Beyond ventilatory support: challenges in general practice and in the treatment of critically Ill children and adolescents with SARS-CoV-2 infection

Abstract

<jats:p>SUMMARY Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery.</jats:p>

Update on the diagnosis and management of COVID-19 in pediatric patients

“…Ground-glass opacities and consolidation may be observed in severe cases. Lesions are most often bilateral, peripheral, and lower-zone predominant and pleural effusion is uncommon (3%) ( 18 - 22 ).…”

“…Advanced COVID-19 pneumonia is characterized by evident consolidation, particularly in the posterobasal regions. Possible findings include multiple B-lines (ranging from focal to diffuse with spared areas, representing thickened subpleural interlobular septa); irregular, thickened pleural line with scattered discontinuities; and subpleural consolidations and alveolar consolidation, with restitution of aeration during recovery (reappearance of bilateral A-lines) ( 22 , 23 ).…”

“…Children presenting with severe infection may show bilateral lobar consolidation ( 2 ). CT imaging of COVID-19 infection should be differentiated from other viral pneumonia caused by influenza virus, parainfluenza virus, respiratory syncytial virus, and adenovirus ( 20 - 22 , 24 ).…”

Success of multiprofessional management of non-invasive ventilation: positive covid-19 pediatric case report

“…Transmission of infection occurs by inhaling droplets, aerosols or direct contact with contaminated surfaces. [5][6][7] Due to the risks of viral contamination of the environment and the multidisciplinary team; in view of the initial lack of knowledge about individual protection methods and what would be the appropriate environment for the use of non-invasive ventilatory support, the use of NIV was initially contraindicated in cases of COVID-19 that deal with AVF. 6 However, based on the definition of professional biosafety care and the course of the disease, NIV was indicated in specific clinical cases, which have moderate AVF (SpO2 / FiO2 ratio between 221-264) during a 60-90 minutes, with the patient being monitored in a private room (preferably with negative pressure), provided that NIV is applied: through the interface of the total unventilated face; use of level 3 PPE by professionals; use of double branch NIV devices with HEPA filter in the expiratory branch or HMEF close to the interface.…”

“…6 However, based on the definition of professional biosafety care and the course of the disease, NIV was indicated in specific clinical cases, which have moderate AVF (SpO2 / FiO2 ratio between 221-264) during a 60-90 minutes, with the patient being monitored in a private room (preferably with negative pressure), provided that NIV is applied: through the interface of the total unventilated face; use of level 3 PPE by professionals; use of double branch NIV devices with HEPA filter in the expiratory branch or HMEF close to the interface. [7][8][9] Thus, the objective of this article is to report a clinical case of a complex chronic child with COVID-19, who developed moderate AVF who was successful in using NIV during his stay in a(PICU) referenced for care of pediatric patients with moderate, severe or critical SARS-CoV-2 infection.…”