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IntroductionThe purpose of this study is to describe the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV2) disease characteristics and management in children admitted to the pediatric intensive care units (PICU).MethodsThe present study was based on a national multicentric prospective registry including PICU patients with SARS‐CoV2 infection or symptoms of multisystem inflammatory syndrome in children (MIS‐C).ResultsA total of 298 patients were admitted to 41 different Spanish PICUs. A total of 76% of them were previously healthy. The most frequent manifestation was MIS‐C (69.8%). On admission, 59.4% of patients did not have respiratory distress, and only 17.4% needed conventional mechanical ventilation (MV). The need for MV was associated with age (incidence rate ratios [IRR] 1.21, p < .012), pediatric sequential organ failure assessment score (p‐SOFA) Score (IRR 1.12, p = .001), and need for transfusion (IRR 4.5, p < .004) in MIS‐C patients, and with vasoactive drug use (IRR 2.73, p = .022) and the diagnosis of acute respiratory distress syndrome (IRR 2.83, p = .018) in patients admitted for other reasons. During the first day of admission, 56% of patients met shock criteria and 50.7% needed vasoactive drugs. In MIS‐C patients, their use was associated with higher p‐SOFA score (IRR 1.06, p < .001) and with the diagnosis of shock (IRR 5.78, p < .001). In patients without MIS‐C, it was associated with higher p‐SOFA score (IRR 1.05, p = .022). The mortality rate was 3%, being lower in MIS‐C patients compared to patients admitted for other reasons (0.5% vs. 9.4%, p < .001). It was also lower in previously healthy patients compared to patients with previous comorbidities (0.9% vs. 9.7%, p < .001).ConclusionsSevere SARS‐CoV2 infection is uncommon in the pediatric population. In our series, respiratory distress was rare, being MIS‐C the most frequent cause of PICU admission related to SARS‐CoV2. In most cases, the course of the disease was mild except in children with previous diseases.