Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists*

Abstract

Objective: In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add “surge capacity” has been the use of PICU beds and physicians to care for these critically ill adults. Design: Narrative review/perspective. Setting: Not applicable. Patients: Not applicable. Interventions: None. Measurements and Main Results: The virus’s high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common “adult” issues that may be encountered in the care of these patients and how they can best be managed in a PICU. Conclusions: This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.

Transforming a PICU Into an Adult ICU During the Coronavirus Disease 2019 Pandemic: Meeting Multiple Needs

“…After the first week, we relied on the CI with either phone consultation or could immediately be present in the unit if needed. These adult colleagues provided patient management support, especially in patients with complications unable to be managed with published resources or those with advanced disease ( 14 ). All staff were cleared by hospital epidemiology and infection control to work in both COVID-19 units and non-COVID-19 units.…”

Effect of adult COVID-19 surge on the provision of kidney replacement therapy in children

“…Each model has its unique pros and cons. Being based within an adult-based hospital, equipment, consumables, and staffing have a shared pool, and redeployment and diversion of resources become easier [2]. The mantra is flexible and collaborative working.…”

Caring for Critically Ill Adults in PICUs Is Not “Child’s Play”*

“…In order to successfully provide the care outlined by Remy et al (4) to adults in a pediatric hospital, the enablers of care such as staff, "stuff," space, and systems must be arranged a priori. Successful delivery of care also depends on a robust "3Cs" (command, control, and communication) system (2,11,14).…”