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Later&#44; through a short literature review&#44; a discussion about the questions obtained is done&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Transversal&#44; observational and descriptive study performed by a web-based survey &#40;GoogleDoc<span class="elsevierStyleSup">&#174;</span> formulary&#41; sent to the 324 Spanish pediatric intensivists registered in the Spanish Society of Pediatric Critical Care&#46; No pediatric residents were included in the study&#46; The survey&#44; detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; was anonymous&#46; It was sent to intensivists regardless of the complexity of their units and patients&#46; The intensivists were reminded of the survey every two weeks from April 2011 to May 2011&#46; In case of no answer the participant was not considered for the final analysis&#46; A descriptive analysis of the answers was performed using SPSS 16&#46;0 for Windows&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">The survey was answered by 105 intensivists &#40;32&#37; of surveyed&#41;&#46; In their opinion the treatment applied is always &#40;18&#37;&#41; or frequently &#40;78&#37;&#41; appropriate to CIPHOP complexity and prognosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Medical care team</span><p id="par0030" class="elsevierStylePara elsevierViewall">The treatment and care giving decisions are made in common&#44; if possible&#44; by the oncologist and intensivist &#40;56&#37;&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Hemodynamic monitoring</span><p id="par0035" class="elsevierStylePara elsevierViewall">Non-invasive blood pressure measurements are always used by 80&#37; of respondents&#46; It is associated with intra-arterial blood pressure measurements &#40;always by 85&#47;105&#41; or central venous pressure &#40;CVP&#59; always by 70&#47;105 and frequently by 30&#47;105&#41;&#46; The transpulmonar peripheric arterial thermodilution &#40;PICCO<span class="elsevierStyleSup">&#174;</span>&#41; is never or rarely applied&#46; The mixed venous oxygen saturation is always used by 24&#47;86 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Respiratory management</span><p id="par0040" class="elsevierStylePara elsevierViewall">In case of respiratory failure or hypoxemia the non-invasive pressure support ventilation &#40;NIPPV&#41; is always &#40;36&#47;105&#41; or frequently &#40;60&#47;105&#41; used as first respiratory assistance &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Standardized protocols to replace or withdraw NIPPV are only used by 48&#37; of the respondents &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Before the initiation of conventional mechanical ventilation &#40;MV&#41; the patient prognosis is considered by 69&#37; of respondents &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; 72&#47;105&#41;&#46; In case of no improvement and&#47;or hypoxemia the prone position &#40;PP&#41; is always used by 29&#47;102&#46; High oscillatory frequency ventilation &#40;HOFV&#41; is always applied if refractory hypoxemia despite MV or PP by 19&#47;105 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Pulmonary surfactant is used frequently by 10&#37; of respondents &#40;11&#47;105&#41;&#46; Inhaled nitric oxide is applied frequently &#40;60&#37;&#44; 63&#47;102&#41; as therapy in case of refractory hipoxemia&#46; The extracorporeal membrane oxygenation &#40;ECMO&#41; is used when necessary by 7&#47;105 of intensivists &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Renal management</span><p id="par0050" class="elsevierStylePara elsevierViewall">In cases of oliguric acute kidney injury &#40;AKI&#41; the continuous renal replacement therapy &#40;CRRT&#41; is used by 97&#37; of respondents if no response to diuretic bolus or continuous infusion &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Status epilepticus</span><p id="par0055" class="elsevierStylePara elsevierViewall">Status epilepticus is considered as a cause of PICU incoming by 102&#47;105 of the respondent intensivists &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">End-of-life decisions and care</span><p id="par0060" class="elsevierStylePara elsevierViewall">In case of very bad prognosis the withdrawal of life-sustaining medical therapies is frequently discussed &#40;63&#47;102&#44; 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almost all of the respondents considered their management adequate to the CIPHOP complexity and prognosis&#46; Also&#44; despite there not being a defined standard-of-care about the management of critically ill pediatric hemato-oncology patient&#44; the respondents showed similar therapeutics choices to the different clinical situations examined&#46; The procedures and therapeutic decisions appear to be similar to those taken in other critically ill children and end-of-life decisions are frequently decided in common by the intensivist and oncologist&#44; in order to achieve adequate therapy for the children&#39;s requirements&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Answers discussion</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Medical care team</span><p id="par0070" class="elsevierStylePara elsevierViewall">We have seen that 19&#37; of respondents have not integrated the collaboration with the oncology specialist in their clinical activity despite it being recognized as essential in CIPHOP treatment&#46; It clearly helps to reduce inadequate decisions and supposes a corner stone in case of CIPHOP&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> The medical care team involved must be sensitive to individual requirements and&#44; if it is possible&#44; incorporate an interdisciplinary vision in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Hemodynamic monitoring</span><p id="par0075" class="elsevierStylePara elsevierViewall">In our study the use of invasive hemodynamic measures in CIPHOP appears to be always done if indicated or necessary&#46; As we have seen the measurement of arterial pressure&#44; invasive or not&#44; and CVP are globally included in CIPHOP management to the respondent&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> In case of the CVP maybe the requirement of a central venous line to apply the chemotherapeutics agents usually help to easily measure it&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The optimal mean arterial pressure &#40;MAP&#41; is uncertain and depends on patient characteristic and disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;10</span></a> Non-invasive blood pressure may be inaccurate and repeated mean pressure assessments are needed to optimize the hemodynamic treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;11</span></a> In our study non-invasive monitorization is almost always the first measurement done to the CIPHOP later substituted by invasive methods if necessary&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The use of transpulmonar peripheric arterial thermodilution is considered by only 20&#37; of respondents&#46; Its use is feasible and seems safe in these children&#46; The parameters derived from this monitorization could add clinically important information to asses the volume load in order to take adequate decisions about inotropic drugs or fluid therapy&#46; Its low application could be associated with &#40;1&#41; low availability of this technology in the Spanish PICUs and &#40;2&#41; lack of experience and data to its interpretation&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally in our study almost 40&#37; of intensivists did not monitor mixed venous oxygen saturation usually&#46; The maintenance of an optimal tissue oxygenation is an important task&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> There are many variables which are measured for this purpose&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Nowadays the usefulness and interest to achieve an adequate monitoring of mixed venous oxygen saturation as an index of tissue oxygen delivery is clear<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> and its application should be standardized in CIPHOP always if is indicated and possible&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Respiratory management</span><p id="par0095" class="elsevierStylePara elsevierViewall">There are no prospective studies which confirm the NIPPV efficacy in immunocompromised children or CIPHOP&#46; It seems that it could be applied without complications&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> The NIPPV is feasible and well tolerated<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> and it could avoid intubation in almost half of the patients&#46; It use is extended in the Spanish PICUs and has been applied by 96&#47;105 of respondents as first respiratory assistance&#46; The NIPPV should be initiated early&#44; the clinical characteristics and severity scores between respondents and non respondents do not have clear differences&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Despite the frequent use of NIPPV&#44; 50&#37; of participants did not apply a standardized protocol for its withdrawal or replacement&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In case of severe respiratory distress the conventional mechanical ventilation is indicated in the CIPHOP management&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> The acute respiratory distress syndrome &#40;ARDS&#41; is a common diagnosis among CIPHOP<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">18&#44;19</span></a> and usually evolves to a life threatening refractory hypoxemia&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> The ARDS is associated with significant risk of mortality despite the improvement over time in the general outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> Almost 60&#37; of children treated with hematopoietic stem cell transplantation &#40;HSCT&#41; develop ARDS related to the treatment itself or bacterial&#44; viral or fungal infections&#46; It is also a common phenomenon in non-HSCT oncology patients&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Several techniques are available to improve oxygenation in hypoxemic CIPHOP&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> The choice of MV strategy can significantly influence the course of lung injury&#44; so the volutrauma and atelectrauma must be avoided by an adequate protective lung strategy&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;22</span></a> Avoid a dynamic hyperinflation applying low tidal volume by predicted body weight &#40;6<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#41; should be used as the only strategy that consistently improved outcome in ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#44;24</span></a> The positive end expiratory pressure &#40;PEEP&#41; should be used judiciously to maintain lung recruitment&#44; prevent pulmonary atelectasis and facilitate synchrony in spontaneously breathing patients&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Nowadays there