studies do not adjust for cofounders such as the ability to identify and treat ARF etiology. Patients with malignancies are at high risk of severe pulmonary complications, including ARDS [42]. The disease can also occur in patients with neutropenia [43] or during recovery from neutropenia [44]. The use of the best standard of care in these patients [40] is associated with survival. Hospital mortality of cancer patients with ARDS has dropped to almost 50%, presumably owing to improved standards of invasive mechanical ventilation, development of proper diagnostic strategies, and early treatment of disease-related complications [10, 42, 45, 46]. NIV of severe ARDS cancer patients should be discouraged as it is associated with a high failure rate and increased mortality. Hemodynamics (fluids, vasopressors, monitoring) The available data do not suggest specific needs of septic cancer patients with regard to fluid administration, vasopressors, or monitoring [48, 49]. Neither the macrocirculation (vasopressor dose and duration) nor the microcirculation (flow heterogeneity) seems to be impacted by neutropenia or chemotherapy [50, 51]. In patients with hyperleukocytic leukemia and leukostasis, increasing the hematocrit by transfusions disturbs rheology and end-organ perfusion and leads to life-threatening hyperviscosity. Hydration is recommended using saline at a volume of 30 ml/kg/day. Otherwise, the usual standard of care for managing hemodynamics should apply [52,53,54,55]. Acute kidney injury and renal replacement therapy Acute kidney injury (AKI) occurs in up to 70% of critically ill cancer patients, half of whom need renal replacement therapy (RRT) [56, 57]. Sepsis, hypoperfusion, and nephrotoxic agents are the main leading factors [56, 57]. A few unique causes may, however, require specific management (Table 1). Early ICU admission has been associated with better renal and overall patient outcome [9], which probably relates to preventable causes of AKI such as tumor lysis syndrome or sepsis [58]. Cancer patients who are profoundly thrombocytopenic are at high risk of hemorrhage; thus, systemic anticoagulation may be avoided by using either citrate or RRT without anticoagulation [59]. Transfusion strategies Red cell transfusions should be implemented with caution in plasmatic (Waldenström disease or multiple myloma with high paraproteinemia) or cellular hyperviscosity (hyperleukocytic leukemia) for rheological reasons. In these cases, anemia should be tolerated as much as possible. In unselected patients, a restrictive red blood cell (RBC) transfusion policy to maintain a hemoglobin level above 7 g/dl can be implemented in critical conditions in the ICU in otherwise hemodynamically stable patients. Presumably this may also apply to cancer patients. A large multicenter RCT in patients with septic shock reported that such an approach was safe, although it did not specifically address the optimal transfusion threshold in the event of persistent tissue dysoxia [60, 61]. In cancer patients following major surgery, a single-center RCT suggested benefit from a higher transfusion threshold [62]. Platelet management strategies are derived from studies performed in patients with hematological cancer in whom the risk of major bleeding is related mainly to the depth and duration of thrombocytopenia: prophylactic platelet transfusion at a threshold of 10 × 109/l is associated with less bleeding than therapeutic-only platelet transfusion [63, 64].