Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: experience in a pediatric intensive care unit

The objective of the current study is to compare the use of a nasal continuous positive airway pressure (nCPAP) to a high-flow humidified nasal cannula (HFNC) in infants with acute bronchiolitis, who were admitted to a pediatric intensive care unit (PICU) during two consecutive seasons. We retrospectively reviewed the medical records of all infants admitted to a PICU at a tertiary care French hospital during the bronchiolitis seasons of 2010/11 and 2011/12. Infants admitted to the PICU, who required noninvasive respiratory support, were included. The first noninvasive respiratory support modality was nCPAP during the 2010/11 season, while HFNC was used during the 2011/2012 season. We compared the length of stay (LOS) in the PICU; the daily measure of PCO₂ and pH; and the mean of the five higher values of heart rate (HR), respiratory rate (RR), FiO_2, and SpO₂ each day, during the first 5 days. Thirty-four children met the inclusion criteria: 19 during the first period (nCPAP group) and 15 during the second period (HFNC group). Parameters such as LOS in PICU and oxygenation were similar in the two groups. Oxygen weaning occurred during the same time for the two groups. There were no differences between the two groups for RR, HR, FiO_2, and CO₂ evolution. HFNC therapy failed in three patients, two of whom required invasive mechanical ventilation, versus one in the nCPAP group. Conclusion: We did not find a difference between HFNC and nCPAP in the management of severe bronchiolitis in our PICU. Larger prospective studies are required to confirm these findings.     

中国25家儿科重症监护病房主要配置及住院状况调查分析

目的 调查中国儿科重症监护病房（PICU）的基本配置及住院患儿状况。方法 应用问卷调查中国25家PICU的基本配置，应用儿童危重病例评分和美国PICU出入院指南，对2004年1月1日至2005年6月30日各PICU 29 d至14周岁住院患儿均进行为期12个月的危重病例筛选。结果 中国25家PICU平均床位数（11.4±8.0）张，呼吸机数（6.1±3.7）台，44.0%（11/25）的PICU能进行中心静脉压监测。收治病例12 018例，危重病例60.5％（7 269/12 018）。危重病例中内科疾病占769%（5 590/7 269），外科疾病占16.8%（1 233/7 269），其他科室疾病占6.3%（456/ 7 269）；平均住院日6.3 d；肺炎41.4%（3 013/7 269），脓毒症95%（688/7 269），外伤5.5%（397/7 269），呼吸衰竭27.6%（2 009/7 269）； 行机械通气26.9 %（1 957/7 269），行机械通气>24 h 17.9%（1 300/7 269），ARDS 1.44%（105/7 269）。研究期间，危重病例中病死率为6.7%（485/7 269，95% CI:6.1%～7.3%），PICU中病死率为40%（485/12 018，95% CI:3.7%～4.4%）。主要疾病病死率为1.3%～61.0%，不同PICU间收治患儿及病死率均存在差异。结论 中国PICU配置仍处于初级水平，收治患儿标准及危重患儿病死率可能存在差异。     

有创机械通气重症肺炎患儿的临床特征及死亡危险因素分析

目的 探讨有创机械通气重症肺炎患儿的临床特征及死亡患儿的危险因素.方法 采用回顾性研究,收集2011年1月至2014年12月因需有创机械通气入住天津市儿童医院PICU的重症肺炎患儿资料,分析其年龄分布、病原学特点、机械通气情况、并发症及基础疾病情况,对死亡相关因素进行单因素分析及多因素分析.结果 共214例患儿符合标准纳入研究,其中男134例,女80例,总病死率6.17%.病原学检出率16.36%.死亡组患儿中位年龄大于生存组(4个月比2个月,P=0.039),年龄超过1岁患儿所占比例更高(21.43%比15.8%,P<0.001).脑病和电解质紊乱是有创机械通气重症肺炎患儿常见并发症,构成比分别为11.68%和8.41%.贫血、心脏病、呼吸系统发育异常位列基础疾病前3位(29.91%、14.49%、9.35%).Logistic多元回归分析显示,患儿发病年龄大于1岁(OR值1.019,95%CI 1.003~1.030,P=0.019),合并急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)(OR值7.254,95%CI 1.581~33.277,P=0.011),患有心脏病(OR值0.47,95%CI 0.273~0.810,P=0.007)是有创机械通气重症肺炎患儿死亡的危险因素. 结论 在救治需有创通气重症肺炎患儿时,对于年龄大于1岁、合并ARDS或患有心脏病的患儿要加强监护,积极治疗原发病,防治ARDS,必要时可行心脏手术以改善预后,降低需有创通气重症肺炎患儿的病死率.     