is insufficient evidence to routinely recommend the use of HFVO&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> prone positioning&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> instilated surfactant or inhaled nitric oxide&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The HOFV is applied by 81&#37; of respondents&#44; 4&#37; of them choose HFVO as first therapeutic option in selected patients&#46; The HFOV generally improves the ratio of partial pressure of oxygen to inspired fraction on oxygen &#40;PO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41; and might improve survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#44;27</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The role of prone position &#40;PP&#41; is not clear with controversial results in prospective studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;28</span></a> Several mechanisms can explain it benefits<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> such an improving recruitment and more homogeneously distributing alveolar inflation&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> Prone position also influences the synthesis of some proinflammatory cytokines such IL-6 so it could have not only local effects&#46; The prone position is a common therapy option of the intensivists in the study in case of hypoxemic respiratory failure with no response to MV&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The use of instilated surfactant is promising<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> related to the extensive biochemical and biophysical changes of the pulmonary surfactant system in case of ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">21&#44;31</span></a> This therapy is frequently applied by only 10&#37; of those surveyed and it may be considered in children with direct lung injury&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> The optimum dosage and timing of administration are not clear&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> Tamburro et al&#46; suggested it potentials benefits establishing the bases to future clinical trials&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> About inhaled nitric oxide its use is extensive by the respondents &#40;73&#37;&#41; to achieve pulmonary vasodilatation and better oxygenation&#46; There is no evidence that its use should be protocolized and it must be based on individual characteristics&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In relation to the use of ECMO there is a lack of data to clearly support its use in CIPHOP&#59; it should be used in case of clinical features that suggest a reasonable indication&#46; It has been recommended for severe ARDS because it avoids lung overdistension and the use of high oxygen concentrations&#46; Its use in Spain is restricted to a short number of units&#46; ECMO could be a therapy that may be appropriate for CIPHOP&#46; It is necessary to have adequate entry criteria and treatment protocol in order to collect data from such experiences to advance the standard of care&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Renal management</span><p id="par0135" class="elsevierStylePara elsevierViewall">The acute kidney injury produces a high additional mortality and morbidity&#46; An aggressive therapy is necessary mainly directed to achieve an adequate kidney perfusion and&#44; as a consequence&#44; the diuresis normalization&#46; The use of diuretics by bolus or perfusion is usually the first therapy option&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In our survey the continuous renal replacement therapy &#40;CRRT&#41; is frequently applied by the respondents&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> In case of CIPHOP it could also be applied to treat fluid overload or as curative therapy for a great variety of disorders and multiorgan dysfunction &#40;attenuate inflammation and improved oxygenation in mechanically ventilated children&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">33&#44;34</span></a> The intensity is not yet well defined but it is known that high-dose CRRT in AKI does not improve patient survival or recovery function&#46; Related to this&#44; recently Rajasekaran et al&#46; described in a retrospective study that CRRT is not associated with long-term survival in pediatric with HSCT&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Status epilepticus</span><p id="par0145" class="elsevierStylePara elsevierViewall">Almost all the respondents consider as a cause of PICU income the presence of status epilepticus&#46; In case of CIPHOP the seizures could be derived from the oncological disease&#44; the radiotherapy or chemotherapy treatment and the infections&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> In our survey there were no questions about the pharmacological treatment&#46; Actually some novel pharmacological agents such as levetiracetam are recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">36&#44;37</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">End-of-life decisions</span><p id="par0150" class="elsevierStylePara elsevierViewall">It is known that the majority of deaths in PICU require discussions or decisions about when or how to limit support by withdrawal of life-sustaining medical therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;38</span></a> This situation is frequently common in case of CIPHOP&#46; The work in a children&#39;s hospital is focused on treatments aimed toward cure&#46; Death is often seen as a failure&#44; and it may not be discussed or acknowledged as a possibility until very late in a child&#39;s stay in hospital&#46; About the care of dying child or about end-of-life decisions in children there is no right model of care moreover that pain and symptom management must be intensified to achieve an adequate quality of life&#46; It appears clear that open discussions about treatment discontinuation are necessary in order to generate better interventions&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;39</span></a> Understandable information to the parents about child health status influences their ability to participate in end of life decisions&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> Both things&#44; collaborative work and family participation&#44; are well considered and applied by the intensivist consulted&#46; Those who refer an absence of the oncology in case of death are probably related to not having an on-call oncologist in their hospital&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">There are several limitations to our study&#46; It was conceived as an observational transversal study so the results are influenced by the number of respondents&#46; Besides&#44; based on the answers and in the survey characteristics&#44; it was only possible to make a descriptive analysis&#46; Also our survey was not standardized&#44; because there are no similar previous studies or papers&#46; Related to the study designs there are multiple confusion factors that were impossible to discard &#40;critical care unit complexity or number of CIPHOP admissions per year and cause of them for example&#41;&#46; The anonymous design&#44; with no questions about the PICU characteristic of each participant&#44; influenced the answers and the results should be related with a personal perception of how these patients should be treated instead of how they are really treated&#46; Future observational and prospective studies should be performed to describe PICU treatment in pediatric oncological patients to acquire knowledge about what is really done and&#44; if necessary&#44; set new or different therapies&#46;</p></span></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">Despite there not being a standard-of-care&#44; Spanish intensivists showed an elevated concordance about the therapeutic decisions taken in case of critically ill pediatric hemato-oncology patient&#46; Related to this&#44; the use of NIPPV as first respiratory assistance is extended&#46; The results of this survey do not establish new treatment criteria or protocols&#44; but it could be used as a base to know the global management of CIPHOP in order to develop future studies and consensus&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest to report&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Primary objective&#44; to describe the management and monitorization of critically ill pediatric hemato-oncology patient &#40;CIPHO&#41; in the Spanish pediatric intensive care units &#40;PICU&#41;&#46; Secondary objective&#44; through a literature review&#44; to identify possible areas of improvement&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational transversal descriptive study&#46; An anonymous web-based survey was sent to 324 Spanish pediatric intensivists from April 2011 to May 2011&#46; None of them were pediatric residents&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The survey was answered by 105 intensivists&#44; 59&#47;105 always agreed on their treatment with the oncologist&#46; In case of hemodynamic instability&#44; non-invasive blood pressure monitoring is always done by 85&#47;105 and almost always optimized by intra-arterial measuring &#40;85&#47;105&#41; and central venous pressure &#40;70&#47;105&#41;&#46; If respiratory failure the use of non-invasive ventilation &#40;NIPPV&#41; is always &#40;36&#47;105&#41; or frequently &#40;60&#47;105&#41; established prior to conventional mechanical ventilation&#46; To replace or withdraw non-invasive ventilation only 44&#47;96 of the respondents to this question use a clinical protocol&#46; Before the instauration of conventional mechanical ventilation the oncological prognosis is considered by 72&#47;105&#46; In case of acute oliguric renal failure the renal replacement techniques are widely used &#40;74&#47;105&#41;&#46; The withdrawal of sustaining life support is frequently discussed &#40;75&#47;103&#41; and agreed with the oncologist &#40;91&#47;103&#41; and caregivers &#40;81&#47;103&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our study&#44; despite there not being a defined standard-of-care&#44; the respondents showed similar therapeutic and monitorization choices&#46; The use of NIPPV as first respiratory assistance is extended&#46; Prospective&#44; observational and multicenter studies should be developed to establish the results of this management in this population&#46;</p></span>"
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            "titulo" => "Material and methods"
