Generally, children infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV-2) have mild symptoms or are asymptomatic. However, some children have severe and critical symptoms affecting several organ systems, including the gastrointestinal, cardiovascular, respiratory, and neurological systems. These severe and critical symptoms are associated with multisystem inflammatory syndrome in children (MISC). This study aimed to describe the clinical features, ventilation modalities usage, and outcome conditions of these children. This was a retrospective study of children with COVID-19 and MISC who were treated in the COVID-19 isolation pediatric intensive care unit (PICU) of Saiful Anwar General Hospital over one year. The data were obtained from medical records and were analyzed descriptively. A total of 491 pediatric patients with suspected COVID-19 were included; 51 had a confirmed COVID-19 diagnosis; 9/491 (1.8%) were patients with MISC who were treated in the PICU; and 7/9 (78%.0) of MISC patients in the PICU used mechanical ventilators. The frequency of MISC patients with gastrointestinal problems was 7/9 (78%) patients, respiratory problems was 9/9 (100%), and myocardial injury (increased troponin) was 5/9 (56%) patients. All MISC patients admitted to the PICU experienced shock with vasoactive drugs including dobutamine, epinephrine, norepinephrine and vasopressin. All MISC patients with severe and critical symptoms had comorbidities. Invasive mechanical ventilation was provided for 7 patients, and 2 patients received non-invasive ventilation. The mean of PEEP used in the invasive ventilation was 7-9 cmH2O. The length of the ventilator usage was 2-21 days, with 2 patients passing away, both with a comorbidity and multiorgan system injuries. It can be concluded that pediatric patients with confirmed COVID-19 may also have MISC with severe and critical symptoms. Early recognition of pediatric patients with MISC is necessary to reduce morbidity and mortality.
Background: Coronavirus Disease-2019 (COVID-19) in children tend to have milder clinical manifestation. However, some develop critical conditions and require mechanical ventilation in the Pediatric Intensive Care Unit (PICU). Various modalities are recommended for mechanical ventilation, such as High Flow Nasal Cannula (HFNC), Continuous Positive Airway Pressure (CPAP), or invasive ventilation with intubation. This study aims to describe the clinical feature, ventilation modalities usage, and the outcome of children with critical COVID-19. Methods: This is a retrospective study in COVID-19 children with respiratory distress who were treated in the COVID-19 isolation PICU room of Saiful Anwar General Hospital for one year. The data was gained from the medical record and analyzed descriptively. Data were analyzed using Ms. Excel for Windows. Results: A total of 51 children with COVID-19 were admitted to Saiful Anwar general Hospital in one year period, with 12 of them in critical condition and 6 children require mechanical ventilation. The main signs developed were fever and dyspnea. Invasive mechanical ventilation applicated in 5 patients, and only 1 patient received Non-Invasive Ventilation (NIV). The mean of PEEP used in invasive ventilation is 7-9 cmH2O, lower than ESPNIC’s recommendation of 8-10 cmH2O. Length of ventilator usage is 2-21 days, with 2 patients passed away, both with a comorbid and organ system injury. Conclusion: The mechanical ventilation setting must be determined individually based on the patients’ condition, despite several guidelines providing the recommendation.
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