Initiation of home mechanical ventilation in children with neuromuscular diseases

OBJECTIVE: To determine how often home mechanical ventilation (HMV) is instituted electively in children with respiratory failure from neuromuscular diseases and whether there were opportunities to discuss therapeutic options with patients/families before respiratory failure. METHODS: Patients with neuromuscular disease (n = 73) requiring HMV (age, 2 months to 24 years) were studied. Whether HMV was initiated nonelectively because of acute respiratory failure or electively before acute respiratory failure, and opportunities for health care providers to discuss therapeutic options with patients/families before acute respiratory failure (hospitalization with pneumonia, clinic visits for preoperative evaluation, pulmonary function testing [PFT] and/or polysomnography [PSG]) were recorded. RESULTS: HMV was initiated electively in 21% of patients with neuromuscular disease; 69% of the nonelective HMV group had HMV initiated after respiratory failure caused by pneumonia. In the nonelective group, opportunities for discussion of therapeutic options with the patients and families could have occurred before respiratory failure during 111 hospitalizations for pneumonia, 13 preoperative evaluations, 43 abnormal PFTs, and 24 abnormal PSGs. CONCLUSIONS: Most patients with neuromuscular disease had HMV initiated nonelectively after acute respiratory failure caused by pneumonia. Opportunities for discussing the therapeutic options with patients and families before respiratory failure were missed or ineffective.     

Mechanical ventilation in children

OBJECTIVE: To make a brief review about mechanical ventilation in Pediatrics.METHODS: Review of the classification of types of mechanical ventilation, characteristics of pression and flow waves and indications for its installation. In a sequential way we discuss the various modes of ventilation (control ventilation, assisted-control ventilation, assisted ventilation, intermittent mandatory ventilation, synchronized intermittent mandatory ventilation, pressure-support ventilation) showing some advantages and disadvantages of using these modes. RESULTS: General rules for mechanical ventilation are presented, considering some specific pathologies in Pediatrics (acute respiratory distress syndrome, bronchopleural fistulae, cranial trauma, cardiac failure, neuromuscular pathology, acute asthma and in patients with acute descompensation of a cronic respiratory failure). CONCLUSIONS: Some limitations of mechanical ventilation and the possible advances in a short period are presented.     

Neurofibromatosis associated with central alveolar hypoventilation syndrome during sleep

We describe polygraphic respiratory alterations during sleep in a child with neurofibromatosis. The patient, a four-year-old boy, had a medical history of neurofibromatosis and recurrent acute respiratory failure responsive to mechanical ventilation. All-night polysomnography showed severe nocturnal hypoventilation with marked hypercapnia (TcPaCO₂ 70 mmHg) and hypoxemia (SaO₂ less than 40%). Nocturnal hypoxemia and hypercapnia and depressed response to the hyperoxic hypercapnic test confirmed the diagnosis of central hypoventilation syndrome. Cerebral magnetic resonance imaging disclosed lucent areas in the globus pallidus, mesencephalus and left upper pons. Therapy with nocturnal nasal positive bilevel ventilation reversed nocturnal hypoxemia and hypercapnia. This study suggests that patients with neurofibromatosis should be investigated for concomitant severe hypoventilation, particularly when clinical symptoms suggest brain stem lesions.     

Mechanical ventilation in pediatrics (III). Weaning, complications and other types of ventilation. Noninvasive ventilation