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          2 => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Objetivo primario&#44; definir el tratamiento y la monitorizaci&#243;n del ni&#241;o cr&#237;tico con enfermedad hemato-oncol&#243;gica en las unidades de cuidados intensivos espa&#241;olas&#46; El objetivo secundario fue&#44; tras una revisi&#243;n de la literatura&#44; contextualizar el enfoque obtenido y detectar posibles puntos de mejora&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; descriptivo y transversal&#46; Se envi&#243; en el periodo abril del 2011-mayo del 2011 una encuesta online a 324 intensivistas y adjuntos de pediatr&#237;a registrados en la Sociedad Espa&#241;ola de Cuidados Intensivos Pedi&#225;tricos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se obtienen 105 respuestas globales&#44; 59&#47;105 indicaron acordar el tratamiento con el onc&#243;logo&#46; Ante hipotensi&#243;n&#44; taquicardia y requerimiento de inotr&#243;picos&#44; 85&#47;105 realizan siempre monitorizaci&#243;n no invasiva de presi&#243;n arterial asociando adem&#225;s medici&#243;n intraarterial &#40;85&#47;105&#41; y casi siempre presi&#243;n venosa central &#40;70&#47;105&#41;&#46; Ante dificultad respiratoria&#44; se instaura siempre &#40;36&#47;105&#41; o frecuentemente &#40;60&#47;105&#41; ventilaci&#243;n no invasiva&#46; De forma previa a iniciar ventilaci&#243;n mec&#225;nica convencional&#44; 72&#47;105 consideran el pron&#243;stico global del paciente&#46; Ante fallo renal agudo olig&#250;rico&#44; las t&#233;cnicas de depuraci&#243;n extrarrenal son ampliamente utilizadas &#40;74&#47;105&#41;&#46; En caso de mal pron&#243;stico&#44; la adecuaci&#243;n del tratamiento es considerada de forma frecuente &#40;75&#47;103&#41; y conjunta con el onc&#243;logo &#40;91&#47;103&#41; y la familia &#40;81&#47;103&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se observa gran similitud en las respuestas a pesar de que el manejo de este tipo de pacientes no est&#225; estandarizado&#46; En caso de dificultad respiratoria&#44; el uso de ventilaci&#243;n no invasiva como primera asistencia est&#225; ampliamente extendido&#46; El desarrollo de futuros estudios observacionales prospectivos y multic&#233;ntricos permitir&#237;a conocer los resultados derivados de este enfoque&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a-Salido A&#44; Nieto-Moro M&#44; Iglesias-Bouzas MI&#44; Gonz&#225;lez-Vicent M&#44; Serrano-Gonz&#225;lez A&#44; Casado-Flores J&#46; Paciente cr&#243;nico oncohematol&#243;gico&#44; &#191;hacemos lo que deber&#237;amos hacer&#63; An Pediatr &#40;Barc&#41;&#46; 2016&#59;85&#58;61&#8211;69&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">If respiratory failure or hypoxemia is NIPPV the first step of assistance&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Do you use HFOV if refractory hypoxemia and&#47;or hypoventilation to conventional mechanical ventilation&#63; &#40;b&#41; Respiratory management if refractory hypoxemia or hypoventilation to conventional mechanical ventilation&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">End-of-life decisions&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; If the patient died in PICU is he&#47;she accompanied by an oncologist&#63; &#40;b&#41; Is there an oncologist on-call in your hospital&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; For inpatient from hematological stem cell transplantation or onco-hematology units&#44; is the medical treatment always decided in common by the oncologist and intensivist&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; Do you think that treatment to these patients is always appropriate to its complexity and prognosis&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; What kind of monitoring is applied to critically ill pediatric hemato-oncology patient with hemodynamic instability and inotropic requirements&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; To treat respiratory failure or hypoxemia is non-invasive positive pressure ventilation &#40;NIPPV&#41; the first step of assistance&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; If NIPPV is applied do you use a protocol for its removal or substitution by another kind of assistance&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; Do you consider the initiation of conventional mechanical ventilation regardless of the underlying disease prognosis&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; Does your pediatric intensive care unit &#40;PICU&#41; have extracorporeal membrane oxygenation&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; Respiratory management if refractory hypoxemia or hypoventilation to conventional mechanical ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; In case of oliguric acute kidney injury &#40;creatinin<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 over the limit for the patient age or twice the baseline&#41; which of the following measures are never applied in your unit&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Is convulsive status in critically ill pediatric hemato-oncology patient cause of admission to your PICU&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46; If the patient died in PICU is he&#47;she accompanied by an oncologist&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#46; Is there an oncologist on-call in your hospital&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&#46; In case of critically ill pediatric hemato-oncology patient with a poor prognosis is the withdrawal of sustaining life support discussed&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#46; Is the decision of withdrawal sustaining life support agreed with the oncologist&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; Is the decision of withdrawal sustaining life support agreed with family&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Questions included in the survey&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">HSCT&#58; hematological stem cell transplantation&#46; PICU&#58; pediatric intensive care unit&#46; CIPHOP&#58; critically ill pediatric hemato-oncology patient&#46; Answers &#40;&#37;&#41;&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Do you think that treatment to these patients is always appropriate to its complexity and prognosis&#63;</td><td class="td" title="table-entry  " align="left" valign="top">Never&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Always&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rarely&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Frequently&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 &#40;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Always if possible</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">For inpatient from HSCT or onco-hematology units the medical treatment is always decided in common by oncologist and intensivist&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;24&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">59 &#40;56&#37;&#41;</td></tr></tbody></table>
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Medical care team&#46;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">PICU&#58; pediatric intensive care unit&#46; NIPPV&#58; non-invasive positive pressure ventilation&#46; ECMO&#58; extracorporeal membrane oxygenation&#46; Answers &#40;&#37;&#41;&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Question&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">If NIPPV is applied do you use a protocol for its removal or substitution by another kind of assistance&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do you consider the initiation of conventional mechanical ventilation regardless of the underlying disease prognosis&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;69&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Does your PICU has ECMO&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Respiratory management&#46;</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">CIPHOP&#58; critically ill pediatric hemato-oncology patient&#46; CRRT&#58; continuous renal replacement therapy&#46; AKI&#58; acute kidney injury&#46; Answers &#40;&#37;&#41;&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Renal management</span></th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">In case of oliguric AKI &#40;creatinin</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2 over the limit for the patient age or twice the baseline&#41; which of the following measures is never applied in your unit&#63;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diuretics &#40;bolus or perfusion&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peritoneal dialysis&nbsp;\t\t\t\t\t\t\n
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          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of oncology patients admitted to the paediatric intensive care unit of a general children&#39;s hospital&#8212;a single center analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Haase"
                            1 => "U&#46; Lieser"
                            2 => "C&#46; Kramm"
                            3 => "M&#46; Stiefel"
                            4 => "C&#46; Vilser"
                            5 => "T&#46; Bernig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0031-1275291"
                      "Revista" => array:6 [
                        "tituloSerie" => "Klin Padiatr"
                        "fecha" => "2011"
                        "volumen" => "223"
                        "paginaInicial" => "142"
                        "paginaFinal" => "146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21567369"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric Intensive Care Unit admission criteria for haemato-oncological patients&#58; a basis for clinical guidelines implementation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Piastra"
                            1 => "G&#46; Fognani"
                            2 => "A&#46; Franceschi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4081/pr.2011.s2.e13"
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Rep"
                        "fecha" => "2011"
                        "volumen" => "3"
                        "paginaInicial" => "e13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22053275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of unstable pediatric hemato-oncology patient&#58; results of a Web-based survey to pediatric oncologists in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Garcia-Salido"
                            1 => "M&#46;I&#46; Iglesias-Bouzas"
                            2 => "M&#46; Nieto-Moro"
                            3 => "A&#46; Lassaleta-Atienza"
                            4 => "A&#46; Serrano-Gonzalez"
                            5 => "J&#46; Casado-Flores"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00431-012-1840-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2013"
                        "volumen" => "172"
                        "paginaInicial" => "51"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23015044"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in outcomes &#40;1996&#8211;2004&#41; for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;F&#46; Tamburro"
                            1 => "R&#46;C&#46; Barfield"
                            2 => "M&#46;L&#46; Shaffer"
                            3 => "S&#46; Rajasekaran"
                            4 => "P&#46; Woodard"
                            5 => "R&#46;R&#46; Morrison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e31816c7260"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "270"
