Critical Care for Coronavirus Disease 2019: Perspectives From the PICU to the Medical ICU

Abstract

Objectives: To describe the unique perspective of pediatric intensivists caring for critically ill adults during the coronavirus disease 2019 pandemic. Design: Observational study. Setting: Academic medical center in New York City. Patients: Coronavirus disease 2019 positive adults requiring admission to an ICU. Interventions: None. Measurements and Main Results: In late March 2020, New York Presbyterian Hospital centralized all of its inpatient pediatric units ( n = 4) from across the network to a single center, in order to create space to accommodate the increasing number of critically ill adults with coronavirus disease 2019. Within 1 week, the PICU at New York Presbyterian Hospital-Weill Cornell Medicine transferred or discharged all inpatients, underwent a transformation of the physical space, and began admitting adults of all ages with coronavirus disease 2019 related acute respiratory failure. The New York Presbyterian Hospital-Weill Cornell Medicine PICU physician group continued to lead this unit. PICU nurses, respiratory therapists, social workers, and child life specialists joined their PICU physician colleagues to care for these critically ill adults. Conclusions: In the coronavirus disease 2019 pandemic, PICU physicians are well poised to care for adult patients in a surge capacity, and bring a unique perspective to the experience.

Repurposing a PICU for Adult Care in a State Mandated COVID-19 Only Hospital: Outcome Comparison to the MICU Cohort to Determine Safety and Effectiveness

“…There are published descriptive reports, retrospective studies, and expert opinions pertaining to the care of adults in pediatric settings during the COVID-19 pandemic (10)(11)(12)(13)(14)(15)(16). This study differs in that it describes experiences of a PICU serving as the primary team for a cohort of critically ill adult patients within a state-designated "COVID-19 only facility" and compares the outcomes to adult patients who received care in the institution's MICU during the same period.…”

“…The logistics in preparing a PICU for adult care will differ for general and free-standing children's hospitals. PICUs in areas enacting crisis standards of care have already started to support adult patients using a variety of novel patient care models (10)(11)(12)(13)(14)(15)(16).…”

Everyone is Someone's Child: The Experiences of Pediatric Nurses Caring for Adult COVID-19 Patients

“…Many institutions repurposed pediatric units and transitioned clinical practices to meet the needs of this global crisis ( Joyce et al, 2020 ; Levy et al, 2020 ; Philips et al, 2020 ; Yager et al, 2020 ). Reports described the transformation of pediatric units, with physical spaces converted, staffing models restructured, and supplies and equipment replaced or adjusted for adult use ( Joyce et al, 2020 ; Levy et al, 2020 ; Philips et al, 2020 ). Like the pediatric nurses in this study, pediatric nurses and providers in these reports continued to care for adult patients on their restructured units.…”

“…Leadership, support, and collaboration facilitated the pediatric provider's transition to caring for adult patients, as pediatric providers consulted with adult hospital medicine providers, educators reviewed protocols with providers, and resources were provided to familiarize pediatric staff with adult medications and conditions ( Joyce et al, 2020 ; Philips et al, 2020 ; Yager et al, 2020 ). Providers commented on the benefits that ensued – the care that was provided, the lives that were saved, the relationships that were built, the knowledge that was gained, and the recognition that pediatric providers are equipped to care for adult patients ( Joyce et al, 2020 ; Levy et al, 2020 ; Philips et al, 2020 ). This study adds to the current literature on pediatric providers caring for adult patients and provides an understanding of what pediatric nurses' experiences were like amidst the changes, the challenges, and the benefits.…”

“…The COVID-19 pandemic presented a public health emergency as an influx in adult cases was seen and hospitals" capacities were insufficient. Many institutions repurposed pediatric units and transitioned clinical practices to meet the needs of this global crisis (Joyce et al, 2020;Levy et al, 2020;Philips et al, 2020;Yager et al, 2020). Reports described the transformation of pediatric units, with physical spaces converted, staffing models restructured, and supplies and equipment replaced or adjusted for adult use (Joyce et al, 2020;Levy et al, 2020;Philips et al, 2020).…”