Noninvasive ventilation (NIV), i.e. without tracheal intubation, has been reintroduced for the treatment of respiratory failure to reduce the complications of mechanical ventilation. Nowadays, NIV with positive pressure is the preferred method, applied through a mask held in place by a harness. Several masks can be used (nasal, bucconasal facial) and a variety of means can be used to keep them in place. Many respirators can be selected, ranging from those traditionally used in the intensive care unit(ICU) to specific NV respirators and conventional ICU respirators with specific software for NIV. Many respiratory modalities can be used according to the respirator (biphasic positive airway pressure [BIPAP], proportional assist ventilation, pressure support, synchronized intermittent mandatory ventilation [SIMV], etc.). NIV is mainly indicated in exacerbations of chronic respiratory failure: neuromuscular diseases, pretransplantation cystic fibrosis, and obstructive sleep apnea syndrome. It is also indicated in acute respiratory failure: pneumonia, status asthmaticus, and acute lung edema. The main contraindications are a weakened airway protection reflex(absent cough reflex) and hemodynamic instabiity. The advantages of NIV derive mainly from avoiding the complications associated with invasive ventilation. NIV also presents some disadvantages, especially the greater workload involved to ensure good patient adaptation to the respirator. The most common sequelae of NIV are skin lesions due to pressure on the nasal bridge.     

Noninvasive therapy with helium-oxygen for severe bronchiolitis

OBJECTIVE: To determine whether noninvasive therapy using a helium-oxygen mixture reduces the use of positive-pressure ventilation in the treatment of respiratory failure caused by severe bronchiolitis. STUDY DESIGN: This was a multicenter, randomized, double-blind, placebo-controlled trial that recruited infants in 4 pediatric intensive care units (PICUs). A total of 39 nonintubated infants with severe bronchiolitis caused by respiratory syncytial virus (RSV) were randomly assigned within 8 hours of PICU admission to receive a helium-oxygen mixture (helium group) or an air-oxygen mixture (control group) through an inflatable head hood. The primary study outcome was the requirement for positive pressure mechanical ventilation. Results were compared using Fisher's exact test. RESULTS: No differences were noted between the control and helium groups with respect to age (1.0 vs 1.1 months), prematurity, or family history of asthma or smoking. Positive pressure ventilation was judged necessary for 4 of the 21 (19.0%) infants in the control group and in 4 of the 18 (22.2%) in the helium group (relative risk = 1.17; 95% confidence interval = 0.34 to 4.01). CONCLUSIONS: This study did not detect any differences between the patients in the helium group and the control group with respect to the rate of positive-pressure ventilation.     

高频振荡机械通气在血液肿瘤及多种疾病并发儿童急性低氧性呼吸衰竭中的应用

目的 评估儿童急性低氧性呼吸衰竭（acute hypoxemic respiratory failure,AHRF）给予高频振荡机械通气（high-frequency oscillatory ventilation,HFOV）治疗的意义.方法 回顾2011年1月至2013年9月收入我院PICU诊断为AHRF的病例,首先给予常规机械通气（CMV）,当PIP＞ 30cmH2O（1 cmH2O =0.098 kPa）或PEEP＞ 10 cmH2O、FiO2100％时具有以下情况之一：（1）SpO2 ＜90％或PaO2 ＜60 mmHg（1 mmHg =0.133 kPa）;（2）有严重呼吸性酸中毒（PaCO2＞ 80mmHg）;（3）严重气漏（纵隔气肿或气胸）,改为HFOV通气治疗.收集患儿性别、年龄、住PICU时间、CMV通气时间、HFOV通气时间等一般资料.分别于CMV通气末（H0）及HFOV后2 h（H2）、6 h（H6）、12 h（H12）、24 h（H24）、48 h（H48）记录并比较各时间点呼吸机参数（平均气道压、振幅、频率、FiO2）、氧合指数（PaO2/FiO2、OI）、动脉血气、心率、血压变化.分别比较存活组与死亡组、血液肿瘤组及非血液肿瘤组在H0、H2、H6、H12、H24、H48时间点的指标变化.结果 HFOV通气后,H2时间点PaO2较H0升高[76.9（61.9～128.0） mm-Hg vs 50.1 （49.5 ～ 68.0） mmHg],差异有统计学意义（P=0.006）.H2、H48时间点PaO2/FiO2分别较Ho、H24升高,差异有统计学意义[94.9（66.8 ～ 138.9） mmHg vs 68.0（49.5 ～ 86.8）mmHg,P=0.039;135.0（77.6 ～240.0）mmHg vs 90.7（54.6 ～ 161.7） mmHg,P=0.023）].所有患儿收缩压、舒张压、心率在各时间点没有明显变化（P＞0.05）.存活组（n=9）与死亡组（n=14）相比,PaO2/FiO2、OI在H6、H12、H24、H48差异有统计学意义（P＜0.05）.非血液肿瘤组（n=10）与血液肿瘤组（n=13）相比,OI在H2、H6差异有统计学意义[19.2（13.9～26.6） vs 33.8（19.7 ～48.3）,P=0.049;16.0（8.4～27.1） vs28.9（20.9 ～38.9）,P=0.027）],两组的平均气道压在H2、H6、H12差异有统计学意义（P＜0.05）.两组病死率差异无统计学意义（40.0％ vs 76.9％,P=0.086）.结论     