                        "paginaFinal" => "277"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18446105"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "End-of-life experiences in adolescents dying with cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;J&#46; Bell"
                            1 => "J&#46; Skiles"
                            2 => "K&#46; Pradhan"
                            3 => "V&#46;L&#46; Champion"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00520-009-0716-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Support Care Cancer"
                        "fecha" => "2009"
                        "volumen" => "18"
                        "paginaInicial" => "827"
                        "paginaFinal" => "835"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19727847"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "C&#225;ncer infantil en Espa&#241;a&#46; Estad&#237;sticas 1980&#8211;2009&#44; III Congreso de la SEHOP"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Peris-Bonet"
                            1 => "S&#46; Felipe Garc&#237;a"
                            2 => "G&#46; Fuentes-Garc&#237;a"
                            3 => "R&#46; Navarro-Jord&#225;n"
                            4 => "R&#46; Pardo Romaguera"
                            5 => "C&#46; Tamarit-Gim&#233;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2009"
                        "editorial" => "Servei de Publicacions de la Universitat de Val&#232;ncia"
                        "editorialLocalizacion" => "Almer&#237;a"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interdisciplinary interventions to improve pediatric palliative care and reduce health care professional suffering"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;H&#46; Rushton"
                            1 => "E&#46; Reder"
                            2 => "B&#46; Hall"
                            3 => "K&#46; Comello"
                            4 => "D&#46;E&#46; Sellers"
                            5 => "N&#46; Hutton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/jpm.2006.9.922"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Palliat Med"
                        "fecha" => "2006"
                        "volumen" => "9"
                        "paginaInicial" => "922"
                        "paginaFinal" => "933"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16910807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock&#58; 2007 update from the American College of Critical Care Medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Brierley"
                            1 => "J&#46;A&#46; Carcillo"
                            2 => "K&#46; Choong"
                            3 => "T&#46; Cornell"
                            4 => "A&#46; Decaen"
                            5 => "A&#46; Deymann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e31819323c6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "37"
                        "paginaInicial" => "666"
                        "paginaFinal" => "688"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19325359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of changes in arterial pressure on organ perfusion during septic shock"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Thooft"
                            1 => "R&#46; Favory"
                            2 => "D&#46; Ribeiro Salgado"
                            3 => "F&#46;S&#46; Taccone"
                            4 => "K&#46; Donadello"
                            5 => "D&#46; de Backer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc10462"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2011"
                        "volumen" => "15"
                        "paginaInicial" => "R222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21936903"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surviving sepsis campaign&#58; international guidelines for management of severe sepsis and septic shock&#58; 2008"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;P&#46; Dellinger"
                            1 => "M&#46;M&#46; Levy"
                            2 => "J&#46;M&#46; Carlet"
                            3 => "J&#46; Bion"
                            4 => "M&#46;M&#46; Parker"
                            5 => "R&#46; Jaeschke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000298158.12101.41"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "36"
                        "paginaInicial" => "296"
                        "paginaFinal" => "327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18158437"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0255"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of shock in children in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Santhanam"
                            1 => "S&#46; Ranjit"
                            2 => "N&#46; Kissoon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Minerva Pediatr"
                        "fecha" => "2009"
                        "volumen" => "61"
                        "paginaInicial" => "23"
                        "paginaFinal" => "37"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19180000"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemodynamic monitoring using PiCCO system in a 10 months old infant suffering from serious burn injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Koppl"
                            1 => "D&#46; Karovic"
                            2 => "B&#46; Podhoransky"
                            3 => "D&#46; Csomor"
                            4 => "P&#46; Gasparec"
                            5 => "T&#46; Sagat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Bratisl Lek Listy"
                        "fecha" => "2007"
                        "volumen" => "108"
                        "paginaInicial" => "359"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18203541"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Preliminary clinical experience with PiCCO system in children with shock&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Gil Anton"
                            1 => "C&#46; Cecchetti"
                            2 => "S&#46; Menendez"
                            3 => "F&#46;J&#46; Cambra"
                            4 => "J&#46; Lopez-Herce"
                            5 => "A&#46; Rodriguez-Nunez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2009"
                        "volumen" => "71"
                        "paginaInicial" => "135"
                        "paginaFinal" => "140"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0270"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trial of early&#44; goal-directed resuscitation for septic shock"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;R&#46; Mouncey"
                            1 => "T&#46;M&#46; Osborn"
                            2 => "G&#46;S&#46; Power"
                            3 => "D&#46;A&#46; Harrison"
                            4 => "M&#46;Z&#46; Sadique"
                            5 => "R&#46;D&#46; Grieve"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1500896"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "372"
                        "paginaInicial" => "1301"
                        "paginaFinal" => "1311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25776532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Velissaris"
                            1 => "C&#46; Pierrakos"
                            2 => "S&#46; Scolletta"
                            3 => "D&#46; de Backer"
                            4 => "J&#46;L&#46; Vincent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc10326"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2011"
                        "volumen" => "15"
                        "paginaInicial" => "R177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21791090"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0280"
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                      "titulo" => "Therapies for refractory hypoxemia in acute respiratory distress syndrome"
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                          0 => array:2 [
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                      "titulo" => "Post hoc analysis of calfactant use in immunocompromised children with acute lung injury&#58; impact and feasibility of further clinical trials"
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                    0 => array:2 [
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                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "459"
                        "paginaFinal" => "464"
                        "link" => array:1 [
                          0 => array:2 [
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                      "titulo" => "Prone positioning&#58; beyond physiology"
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                        "paginaFinal" => "1264"
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                          0 => array:2 [
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20483951"
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                0 => array:2 [
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                    ]
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                      "Revista" => array:6 [
                        "tituloSerie" => "Indian Pediatr"
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                        "paginaInicial" => "861"
                        "paginaFinal" => "868"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21048239"
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                          "etal" => false
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                            3 => "L&#46; Gattinoni"
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                        "tituloSerie" => "Minerva Anestesiol"
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                        "paginaFinal" => "936"
                        "link" => array:1 [
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                0 => array:2 [
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                        "paginaInicial" => "1977"
                        "paginaFinal" => "1984"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19903918"
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                    0 => array:2 [
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                        "paginaInicial" => "588"
                        "paginaFinal" => "594"
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                0 => array:2 [
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Original Article
Critically ill pediatric hemato-oncology patient: What we do is what we should do?
Paciente crónico oncohematológico, ¿hacemos lo que deberíamos hacer?
