Learning from the COVID-19 pandemic: IMCU as a more efficient model of pediatric critical care organization

Brisca, Giacomo; Tardini, Giacomo; Pirlo, Daniela; Romanengo, Marta; Buffoni, Isabella; Mallamaci, Marisa; Carrato, Valentina; Lionetti, Barbara; Molteni, Marta; Castagnola, Elio; Moscatelli, Andrea

doi:10.1016/j.ajem.2022.12.009

Cited by 3 publications

(4 citation statements)

References 20 publications

(25 reference statements)

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“…It is based on a retrospective review at a single tertiary children's hospital, thus limiting the value of our speculations. Moreover, our findings could be altered by the establishment in March 2020 in our Institute of a new stand‐alone pediatric intermediate care unit (IMCU), 33 adjacent but physically distinct from the Pediatric ICU, and covered by a separate medical and nursing staff. The IMCU provides a higher level of care than the pre‐existing general pediatric ward.…”

Section: Discussionmentioning

confidence: 84%

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How has the SARS‐CoV‐2 pandemic changed the epidemiology and management of acute bronchiolitis?

Brisca

Mariani

Buratti

et al. 2023

Pediatric Pulmonology

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Objective SARS‐COV‐2 pandemic profoundly impacted acute bronchiolitis epidemiology worldwide, especially respiratory syncytial virus (RSV) diffusion and the burden of disease, with remarkable implications on the management of health resources. We aimed to study the epidemiology and clinical course of bronchiolitis in the past 5 years in our region and to assess the trends that occurred during and after the SARS‐COV‐2 pandemic. Methods We conducted an observational study including all children aged 0–2 years with bronchiolitis admitted to a tertiary children's hospital during the last 5 years. Demographic, clinical, and microbiological data were collected. Comparisons between patient subgroups were carried out. Results A total of 647 patients admitted for bronchiolitis were included (median age 78 days). Molecular diagnostic tests were performed in 617 patients (95.4%) with RSV detected in 51.5% of patients in prepandemic years and 74.5% in pandemic years. Through the study period, we observed a progressive increase in the number of children requiring respiratory support, RSV infections, and children with a history of prematurity. Conversely, this was not true for mechanical ventilation, duration of respiratory support, intensive care unit admission, and length of stay. Conclusions Clinical course and epidemiology of bronchiolitis showed a significant change through the study years with a heavy impact during the 2021–2022 season. The increase in the number of patients requiring respiratory support, although not associated with an increase in mechanical ventilation, may be explained by the higher prevalence of RSV. The change in epidemiology highlights the importance of surveillance systems to monitor RSV circulation, to plan prophylactic strategies, and prepare healthcare systems.

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Section: Discussionmentioning

confidence: 84%

“…1175 pediatric intermediate care unit (IMCU),33 adjacent but physically distinct from the Pediatric ICU, and covered by a separate medical and nursing staff. The IMCU provides a higher level of care than the pre-existing general pediatric ward.…”

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confidence: 99%

How has the SARS‐CoV‐2 pandemic changed the epidemiology and management of acute bronchiolitis?

Brisca

Mariani

Buratti

et al. 2023

Pediatric Pulmonology

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“…It is equipped with 328 pediatric beds and 18–20 level‐IV beds in the pediatric intensive care unit (ICU) with critical care transport and extracorporeal membrane oxygenation (ECMO) retrieval capability. A new standing‐alone 12‐bed pediatric Intermediate Care Unit (IMCU) was also established in December 2020 12 …”

Section: Methodsmentioning

confidence: 99%

The increase of bronchiolitis severity in the 2022–2023 season in an Italian tertiary children's hospital: An isolated phenomenon or a warning sign?

Brisca,

Strati,

Buratti

et al. 2024

Pediatric Pulmonology

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AimRecent literature has shown epidemiological changes in bronchiolitis with an increased incidence in the post‐SARS‐CoV‐2 pandemic period but reports regarding disease severity are conflicting. We aimed to describe the epidemiology, disease severity, and microbiology of bronchiolitis during the 2022–2023 cold season compared to the previous 5 years.MethodsThis single‐center retrospective observational study at IRCCS Gaslini, Italy, included all children aged 0–2 years hospitalized for bronchiolitis from 1 September 2017 to 31 August 2023. Findings from the 2022–2023 season were compared to the previous 5 years.ResultsWe observed a statistically significant increase in the 2022–2023 season in the absolute number of bronchiolitis admissions. Children who required mechanical ventilation (MV) dramatically increased from a total of seven patients in the previous five seasons to 17 in the 2022–2023 season alone (p = .001). All other severity parameters significantly increased: the need for respiratory support (p = .002), the median length of stay (5 days vs. 4 days, p = .001), and the median duration of respiratory support (4 days vs. 3 days, p = .016).ConclusionsWe report a substantial increase in the severity of bronchiolitis in the season 2022–2023 with a remarkable number of previously healthy infants requiring MV. Further studies are needed to confirm whether our findings are an isolated phenomenon or part of a true global trend. Health systems need to be prepared and protective preventive measures should be implemented for all newborns.

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“…Seven pediatricians with extensive experience in pediatric emergency medicine, cover the IMCU 24/7 with a variable nurse-patient ratio of 1:3 to 1:4. Other details on the infrastructure, equipment, and organization of the IMCU have already been published (20).…”

Section: Methodsmentioning

confidence: 99%

Evaluating Treatment and Care Outcomes for Neuromuscular Diseases in a Pediatric Intermediate Care Setting

Brisca,

Strati,

Canzoneri

et al. 2024

Preprint

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Background Neuromuscular disorders (NMDs) represent a complex group requiring specialized care, often straddling the needs between general pediatric wards and Intensive Care Units (ICUs). Our research focuses on the role of a newly established pediatric Intermediate Care Unit (IMCU) in this context. Methods We conducted a single-center retrospective observational study, encompassing patients with NMDs admitted to the newly established pediatric IMCU at IRCCS Istituto Giannina Gaslini, Genoa, Italy, from January 2021 to June 2023. The study assessed demographics, clinical characteristics, therapeutic management, length of stay, and outcomes including mortality 28 days post-discharge. Results Sixty-three patients (median age 12, female 58.7%) were included. The majority of admissions were due to neurological issues (39.7%) and respiratory complications (22%), with a significant proportion of patients requiring initiation or potentiation of respiratory support (59%). Factors such as the presence of tracheostomy (p = 0.021), the need for antibiotics (p = 0.025), and parenteral nutrition (p = 0.026) were associated with ICU admissions while steroid treatment (p = 0.047) increased IMCU stay. Conclusions The establishment of the IMCU has shown promising results in managing NMDs patients, serving as a crucial step-down unit for ICU patients and a step-up unit for those with worsening conditions in low-intensity care units. It has led to decreased ICU admissions and shorter ICU stays, suggesting potential healthcare costs and patient comfort benefits. The study underscores the importance of pediatric IMCUs in providing specialized care for children with NMDs, balancing the need for intensive monitoring and treatment in a less intensive setting than an ICU.

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Learning from the COVID-19 pandemic: IMCU as a more efficient model of pediatric critical care organization

Cited by 3 publications

References 20 publications

How has the SARS‐CoV‐2 pandemic changed the epidemiology and management of acute bronchiolitis?

How has the SARS‐CoV‐2 pandemic changed the epidemiology and management of acute bronchiolitis?

The increase of bronchiolitis severity in the 2022–2023 season in an Italian tertiary children's hospital: An isolated phenomenon or a warning sign?

Evaluating Treatment and Care Outcomes for Neuromuscular Diseases in a Pediatric Intermediate Care Setting

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