Mechanical ventilatory support in preterm infants

A large proportion of premature infants presents with acute respiratory failure after birth and require mechanical ventilatory support. In addition to conventional mechanical ventilation, an increasing number of these infants are currently supported by newer modes including synchronized, volume targeted and noninvasive mechanical ventilation. While these new modes have improved weaning from mechanical ventilation they have not had a consistent impact on respiratory outcome or other morbidities. This is a review of the different modes of invasive and noninvasive mechanical ventilation used to support premature infants with respiratory failure.     

新生儿无创高频振荡通气的研究进展

在新生儿重症监护室,无创通气是治疗轻中度呼吸衰竭重要的呼吸管理技术,正确合理的应用可以有效避免有创呼吸机的使用及相应并发症的发生。近年研究发现,无创高频振荡通气(nHFOV)结合了经鼻持续气道正压通气(nCPAP)和高频通气(HFV)的优点,可以迅速改善氧合、有效清除二氧化碳,较好地改善呼吸衰竭,被认为是一类新型有效的无创通气模式。国际上对新生儿nHFOV技术的合理使用及有效性、安全性等进行了许多研究,取得了许多重要的经验和结果,该文就新生儿nHFOV的临床研究进展进行综述。     

Noninvasive ventilation in pediatric acute respiratory failure by means of a conventional volumetric ventilator

Background  

Acute respiratory failure (ARF) is one of the main causes for admission to pediatric intensive care unit (PICU). This study aimed to evaluate the feasibility and outcome of noninvasive ventilation (NIV) by a volumetric ventilator with a specific mode in pediatric acute respiratory failure.     

Influenza in pediatric intensive cure unit]

OBJECTIVES: The purpose was to identify clinical presentation leading to admission to PICU of children affected by influenza, to describe predisposing factors and outcome and to propose preventive measures. METHODS: Ten years (1989-1999) retrospective study carried out in the ten beds PICU. Every child in PICU with an influenza positive culture was enrolled. RESULTS: Twenty four cases collected, aged two weeks-15 years (m =43 months), 19 males. Acute respiratory failure (16/24 =67%) was the first manifestation: pneumonia (13), bronchiolitis (2), status asthmaticus (1). Eleven children had underlying diseases including five immunocompromized. Thirteen patients required mechanical ventilation (mean duration: 22 days), seven developed ARDS (4 immunocompromized) and three died. Central nervous system was the second system affected (8 cases). Four exhibited a chronical cerebral disease and five presented afebrile status epilepticus which required i.v. barbiturates and mechanical ventilation (mean duration: 22 hours). One presented encephalitis, one an apparent life-threatening event, both had a favorable outcome. One child exhibited severe hyperpyrexia and died from multiorgan failure. CONCLUSION: Severe forms of influenza are rare in children but may lead to life-threatening conditions and death(16.5%). Most occur in children with underlying disease, particularly immunocompromized who may exhibit ARDS.     

Randomized comparison of oxygen mask treatment vs. nasal continuous positive airway pressure in dengue shock syndrome with acute respiratory failure

Dengue hemorrhagic fever (DHF) is caused by dengue virus. Patients with DHF grade 3-4, termed Dengue Shock Syndrome (DSS), may develop acute respiratory failure after initial fluid resuscitation. Previously, these patients were treated with oxygen on a nasal cannula, or if necessary with tracheal intubation and mechanical ventilation. In the present prospective randomized study, we compared the effectiveness of oxygen treatment administered by a face mask vs. nasal continuous positive airway pressure (NCPAP). Morbidity, mortality, and supportive treatment was evaluated. Thirty-seven patients with DSS complicated by respiratory failure were enrolled. On admission and after 30 min of treatment, clinical and paraclinical data were obtained. Chest X-ray revealed pleural effusion in 92 per cent and showed interstitial oedema in 33 per cent. After 30 min of treatment the respiratory rate decreased significantly in the NCPAP group (p < 0.05), while SaO2 and PaO2 increased in both groups (p < 0.01). However, subsequently a significant difference of unresponsiveness to treatment between the oxygen mask group and the NCPAP group (13/19 vs. 4/18,p < 0.01) was noted. Complications of NCPAP or oxygen mask treatment were not documented. We conclude that NCPAP is useful in improving the management of acute respiratory failure in children with DHF/DSS in dengue-endemic areas.     