Alberto García-Salidoa,
Corresponding author
citopensis@yahoo.es

Corresponding author.
, Montserrat Nieto-Moroa, María Isabel Iglesias-Bouzasa, Marta González-Vicentb, Ana Serrano-Gonzáleza, Juan Casado-Floresa
a Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
b Unidad de Trasplante de progenitores hematopoyéticos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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            "entidad" => "Unidad de Cuidados Intensivos Pedi&#225;tricos&#44; Hospital Infantil Universitario Ni&#241;o Jes&#250;s&#44; Madrid&#44; Spain"
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            "identificador" => "aff0010"
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            "entidad" => "Unidad de Trasplante de progenitores hematopoy&#233;ticos&#44; Hospital Infantil Universitario Ni&#241;o Jes&#250;s&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0015"
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        "titulo" => "Paciente cr&#243;nico oncohematol&#243;gico&#44; &#191;hacemos lo que deber&#237;amos hacer&#63;"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Do you use HFOV if refractory hypoxemia and&#47;or hypoventilation to conventional mechanical ventilation&#63; &#40;b&#41; Respiratory management if refractory hypoxemia or hypoventilation to conventional mechanical ventilation&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Nowadays there isn&#8217;t any standard-of-care of critically ill pediatric hemato-oncology patient &#40;CIPHOP&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2</span></a> In case of pediatric intensive care unit &#40;PICU&#41; admission the treatment and monitoring protocols applied are not different from those used in children without an oncological disease&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Critically ill pediatric hemato-oncology patient survival has improved in recent years<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> thanks to a better management of their complications and the evolution and development of new therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> Unfortunately&#44; the PICU mortality and morbidity are still important and discussions about which is the better therapeutic option in each moment&#44; or when to withdraw the therapies initiated are common&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">There are nearly 1100 new cases of pediatric cancer each year in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> There are no institutions exclusively dedicated to the pediatric hemato-oncology patient &#40;PHOP&#41;&#46; These patients are treated in 47 hospitals with different characteristics and equipment&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;6</span></a> This heterogeneity&#44; despite the 80&#37; of global survival&#44; maybe implies an obstacle to homogenize and optimize the therapies applied&#46; The aim of this study is to describe the management and monitorization of CIPHO in the Spanish PICUs&#46; Later&#44; through a short literature review&#44; a discussion about the questions obtained is done&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Transversal&#44; observational and descriptive study performed by a web-based survey &#40;GoogleDoc<span class="elsevierStyleSup">&#174;</span> formulary&#41; sent to the 324 Spanish pediatric intensivists registered in the Spanish Society of Pediatric Critical Care&#46; No pediatric residents were included in the study&#46; The survey&#44; detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; was anonymous&#46; It was sent to intensivists regardless of the complexity of their units and patients&#46; The intensivists were reminded of the survey every two weeks from April 2011 to May 2011&#46; In case of no answer the participant was not considered for the final analysis&#46; A descriptive analysis of the answers was performed using SPSS 16&#46;0 for Windows&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">The survey was answered by 105 intensivists &#40;32&#37; of surveyed&#41;&#46; In their opinion the treatment applied is always &#40;18&#37;&#41; or frequently &#40;78&#37;&#41; appropriate to CIPHOP complexity and prognosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Medical care team</span><p id="par0030" class="elsevierStylePara elsevierViewall">The treatment and care giving decisions are made in common&#44; if possible&#44; by the oncologist and intensivist &#40;56&#37;&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Hemodynamic monitoring</span><p id="par0035" class="elsevierStylePara elsevierViewall">Non-invasive blood pressure measurements are always used by 80&#37; of respondents&#46; It is associated with intra-arterial blood pressure measurements &#40;always by 85&#47;105&#41; or central venous pressure &#40;CVP&#59; always by 70&#47;105 and frequently by 30&#47;105&#41;&#46; The transpulmonar peripheric arterial thermodilution &#40;PICCO<span class="elsevierStyleSup">&#174;</span>&#41; is never or rarely applied&#46; The mixed venous oxygen saturation is always used by 24&#47;86 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Respiratory management</span><p id="par0040" class="elsevierStylePara elsevierViewall">In case of respiratory failure or hypoxemia the non-invasive pressure support ventilation &#40;NIPPV&#41; is always &#40;36&#47;105&#41; or frequently &#40;60&#47;105&#41; used as first respiratory assistance &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Standardized protocols to replace or withdraw NIPPV are only used by 48&#37; of the respondents &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Before the initiation of conventional mechanical ventilation &#40;MV&#41; the patient prognosis is considered by 69&#37; of respondents &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; 72&#47;105&#41;&#46; In case of no improvement and&#47;or hypoxemia the prone position &#40;PP&#41; is always used by 29&#47;102&#46; High oscillatory frequency ventilation &#40;HOFV&#41; is always applied if refractory hypoxemia despite MV or PP by 19&#47;105 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Pulmonary surfactant is used frequently by 10&#37; of respondents &#40;11&#47;105&#41;&#46; Inhaled nitric oxide is applied frequently &#40;60&#37;&#44; 63&#47;102&#41; as therapy in case of refractory hipoxemia&#46; The extracorporeal membrane oxygenation &#40;ECMO&#41; is used when necessary by 7&#47;105 of intensivists &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Renal management</span><p id="par0050" class="elsevierStylePara elsevierViewall">In cases of oliguric acute kidney injury &#40;AKI&#41; the continuous renal replacement therapy &#40;CRRT&#41; is used by 97&#37; of respondents if no response to diuretic bolus or continuous infusion &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Status epilepticus</span><p id="par0055" class="elsevierStylePara elsevierViewall">Status epilepticus is considered as a cause of PICU incoming by 102&#47;105 of the respondent intensivists &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">End-of-life decisions and care</span><p id="par0060" class="elsevierStylePara elsevierViewall">In case of very bad prognosis the withdrawal of life-sustaining medical therapies is frequently discussed &#40;63&#47;102&#44; 60&#37;&#41;&#46; This decision is taken in common by the oncologist and intensivist in 87&#37; of cases &#40;91&#47;103&#41;&#59; the caregivers participate always &#40;81&#47;103&#41; or frequently &#40;21&#47;103&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; In case of death the oncologist is beside the patient always if possible &#40;79&#37;&#44; <a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Our survey&#44; the first done about this topic to European pediatric intensivists&#44; was answered by one third of the Spanish intensivists registered in the Spanish Society of Pediatric Critical Care&#46; Although there are no previous data about the global management of CIPHOP&#44; almost all of the respondents considered their management adequate to the CIPHOP complexity and prognosis&#46; Also&#44; despite there not being a defined standard-of-care about the management of critically ill pediatric hemato-oncology patient&#44; the respondents showed similar therapeutics choices to the different clinical situations examined&#46; The procedures and therapeutic decisions appear to be similar to those taken in other critically ill children and end-of-life decisions are frequently decided in common by the intensivist and oncologist&#44; in order to achieve adequate therapy for the children&#39;s requirements&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Answers discussion</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Medical care team</span><p id="par0070" class="elsevierStylePara elsevierViewall">We have seen that 19&#37; of respondents have not integrated the collaboration with the oncology specialist in their clinical activity despite it being recognized as essential in CIPHOP treatment&#46; It clearly helps to reduce inadequate decisions and supposes a corner stone in case of CIPHOP&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> The medical care team involved must be sensitive to individual requirements and&#44; if it is possible&#44; incorporate an interdisciplinary vision in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Hemodynamic monitoring</span><p id="par0075" class="elsevierStylePara elsevierViewall">In our study the use of invasive hemodynamic measures in CIPHOP appears to be always done if indicated or necessary&#46; As we have seen the measurement of arterial pressure&#44; invasive or not&#44; and CVP are globally included in CIPHOP management to the respondent&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> In case of the CVP maybe the requirement of a central venous line to apply the chemotherapeutics agents usually help to easily measure it&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The optimal mean arterial pressure &#40;MAP&#41; is uncertain and depends on patient characteristic and disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;10</span></a> Non-invasive blood pressure may be inaccurate and repeated mean pressure assessments are needed to optimize the hemodynamic treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;11</span></a> In our study non-invasive monitorization is almost always the first measurement done to the CIPHOP later substituted by invasive methods if necessary&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The use of transpulmonar peripheric arterial thermodilution is considered by only 20&#37; of respondents&#46; Its use is feasible and seems safe in these children&#46; The parameters derived from this monitorization could add clinically important information to asses the volume load in order to take adequate decisions about inotropic drugs or fluid therapy&#46; Its low application could be associated with &#40;1&#41; low availability of this technology in the Spanish PICUs and &#40;2&#41; lack of experience and data to its interpretation&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally in our study almost 40&#37; of intensivists did not monitor mixed venous oxygen saturation usually&#46; The maintenance of an optimal tissue oxygenation is an important task&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> There are many variables which are measured for this purpose&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Nowadays the usefulness and interest to achieve an adequate monitoring of mixed venous oxygen saturation as an index of tissue oxygen delivery is clear<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> and its application should be standardized in CIPHOP always if is indicated and possible&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Respiratory management</span><p id="par0095" class="elsevierStylePara elsevierViewall">There are no prospective studies which confirm the NIPPV efficacy in immunocompromised children or CIPHOP&#46; It seems that it could be applied without complications&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> The NIPPV is feasible and well tolerated<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> and it could avoid intubation in almost half of the patients&#46; It use is extended in the Spanish PICUs and has been applied by 96&#47;105 of respondents as first respiratory assistance&#46; The NIPPV should be initiated early&#44; the clinical characteristics and severity scores between respondents and non respondents do not have clear differences&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Despite the frequent use of NIPPV&#44; 50&#37; of participants did not apply a standardized protocol for its withdrawal or replacement&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In case of severe respiratory distress the conventional mechanical ventilation is indicated in the CIPHOP management&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> The acute respiratory distress syndrome &#40;ARDS&#41; is a common diagnosis among CIPHOP<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">18&#44;19</span></a> and usually evolves to a life threatening refractory hypoxemia&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> The ARDS is associated with significant risk of mortality despite the improvement over time in the general outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> Almost 60&#37; of children treated with hematopoietic stem cell transplantation &#40;HSCT&#41; develop ARDS related to the treatment itself or bacterial&#44; viral or fungal infections&#46; It is also a common phenomenon in non-HSCT oncology patients&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Several techniques are available to improve oxygenation in hypoxemic CIPHOP&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> The choice of MV strategy can significantly influence the course of lung injury&#44; so the volutrauma and atelectrauma must be avoided by an adequate protective lung strategy&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;22</span></a> Avoid a dynamic hyperinflation applying low tidal volume by predicted body weight &#40;6<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#41; should be used as the only strategy that consistently improved outcome in ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#44;24</span></a> The positive end expiratory pressure &#40;PEEP&#41; should be used judiciously to maintain lung recruitment&#44; prevent pulmonary atelectasis and facilitate synchrony in spontaneously breathing patients&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Nowadays there is insufficient evidence to routinely recommend the use of HFVO&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> prone positioning&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> instilated surfactant or inhaled nitric oxide&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The HOFV is applied by 81&#37; of respondents&#44; 4&#37; of them choose HFVO as first therapeutic option in selected patients&#46; The HFOV generally improves the ratio of partial pressure of oxygen to inspired fraction on oxygen &#40;PO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41; and might improve survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#44;27</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The role of prone position &#40;PP&#41; is not clear with controversial results in prospective studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;28</span></a> Several mechanisms can explain it benefits<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> such an improving recruitment and more homogeneously distributing alveolar inflation&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> Prone position also influences the synthesis of some proinflammatory cytokines such IL-6 so it could have not only local effects&#46; The prone position is a common therapy option of the intensivists in the study in case of hypoxemic respiratory failure with no response to MV&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The use of instilated surfactant is promising<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> related to the extensive biochemical and biophysical changes of the pulmonary surfactant system in case of ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">21&#44;31</span></a> This therapy is frequently applied by only 10&#37; of those surveyed and it may be considered in children with direct lung injury&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> The optimum dosage and timing of administration are not clear&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> Tamburro et al&#46; suggested it potentials benefits establishing the bases to future clinical trials&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> About inhaled nitric oxide its use is extensive by the respondents &#40;73&#37;&#41; to achieve pulmonary vasodilatation and better oxygenation&#46; There is no evidence that its use should be protocolized and it must be based on individual characteristics&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In relation to the use of ECMO there is a lack of data to clearly support its use in CIPHOP&#59; it should be used in case of clinical features that suggest a reasonable indication&#46; It has been recommended for severe ARDS because it avoids lung overdistension and the use of high oxygen concentrations&#46; Its use in Spain is restricted to a short number of units&#46; ECMO could be a therapy that may be appropriate for CIPHOP&#46; It is necessary to have adequate entry criteria and treatment protocol in order to collect data from such experiences to advance the standard of care&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Renal management</span><p id="par0135" class="elsevierStylePara elsevierViewall">The acute kidney injury produces a high additional mortality and morbidity&#46; An aggressive therapy is necessary mainly directed to achieve an adequate kidney perfusion and&#44; as a consequence&#44; the diuresis normalization&#46; The use of diuretics by bolus or perfusion is usually the first therapy option&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In our survey the continuous renal replacement therapy &#40;CRRT&#41; is frequently applied by the respondents&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> In case of CIPHOP it could also be applied to treat fluid overload or as curative therapy for a great variety of disorders and multiorgan dysfunction &#40;attenuate inflammation and improved oxygenation in mechanically ventilated children&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">33&#44;34</span></a> The intensity is not yet well defined but it is known that high-dose CRRT in AKI does not improve patient survival or recovery function&#46; Related to this&#44; recently Rajasekaran et al&#46; described in a retrospective study that CRRT is not associated with long-term survival in pediatric with HSCT&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Status epilepticus</span><p id="par0145" class="elsevierStylePara elsevierViewall">Almost all the respondents consider as a cause of PICU income the presence of status epilepticus&#46; In case of CIPHOP the seizures could be derived from the oncological disease&#44; the radiotherapy or chemotherapy treatment and the infections&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> In our survey there were no questions about the pharmacological treatment&#46; Actually some novel pharmacological agents such as levetiracetam are recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">36&#44;37</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">End-of-life decisions</span><p id="par0150" class="elsevierStylePara elsevierViewall">It is known that the majority of deaths in PICU require discussions or decisions about when or how to limit support by withdrawal of life-sustaining medical therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;38</span></a> This situation is frequently common in case of CIPHOP&#46; The work in a children&#39;s hospital is focused on treatments aimed toward cure&#46; Death is often seen as a failure&#44; and it may not be discussed or acknowledged as a possibility until very late in a child&#39;s stay in hospital&#46; About the care of dying child or about end-of-life decisions in children there is no right model of care moreover that pain and symptom management must be intensified to achieve an adequate quality of life&#46; It appears clear that open discussions about treatment discontinuation are necessary in order to generate better interventions&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;39</span></a> Understandable information to the parents about child health status influences their ability to participate in end of life decisions&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> Both things&#44; collaborative work and family participation&#44; are well considered and applied by the intensivist consulted&#46; Those who refer an absence of the oncology in case of death are probably related to not having an on-call oncologist in their hospital&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">There are several limitations to our study&#46; It was conceived as an observational transversal study so the results are influenced by the number of respondents&#46; Besides&#44; based on the answers and in the survey characteristics&#44; it was only possible to make a descriptive analysis&#46; Also our survey was not standardized&#44; because there are no similar previous studies or papers&#46; Related to the study designs there are multiple confusion factors that were impossible to discard &#40;critical care unit complexity or number of CIPHOP admissions per year and cause of them for example&#41;&#46; The anonymous design&#44; with no questions about the PICU characteristic of each participant&#44; influenced the answers and the results should be related with a personal perception of how these patients should be treated instead of how they are really treated&#46; Future observational and prospective studies should be performed to describe PICU treatment in pediatric oncological patients to acquire knowledge about what is really done and&#44; if necessary&#44; set new or different therapies&#46;</p></span></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">Despite there not being a standard-of-care&#44; Spanish intensivists showed an elevated concordance about the therapeutic decisions taken in case of critically ill pediatric hemato-oncology patient&#46; Related to this&#44; the use of NIPPV as first respiratory assistance is extended&#46; The results of this survey do not establish new treatment criteria or protocols&#44; but it could be used as a base to know the global management of CIPHOP in order to develop future studies and consensus&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest to report&#46;</p></span></span>"
