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Critical Care

The Global Critical Care Program strives to strengthen care for critically ill children with cancer everywhere.


Children with cancer and other catastrophic diseases frequently develop acute, critical complications. One in every three or four patients with cancer will require pediatric intensive care unit (PICU) care at least once during their cancer treatment. Unfortunately, these patients also have a higher risk of death during critical illnesses. This risk is especially true in settings with limited resources. 


Common critical illnesses in children with cancer and other blood disorders include sepsis (severe widespread infection), respiratory insufficiency and serious neurological complications such as seizures or encephalopathies. Improving the management of these illnesses is integral to developing new global standards and improved patient outcomes, including reducing rates of toxic death.


Aligned with the St. Jude Global mission and with more than 1,160 collaborators from 65 countries, the Global Critical Care Program aims to strengthen hospital care for critically ill children with cancer and other catastrophic diseases, focusing on four pillars of work:

  • Innovative, evidence-based interventions
  • Education to enhance skills and knowledge
  • High-quality research
  • Development of a global horizontal collaboration network.


Program Initiatives


Innovative Evidence-Based Interventions


The program's multidisciplinary, evidence-based interventions are designed to improve the quality of care for critically ill children with cancer. Currently, our efforts include the multicenter Pediatric Early Warning System (PEWS) program and its sibling program, the PEWS Adaptation to Support Hospitals in Africa/Asia (PASHA), which are dedicated to supporting participating hospitals in implementing and sustaining a system that promotes the early identification of clinical deterioration in hospitalized children, thus increasing the window for treatment and patients’ chances of recovery.


Proyecto EVAT, our most extensive PEWS implementation collaborative effort, now features 83 participating pediatric hematology-oncology centers in Latin America and Europe. Meanwhile, Project PASHA was recently launched as an adaptation of the EVAT implementation methodology, focusing on scalability. Project PASHA’s pilot run is now underway, with the first cohort of five centers in Sub-Saharan Africa and Asia. 


Assessment Interventions. Our program has also developed several tools that centers can implement to assess current pediatric onco-critical care services and identify priorities for future interventions. 


PROACTIVE (Pediatric Oncology Capacity Assessment Tool for Intensive Care) is a tool to assess the capacity and quality of pediatric onco-critical care in resource-limited settings. Centers participating in annual PROACTIVE cohorts (available in English and Spanish) receive a center report identifying areas of strengths and opportunities to improve care.


CritCom is a provider survey to evaluate the quality of team communication across disciplines (ICU, oncology, etc.) and professions (nurses, physicians) for children with cancer who are at risk of deterioration. As with PROACTIVE, centers completing the CritCom assessment receive a report evaluating the quality of interdisciplinary communication across six domains.




To improve health care providers’ knowledge about the care of critically ill children with cancer, the Global Critical Care Program works with experts in the field to develop curricula, workshops and training materials on pediatric onco-critical care. These efforts include:

  • Pediatric onco-critical care workshops and conferences, including the annual Pediatric Onco-Critical Care Symposium (POCCS) at St. Jude.
  • The St. Jude Global Academy in Pediatric Onco-Critical Care.
  • Critical care observerships in the St. Jude pediatric intensive care unit. 
  • POC3, a clinical case review conference connecting providers to experts in the field to review and analyze complex cases with onco-critical illnesses. 
  • Monthly meetings to discuss relevant topics in pediatric onco-critical care and encourage collaboration between participants to build our pediatric onco-critical care community.



The Global Critical Care Program develops research tools and conducts high-quality research on topics related to pediatric onco-critical care in high-resource and resource-limited settings. These efforts include:

  • Working with regional experts to develop common data elements that investigators and clinicians can use to study the global epidemiology, burden and outcomes of critical illness in children with cancer. One example is POCIReg, the Pediatric Oncology Critical Illness Registry.
  • Using implementation science methodology to study the implementation and sustainability of evidence-based interventions in low-resource settings. One example is our work with the Clinical Sustainability Assessment Tool (CSAT), a structured assessment of a center’s capacity to sustain an evidence-based practice like PEWS. These findings can guide a sustainability action plan and inform the development of strategies to promote intervention sustainability in these settings.

Our Team 


Asya Agulnik, MD, MPH

Director, Global Critical Care Program 

Director, Euro Regional Program

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Adolfo Cardenas-Aguirre, MD

Program Manager, Global Critical Care Program 

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Maria Puerto Torres

Project Coordinator, Global Critical Care Program

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Stacey Wiedower, MS

Program Coordinator, Global Critical Care Program

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To learn more about the Global Critical Care Program, email


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