/105. In case of acute oliguric renal failure the renal replacement techniques are widely used (74/105). The withdrawal of sustaining life support is frequently discussed (75/103) and agreed with the oncologist (91/103) and caregivers (81/103).
  
  
  CONCLUSIONS
  In our study, despite there is not a defined standard-of-care, the respondents showed similar therapeutics and monitorization choices. The use of NIPPV as first respiratory assistance is extended. Prospective, observational and multicenter studies should be developed to establish the results of this management in this population.
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España. Electronic address: citopensis@yahoo.es.
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Salido
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Nieto-Moro
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Iglesias-Bouzas
authors.affiliation: Unidad de Trasplante de progenitores hematopoyéticos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
authors.forename: Marta
authors.initials: M
authors.lastname: González-Vicent
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Serrano-González
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
authors.forename: Juan
authors.initials: J
authors.lastname: Casado-Flores
mesh_terms: D002648:Child; D003422:Critical Care; D016638:Critical Illness; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D008495:Medical Oncology; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement
keywords: Critical care; Cuidados intensivos; Cuidados paliativos; Encuesta sanitaria; Health care survey; Medical oncology; Oncología médica; Palliative Care; Pediatrics; Pediatría