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    "fechaRecibido" => "2015-05-21"
    "fechaAceptado" => "2015-07-20"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Primary objective&#44; to describe the management and monitorization of critically ill pediatric hemato-oncology patient &#40;CIPHO&#41; in the Spanish pediatric intensive care units &#40;PICU&#41;&#46; Secondary objective&#44; through a literature review&#44; to identify possible areas of improvement&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational transversal descriptive study&#46; An anonymous web-based survey was sent to 324 Spanish pediatric intensivists from April 2011 to May 2011&#46; None of them were pediatric residents&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The survey was answered by 105 intensivists&#44; 59&#47;105 always agreed on their treatment with the oncologist&#46; In case of hemodynamic instability&#44; non-invasive blood pressure monitoring is always done by 85&#47;105 and almost always optimized by intra-arterial measuring &#40;85&#47;105&#41; and central venous pressure &#40;70&#47;105&#41;&#46; If respiratory failure the use of non-invasive ventilation &#40;NIPPV&#41; is always &#40;36&#47;105&#41; or frequently &#40;60&#47;105&#41; established prior to conventional mechanical ventilation&#46; To replace or withdraw non-invasive ventilation only 44&#47;96 of the respondents to this question use a clinical protocol&#46; Before the instauration of conventional mechanical ventilation the oncological prognosis is considered by 72&#47;105&#46; In case of acute oliguric renal failure the renal replacement techniques are widely used &#40;74&#47;105&#41;&#46; The withdrawal of sustaining life support is frequently discussed &#40;75&#47;103&#41; and agreed with the oncologist &#40;91&#47;103&#41; and caregivers &#40;81&#47;103&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our study&#44; despite there not being a defined standard-of-care&#44; the respondents showed similar therapeutic and monitorization choices&#46; The use of NIPPV as first respiratory assistance is extended&#46; Prospective&#44; observational and multicenter studies should be developed to establish the results of this management in this population&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Objetivo primario&#44; definir el tratamiento y la monitorizaci&#243;n del ni&#241;o cr&#237;tico con enfermedad hemato-oncol&#243;gica en las unidades de cuidados intensivos espa&#241;olas&#46; El objetivo secundario fue&#44; tras una revisi&#243;n de la literatura&#44; contextualizar el enfoque obtenido y detectar posibles puntos de mejora&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; descriptivo y transversal&#46; Se envi&#243; en el periodo abril del 2011-mayo del 2011 una encuesta online a 324 intensivistas y adjuntos de pediatr&#237;a registrados en la Sociedad Espa&#241;ola de Cuidados Intensivos Pedi&#225;tricos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se obtienen 105 respuestas globales&#44; 59&#47;105 indicaron acordar el tratamiento con el onc&#243;logo&#46; Ante hipotensi&#243;n&#44; taquicardia y requerimiento de inotr&#243;picos&#44; 85&#47;105 realizan siempre monitorizaci&#243;n no invasiva de presi&#243;n arterial asociando adem&#225;s medici&#243;n intraarterial &#40;85&#47;105&#41; y casi siempre presi&#243;n venosa central &#40;70&#47;105&#41;&#46; Ante dificultad respiratoria&#44; se instaura siempre &#40;36&#47;105&#41; o frecuentemente &#40;60&#47;105&#41; ventilaci&#243;n no invasiva&#46; De forma previa a iniciar ventilaci&#243;n mec&#225;nica convencional&#44; 72&#47;105 consideran el pron&#243;stico global del paciente&#46; Ante fallo renal agudo olig&#250;rico&#44; las t&#233;cnicas de depuraci&#243;n extrarrenal son ampliamente utilizadas &#40;74&#47;105&#41;&#46; En caso de mal pron&#243;stico&#44; la adecuaci&#243;n del tratamiento es considerada de forma frecuente &#40;75&#47;103&#41; y conjunta con el onc&#243;logo &#40;91&#47;103&#41; y la familia &#40;81&#47;103&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se observa gran similitud en las respuestas a pesar de que el manejo de este tipo de pacientes no est&#225; estandarizado&#46; En caso de dificultad respiratoria&#44; el uso de ventilaci&#243;n no invasiva como primera asistencia est&#225; ampliamente extendido&#46; El desarrollo de futuros estudios observacionales prospectivos y multic&#233;ntricos permitir&#237;a conocer los resultados derivados de este enfoque&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a-Salido A&#44; Nieto-Moro M&#44; Iglesias-Bouzas MI&#44; Gonz&#225;lez-Vicent M&#44; Serrano-Gonz&#225;lez A&#44; Casado-Flores J&#46; Paciente cr&#243;nico oncohematol&#243;gico&#44; &#191;hacemos lo que deber&#237;amos hacer&#63; An Pediatr &#40;Barc&#41;&#46; 2016&#59;85&#58;61&#8211;69&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Do you use HFOV if refractory hypoxemia and&#47;or hypoventilation to conventional mechanical ventilation&#63; &#40;b&#41; Respiratory management if refractory hypoxemia or hypoventilation to conventional mechanical ventilation&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; For inpatient from hematological stem cell transplantation or onco-hematology units&#44; is the medical treatment always decided in common by the oncologist and intensivist&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; Do you think that treatment to these patients is always appropriate to its complexity and prognosis&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; What kind of monitoring is applied to critically ill pediatric hemato-oncology patient with hemodynamic instability and inotropic requirements&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; To treat respiratory failure or hypoxemia is non-invasive positive pressure ventilation &#40;NIPPV&#41; the first step of assistance&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; If NIPPV is applied do you use a protocol for its removal or substitution by another kind of assistance&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; Do you consider the initiation of conventional mechanical ventilation regardless of the underlying disease prognosis&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; Does your pediatric intensive care unit &#40;PICU&#41; have extracorporeal membrane oxygenation&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; Respiratory management if refractory hypoxemia or hypoventilation to conventional mechanical ventilation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Is convulsive status in critically ill pediatric hemato-oncology patient cause of admission to your PICU&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46; If the patient died in PICU is he&#47;she accompanied by an oncologist&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#46; Is there an oncologist on-call in your hospital&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&#46; In case of critically ill pediatric hemato-oncology patient with a poor prognosis is the withdrawal of sustaining life support discussed&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#46; Is the decision of withdrawal sustaining life support agreed with the oncologist&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; Is the decision of withdrawal sustaining life support agreed with family&#63;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">HSCT&#58; hematological stem cell transplantation&#46; PICU&#58; pediatric intensive care unit&#46; CIPHOP&#58; critically ill pediatric hemato-oncology patient&#46; Answers &#40;&#37;&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Do you think that treatment to these patients is always appropriate to its complexity and prognosis&#63;</td><td class="td" title="table-entry  " align="left" valign="top">Never&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Always if possible</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">For inpatient from HSCT or onco-hematology units the medical treatment is always decided in common by oncologist and intensivist&#63;&nbsp;\t\t\t\t\t\t\n
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          "identificador" => "bibs0005"
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              "identificador" => "bib0205"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of oncology patients admitted to the paediatric intensive care unit of a general children&#39;s hospital&#8212;a single center analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Haase"
                            1 => "U&#46; Lieser"
                            2 => "C&#46; Kramm"
                            3 => "M&#46; Stiefel"
                            4 => "C&#46; Vilser"
                            5 => "T&#46; Bernig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0031-1275291"
                      "Revista" => array:6 [
                        "tituloSerie" => "Klin Padiatr"
                        "fecha" => "2011"
                        "volumen" => "223"
                        "paginaInicial" => "142"
                        "paginaFinal" => "146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21567369"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric Intensive Care Unit admission criteria for haemato-oncological patients&#58; a basis for clinical guidelines implementation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Piastra"
                            1 => "G&#46; Fognani"
                            2 => "A&#46; Franceschi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4081/pr.2011.s2.e13"
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Rep"
                        "fecha" => "2011"
                        "volumen" => "3"