Noninvasive positive-pressure ventilation in children with lower airway obstruction.

STUDY OBJECTIVES: Mechanical ventilation of patients with severe lower airway obstruction presents significant risks; therefore, avoiding the intubation in these patients has been a principal goal of clinical management. Noninvasive positive-pressure ventilation has been shown to be effective in treating adults with chronic obstructive pulmonary disease, but its use has not been studied prospectively in children with acute obstructive lower airways disease. The objective of this study was to determine whether noninvasive mask ventilation improved respiratory function in children with asthma and other obstructive lower airways diseases. STUDY DESIGN: A prospective, randomized, crossover study. PATIENTS: A total of 20 children admitted to the pediatric intensive care unit with acute lower airway obstruction. METHODS: Children were randomized to receive either 2 hrs of noninvasive ventilation followed by crossover to 2 hrs of standard therapy or 2 hrs of standard therapy followed by 2 hrs of noninvasive ventilation. RESULTS: Using a Clinical Asthma Score, we found that noninvasive ventilation decreased signs of work of breathing such as respiratory rate, accessory muscle use, and dyspnea as compared with standard therapy. There was no serious morbidity associated with noninvasive ventilation. CONCLUSIONS: We conclude that noninvasive ventilation can be an effective treatment for children with acute lower airway obstruction.     

儿童急性呼吸窘迫综合征预后相关因素回顾性分析

目的 参照2015年儿童急性肺损伤共识会议(Pediatric acute lung injury consensus con-ference,PALICC)提出的儿童急性呼吸窘迫综合征(pediatric acute respiratory distress syndrome,pARDS)诊断标准,探讨影响pARDS预后的相关因素.方法 回顾性分析2009年1月至2015年12月首都医科大学附属北京儿童医院PICU收治的pARDS患儿的临床资料,共69例.结果 69例pARDS患儿中,轻度ARDS 13例,中度ARDS 19例,重度ARDS 37例.PICU内死亡17例(轻度2例,中度3例,重度12例;14例女性,3例男性).ARDS 患儿的临床结局与性别、慢性合并症差异有统计学意义(P<0.05),有慢性合并症ARDS患儿的病死率高达69.23%.多因素分析表明,机械通气时间与PICU住院日、总住院日有相关性(相关系数分别为:0.324、0.181,P<0.01);机械通气时间与患儿的入院体重有相关性(相关系数0.491,P<0.01),提示入院体重为保护性因素.结论 pARDS是PICU内患病率低、病死率高的危重症之一,纳入本研究的ARDS患儿病死率达24.64%.女性、有慢性合并症ARDS患儿的预后可能不佳.机械通气时间决定PICU住院日及总住院日,入院体重为机械通气时间的保护性因素.     

双水平正压通气和持续气道正压通气在早产儿呼吸窘迫综合征中应用的比较

目的：对患有新生儿呼吸窘迫综合征（RDS）的早产儿早期使用双水平正压通气（DuoPAP）和经鼻持续气道正压通气（NCPAP）模式在降低有创呼吸支持率和支气管肺发育不良（BPD）发生率方面进行比较分析。方法：该试验为单中心随机对照试验,将胎龄30~35 周患有RDS生后6 h内的早产儿随机分为早期使用DuoPAP组（n=34）和早期使用 NCPAP组（n=33）,若这两种方式不能维持则使用气管内插管、呼吸机辅助呼吸,肺表面活性物质作为急救药物。观察患儿生后24 h、48 h及72 h内的总插管有创呼吸支持率、支气管肺发育不良（BPD）发生率及使用无创呼吸支持后1、12、24、48、72 h 二氧化碳分压（PaCO2）、氧分压（PaO2）及氧合指数（OI）。结果：DuoPAP组48 h内、72 h内总插管有创呼吸支持率明显低于NCPAP组（P0.05）。DuoPAP组OI无创呼吸支持后1、12、24、48、72 h均高于NCPAP组（均P<0.05）。DuoPAP组PaCO2在无创呼吸支持后1、12、24 h明显小于NCPAP组（P<0.05）;DuoPAP组PaO2在无创呼吸支持后1、12 h 明显大于NCPAP组（P<0.05）。结论：早期使用DuoPAP与NCPAP相比,可明显降低RDS患儿插管有创呼吸支持率,值得推广。     

