Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

Abstract

ObjectiveTo describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic.DesignDescriptive study.SettingSeven PICUs in England.Main outcome measures(1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs.ResultsSeven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280–307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50–62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%).ConclusionIn a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.

Clinical and organizational framework of repurposing pediatric intensive care unit to adult critical care in a resource-limited setting: Lessons from the response of an urban general hospital to the COVID-19 pandemic

“…There are several forms of integration of the PICU to the hospital response, especially in a general hospital [ [19] , [20] , [21] , [22] , [23] , [24] ]. Fig.…”

In the eye of the storm: impact of COVID-19 pandemic on admission patterns to paediatric intensive care units in the UK and Eire

“…By contrast, COVID-19 in adults resulted in excess of 25,000 critical care admissions in ICUs in England, Wales and Northern Ireland in 2020 [ 29 ]. Some of the PICU capacity freed up by the reduced number of childhood admissions were then utilised to provide critical care for the adults [ 5 , 30 ]. Moreover, paediatric critical care staff were also redeployed in adult ICUs.…”

“…Several PICUs were either entirely or partially repurposed to provide adult critical care [ 5 ]. During the crisis most institutions reduced their planned surgical activity.…”

Finding ways for children’s doctors to care for big ‘Kids’ and save adults in a pandemic

“…Amid this, Sinha et al in this issue found creative ways for children's doctors to care for sick adults with COVID-19 disease. 3 In a carefully crafted rubric, the authors show how thoughtful planning and methodical implementation in England can mobilise emergency resources in a time of crisis. As such, their success met the demand to increase AICU resources during the early surge of the COVID-19 pandemic while still meeting the paediatric critical care needs of the country.…”