                        "paginaInicial" => "e13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22053275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0215"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of unstable pediatric hemato-oncology patient&#58; results of a Web-based survey to pediatric oncologists in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Garcia-Salido"
                            1 => "M&#46;I&#46; Iglesias-Bouzas"
                            2 => "M&#46; Nieto-Moro"
                            3 => "A&#46; Lassaleta-Atienza"
                            4 => "A&#46; Serrano-Gonzalez"
                            5 => "J&#46; Casado-Flores"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1007/s00431-012-1840-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2013"
                        "volumen" => "172"
                        "paginaInicial" => "51"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23015044"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in outcomes &#40;1996&#8211;2004&#41; for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "R&#46;C&#46; Barfield"
                            2 => "M&#46;L&#46; Shaffer"
                            3 => "S&#46; Rajasekaran"
                            4 => "P&#46; Woodard"
                            5 => "R&#46;R&#46; Morrison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e31816c7260"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "270"
                        "paginaFinal" => "277"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18446105"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0225"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "End-of-life experiences in adolescents dying with cancer"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;J&#46; Bell"
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                            2 => "K&#46; Pradhan"
                            3 => "V&#46;L&#46; Champion"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00520-009-0716-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Support Care Cancer"
                        "fecha" => "2009"
                        "volumen" => "18"
                        "paginaInicial" => "827"
                        "paginaFinal" => "835"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19727847"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0230"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "C&#225;ncer infantil en Espa&#241;a&#46; Estad&#237;sticas 1980&#8211;2009&#44; III Congreso de la SEHOP"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Peris-Bonet"
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                            2 => "G&#46; Fuentes-Garc&#237;a"
                            3 => "R&#46; Navarro-Jord&#225;n"
                            4 => "R&#46; Pardo Romaguera"
                            5 => "C&#46; Tamarit-Gim&#233;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
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                        "editorial" => "Servei de Publicacions de la Universitat de Val&#232;ncia"
                        "editorialLocalizacion" => "Almer&#237;a"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Interdisciplinary interventions to improve pediatric palliative care and reduce health care professional suffering"
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                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "C&#46;H&#46; Rushton"
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                            3 => "K&#46; Comello"
                            4 => "D&#46;E&#46; Sellers"
                            5 => "N&#46; Hutton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/jpm.2006.9.922"
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                        "tituloSerie" => "J Palliat Med"
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                        "volumen" => "9"
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                        "paginaFinal" => "933"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16910807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
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              ]
            ]
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              "identificador" => "bib0240"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock&#58; 2007 update from the American College of Critical Care Medicine"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "J&#46;A&#46; Carcillo"
                            2 => "K&#46; Choong"
                            3 => "T&#46; Cornell"
                            4 => "A&#46; Decaen"
                            5 => "A&#46; Deymann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e31819323c6"
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                        "tituloSerie" => "Crit Care Med"
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                        "volumen" => "37"
                        "paginaInicial" => "666"
                        "paginaFinal" => "688"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19325359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0245"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of changes in arterial pressure on organ perfusion during septic shock"
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                          "autores" => array:6 [
                            0 => "A&#46; Thooft"
                            1 => "R&#46; Favory"
                            2 => "D&#46; Ribeiro Salgado"
                            3 => "F&#46;S&#46; Taccone"
                            4 => "K&#46; Donadello"
                            5 => "D&#46; de Backer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc10462"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2011"
                        "volumen" => "15"
                        "paginaInicial" => "R222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21936903"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0250"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surviving sepsis campaign&#58; international guidelines for management of severe sepsis and septic shock&#58; 2008"
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                          "etal" => true
                          "autores" => array:6 [
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                            2 => "J&#46;M&#46; Carlet"
                            3 => "J&#46; Bion"
                            4 => "M&#46;M&#46; Parker"
                            5 => "R&#46; Jaeschke"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000298158.12101.41"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18158437"
                            "web" => "Medline"
                          ]
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                  "contribucion" => array:1 [
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                        "paginaFinal" => "37"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19180000"
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                      "titulo" => "Hemodynamic monitoring using PiCCO system in a 10 months old infant suffering from serious burn injury"
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                            4 => "P&#46; Gasparec"
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                        "paginaFinal" => "363"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18203541"
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                      "titulo" => "&#91;Preliminary clinical experience with PiCCO system in children with shock&#93;"
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                            4 => "J&#46; Lopez-Herce"
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                      "titulo" => "Trial of early&#44; goal-directed resuscitation for septic shock"
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                      "titulo" => "High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients"
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                            0 => "D&#46; Velissaris"
                            1 => "C&#46; Pierrakos"
                            2 => "S&#46; Scolletta"
                            3 => "D&#46; de Backer"
                            4 => "J&#46;L&#46; Vincent"
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                        "tituloSerie" => "Crit Care"
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                        "volumen" => "15"
                        "paginaInicial" => "R177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21791090"
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                    0 => array:2 [
                      "titulo" => "Evaluation of tissue saturation as a noninvasive measure of mixed venous saturation in children"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
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                        "paginaInicial" => "671"
                        "paginaFinal" => "675"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16276334"
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                      "titulo" => "Noninvasive pressure-support ventilation in immunocompromised children with ARDS&#58; a feasibility study"
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                            4 => "S&#46; D&#8217;Arrigo"
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                        "tituloSerie" => "Intensive Care Med"
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                        "volumen" => "35"
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                        "paginaFinal" => "1427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19547952"
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                    0 => array:2 [
                      "titulo" => "Breathing difficulties in children with cancer"
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                    ]
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                        "tituloSerie" => "Med Intensiva"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21803456"
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                      "titulo" => "Therapies for refractory hypoxemia in acute respiratory distress syndrome"
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                      "titulo" => "Post hoc analysis of calfactant use in immunocompromised children with acute lung injury&#58; impact and feasibility of further clinical trials"
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                        "tituloSerie" => "Pediatr Crit Care Med"
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                0 => array:2 [
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                        "paginaFinal" => "868"
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ISSN: 23412879
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