A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure

OUTCOMES: To compare the benefits of noninvasive ventilation (NIV) plus standard therapy vs. standard therapy alone in children with acute respiratory failure; assess method effectiveness in improving gas exchange and vital signs; and assess method safety. DESIGN: Prospective, randomized, controlled study. SITE: Two pediatric intensive care units in Santiago, Chile, at Clínica Santa María and Clínica Dávila, respectively. PATIENTS AND METHODS: Fifty patients with acute respiratory failure admitted to pediatric intensive care units were recruited; 25 patients were randomly allocated to noninvasive inspiratory positive airway pressure and expiratory positive airway pressure plus standard therapy (study group); the remaining 25 were given standard therapy (control group). Both groups were comparable in demographic terms. INTERVENTIONS AND MEASUREMENTS: The study group received NIV under inspiratory positive airway pressure ranging between 12 cm and 18 cm H2O and expiratory positive airway pressure between 6 cm and 12 cm H2O. Vital signs (cardiac and respiratory frequency), Po2, Pco2, pH, and Po2/Fio2 were recorded at the start and 1, 6, 12, 24, and 48 hrs into the study. RESULTS: Heart rate and respiratory rate improved significantly with NIV. Heart rate and respiratory rate were significantly lower after 1 hr of treatment compared with admission (p = 0.0009 and p = 0.004, respectively). The trend continued over time, heart rate being significantly lower than control after the first hour and heart rate after 6 hrs. With NIV, Po2/Fio2 improved significantly from the first hour. The endotracheal intubation was significantly lower (28%) in the NIV group than in the control group (60%; p = 0.045). CONCLUSIONS: NIV improves hypoxemia and the signs and symptoms of acute respiratory failure. NIV seems to afford these patients protection from endotracheal intubation.     

Mechanical ventilation in children

Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between January 2002-May 2005. Medical records of 407 patients were reviewed. Ninety-one patients (22.3%) were treated with mechanical ventilation. Ages of all patients were between 1-180 (median: 8) months. The mechanical ventilation time was 18.8 +/- 14.1 days. Indication of mechanical ventilation could be divided into four groups as respiratory failure (64.8%), cardiovascular failure (19.7%), central nervous system disease (9.8%) and safety airway (5.4%). Tracheostomy was performed in four patients. The complication ratio of mechanically ventilated children was 42.8%, and diversity of complications was as follows: 26.3% atelectasia, 17.5% ventilator-associated pneumonia, 13.1% pneumothorax, 5.4% bleeding, 4.3% tracheal edema, and 2.1% chronic lung disease. The mortality rate of mechanically ventilated patients was 58.3%, but the overall mortality rate in the PICU was 12.2%. In conclusion, there are few published epidemiological data on the follow-up results and mortality in infants and children who are mechanically ventilated.     

Oncology patients in a pediatric intensive care unit--a 7-year experience

BACKGROUND: As a result of improved therapeutic and diagnostic modalities the survival rate of children with neoplastic disease has increased dramatically. The consequences of these scientific advances have led to increased malignancy-related critical complications requiring the expertise of intensive care practitioners. PATIENTS: From all children admitted to the pediatric intensive care unit (PICU) of the Martin-Luther University Halle those with hematologic-oncologic condition were evaluated. RESULTS: From 4068 PICU admissions 196 (4.8%) oncologic patients were identified. Most of them were admitted for postoperative care, monitoring or intervention. 24 patients were admitted because of severe disease or treatment related complications. 14 out of 24 (58%) patients died on PICU. Mortality was significant higher in a subgroup requiring mechanical ventilation or suffering from sepsis. All patients but two with multi-organ system failure (> or = 2 organs) died. CONCLUSIONS: Children with neoplastic disease can benefit from pediatric intensive care unit (PICU) support. Successful treatment of life-threatening complications requires a close cooperation of pediatric oncology and PICU. Further studies are necessary to improve therapeutic strategies in oncology patients requiring PICU admission.