Rapid Transition of a PICU Space and Staff to Adult Coronavirus Disease 2019 ICU Care

Abstract

Objectives: We describe the process by which a PICU and a PICU care team were incorporated into a hospital-wide ICU care model during the coronavirus disease 2019 pandemic. Design: A descriptive, retrospective report from a single-center PICU. Setting: Twenty-three bed, quaternary PICU, within an 862-bed hospital. Patients: Critically ill adults, with coronavirus disease 2019-related disease. Interventions: ICU care provided by pediatric intensivists with training and support from medical intensivists. Measurements and Main Results: Within the context of the institution’s comprehensive effort to centralize and systematize care for adults with severe coronavirus disease 2019 disease, the PICU was transitioned to an adult coronavirus disease 2019 critical care unit. Nurses and physicians underwent just-in-time training over 3 days and 2 weeks, respectively. Medical ICU physicians and nurses provided oversight for care and designated hospital-based teams were available for procedures and common adult emergencies. Over a 7-week period, the PICU cared for 60 adults with coronavirus disease 2019-related critical illness. Fifty-three required intubation and mechanical ventilation for a median of 18 days. Eighteen required renal replacement therapy and 17 died. Conclusions: During the current and potentially in future pandemics, where critical care resources are limited, pediatric intensivists and staff can be readily utilized to meaningfully contribute to the care of critically ill adults.

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.…”

“…Most of the PICUs of the general hospitals took some of these actions during the first year of the pandemic [ [19] , [20] , [21] , [22] , [23] , [24] ]. Other centers chose to open COVID-19 adult beds in PICUs for non-acute care, like long-term MV, weaning from MV, management of non-COVID-related complications, or low complexity step-down unit.…”

COVID-19 in Children

“…Surges of this pandemic which caused acute shortage of ICU beds worldwide resulted in many PICU teams providing care for adults with COVID-19 in addition to children with severe acute COVID-19. 86 , 87 Hospitals must develop protocols for implementation in their critical care units based on their needs and resources with emphasis on minimizing the spread of virus while still providing excellent patient care.…”

PICU in the MICU

“…1 In the first waves of the pandemic, PICUs in many centers modified their admission criteria to assume care of younger adult patients, decompressing adult ICUs and increasing critical care capacity in their regions. 2 In general, COVID-19 in children has been less severe, with less direct impact on pediatric hospital care than in adult settings. 3 In the summer of 2021, this situation changed.…”