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

Levin, Amanda; Bernier, Meghan; Zero, Stephanie D; Johnson, Emily; Brant, Katelyn N; Dwyer, Joe; Potter, Caroline; Pustavoitau, Aliaksei; Lentz, Thomas A; Warren, Emily; Milstone, Aaron M.; Schwartz, Jamie McElrath

doi:10.1097/cce.0000000000000201

Cited by 19 publications

(27 citation statements)

References 10 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2021

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Objective: The ongoing coronavirus 2019 (COVID-19) pandemic is disproportionally impacting the adult population. This study describes the experiences after repurposing a PICU and its staff for adult critical care within a state mandated COVID-19 hospital and compares the outcomes to adult patients admitted to the institution's MICU during the same period.Design: A retrospective chart review was performed to analyze outcomes for the adults admitted to the PICU and MICU during the 27-day period the PICU was incorporated into the institution's adult critical care surge plan.Setting: Tertiary care state University hospital.Patients: Critically ill adult patients with proven or suspected COVID-19.Interventions: To select the most ideal adult patients for PICU admission a tiered approach that incorporated older patients with more comorbidities at each stage was implemented.Measurements and Main Results: There were 140 patients admitted to the MICU and 9 patients admitted to the PICU during this period. The mean age of the adult patients admitted to the PICU was lower (49.1 vs. 63.2 p = 0.017). There was no statistically significant difference in the number of comorbidities, intubation rates, days of ventilation, dialysis or LOS. Patients selected for PICU care did not have coronary artery disease, CHF, cerebrovascular disease or COPD. Mean admission Sequential Organ Failure Assessment (SOFA) score was lower in patients admitted to the PICU (4 vs. 6.4, p = 0.017) with similar rates of survival to discharge (66.7 vs. 44.4%, p = 0.64).Conclusion: Outcomes for the adult patients who received care in the PICU did not appear to be worse than those who were admitted to the MICU during this time. While limited by a small sample size, this single center cohort study revealed that careful assessment of critical illness considering age and type of co-morbidities may be a safe and effective approach in determining which critically ill adult patients with known or suspected COVID-19 are the most appropriate for PICU admission in general hospitals with primary management by its physicians and nurses.

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Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Of the 19 colleagues constituting our Anesthesia/ICU Service, 4 only kept on working in the OR and 15 were employed in the ICU. This sudden move from children to adult care has been described in other countries too 25 …”

Section: Discussionmentioning

confidence: 67%

Organizational aspects of pediatric anesthesia and surgery between two waves of Covid‐19

Camporesi

Melloni

Diotto

et al. 2021

Acta Anaesthesiol Scand

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Background The initial wave of the Covid‐19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals, although the young population seemed initially spared from the disease. “Vittore Buzzi” Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), had to stop elective procedures—with the exception of urgent/emergent ones—between February and May 2020 to leave space and resources to adults' care. We describe the challenges of reshaping the hospital's identity and structure, and restarting pediatric surgery and anesthesia, from May on, in the most hit area of the world, with the purpose to avoid and contain infections. Both patients and caregivers admitted to hospital have been tested for Sars‐CoV‐2 in every case. Methods Observational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS‐CoV ‐2 RT‐PCR testing outcomes, and comparison to same period surgeries in 2019. Results An increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33‐2.13], P < .001) and a higher increase in the number of surgeries were reported (OR 1.75 (1.43‐2.15), P < .001). Considering only urgent procedures, a significant difference in the distribution of the type of surgery was observed (Chi‐squared P ‐value < .001). Sars‐CoV‐2‐positive patients have been 0.8% of total number; 14% of these was discovered through caregiver's positivity. Conclusion We describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.

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“…One potential explanation for this is the need for surge capacity planning that required pediatric ICUs to admit adult patients with COVID-19 ( Figure 3). 1,2 This is particularly evident in the early period of our survey (March -May 2020).…”

Section: Discussionmentioning

confidence: 74%

The effect of COVID-19 on critical care research during the first year of the pandemic: A prospective longitudinal multinational survey

Duffett

Cook

Strong

et al. 2020

Preprint

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Importance: The COVID-19 pandemic has increased the need for high-quality evidence in critical care, while also increasing the barriers to conducting the research needed to produce such evidence. Objective: To determine the effect of the first wave of the COVID-19 pandemic on critical care clinical research. Design: Monthly electronic survey (March - August 2020). Setting: Adult or pediatric intensive care units (ICUs) from any country participating in at least one research study before the COVID-19 pandemic. Participants: We recruited one researcher or research coordinator per center, identified via established research networks. Intervention(s): None Main Outcome(s) and Measure(s): Primary: Suspending recruitment in clinical research; Secondary: impact of specific factors on research conduct (5-point scales from no effect to very large effect). We assessed the association between research continuity and month, presence of hospitalized patients with COVID-19, and population (pediatric vs. adult ICU) using mixed-effects logistic regression. Results: 126 centers (56% pediatric) from 23 countries participated. 95 (75%) of centers suspended recruitment in at least some studies and 37 (29%) suspended recruitment in all studies on at least one month. The proportion of centers reporting recruitment in all studies increased over time (OR per month 1.3, 95% CI 1.1 to 1.5, p = 0.007), controlling for hospitalized patients with COVID-19 and type of ICU (pediatric vs. other). The five factors most frequently identified as having a large or very large effect on clinical research were: local prioritization of COVID-19 specific research (68, 54%), infection control policies limiting access to patients with COVID-19 (61, 49%), infection control policies limiting access to the ICU (52, 41.6%), increased workload of clinical staff (38, 30%), and safety concerns of research staff (36, 29%). Conclusions and Relevance: Decisions to pause or pursue clinical research varied across centers. Research activity increased over time, despite the presence of hospitalized patients with COVID-19. Guiding principles to safely sustain research during this and future pandemic waves are urgently needed.

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

Abstract: Supplemental Digital Content is available in the text.

Cited by 19 publications

References 10 publications

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

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

Organizational aspects of pediatric anesthesia and surgery between two waves of Covid‐19

The effect of COVID-19 on critical care research during the first year of the pandemic: A prospective longitudinal multinational survey

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