BackgroundThe COVID-19 pandemic has strained health systems world wide. In our region, surging numbers of critically ill adult patients demanded urgent system-wide responses. During the peak of the pandemic, our Pediatric Intensive Care Unit (PICU) team redesigned the existing educational resources and processes of care to ensure for adult patients for the first time in the hospital’s history.AimDescribe the experiences and impacts of the rapidly initiated Adult COVID-19 Program on health care providers (HCP) and family members. Havelock’s Theory of Change framed the examination of Adult COVID-19 Program participant experiences and surfaced lessons learned.Materials and MethodsA quality improvement review was employed to collect feedback about the program experience from the health care team and patient’s family members. HCP completed a questionnaire 10 months following the implementation of the program and feedback from family members was provided during the program was obtained. Havelock’s Theory of Change was used to explore trends and frame participants’ experiences.ResultsPediatric Intensive Care Unit bedside team members and clinical leaders (n = 17), adult hospital partners (n = 3), and family members (n = 8) participated. HCP describe; motivation and readiness; concern for personal safety and uncertainty experienced in the early program phases; the importance of supports and resources; use of relationships and collaboration to facilitate change; the emotional impacts of this unique experience; and opportunities for individual and team growth. An overarching theme of ‘doing our part to help’ emerged. Family members described the positive impacts of family-centered interventions offered, individualized care, and shock at their family member’s illness.ConclusionThe PICU team rapidly adapted to provide care for adults at the peak of the pandemic. Family members expressed feeling grateful for the care their loved ones received in the pediatric setting. The experience of caring for adult patients with COVID-19 was a source of tension, personal growth, and meaning for the pediatric intensive care team.
RESULTS: Amongst 91 children with median age of 16-months (5-46 months), 61 had primary pARDS and 30 had secondary pARDS. Median PRISM-3 score in first 24-hours was 9 (5-13) and median pSOFA on the day of starting HFOV was 10 (7-12). Around 26 (28.57%) children survived with significantly high mortality (p 0.03) amongst children with indirect pARDS (90 %) compared to direct pARDS (42 %) Survivors had significantly lower pSOFA compared to nonsurvivors at the time of initiation of HFOV (p 0.00) however oxygenation index in both groups was similar (p 0.49).Peak inspiratory pressures, Mean Airway Pressures and Dynamic driving pressures were also similar amongst the two groups at the time of initiation of HFOV (p value (0.87, 0.87 and 0.93) respectively). There was significant improvement in Oxygenation Index at the end of 24 hours amongst the survivors (p value 0.03). CONCLUSIONS:HFOV has an important role to play in pARDS as rescue therapy. Mortality is high amongst children with indirect pARDS underlying the contribution of multi system involvement in the final outcome in children with severe pARDS.
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