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

Abstract

Purpose We aim to describe the action plan and clinical results of a COVID-19 unit for adult patient care in units intended for critically ill children, proposing a clinical/administrative framework. Methods We reviewed the preparedness of the PICU team before the surge of cases of COVID-19 and the organizational/administrative issues to increase critical beds in a six-bed PICU allocated to adult critical care in a government-funded general hospital in Latin America. We analyzed the prospectively collected administrative/clinical data of severe COVID-19 cases admitted to PICU during the peak of the first wave of the pandemic. Results We describe a 6-step preparedness plan: recruitment and education, admission criteria, children diversion, team hierarchy, and general and respiratory equipment. The 6-bed PICU was allocated to adult care for 20 weeks, progressively increasing capacity to a 23-bed dedicated COVID-19 unit managed by the PICU team. A six-block bed organizational units were implemented, and personnel increased from 40 to 125 healthcare workers in 24 h shifts. COVID-19 incidence in personnel was 0.5/1000 workdays. One hundred thirty-six patients were admitted, median age 59 (51,65) years old, 68% were male, and 63% had P/F ≤ 100. In addition, 48% received mechanical ventilation, the median length of stay was 7 (3,17), and in-hospital mortality was 15%. Conclusions We propose an organizational framework for the role of PICU in the hospital action plan to increase adult critical beds. The cohort of patients admitted to a PICU repurposed as a COVID-19 ICU had good outcomes. These data are valuable to plan coordinated actions of the healthcare system for future scenarios.

Patient care in rapid-expansion intensive care units during the COVID-19 pandemic crisis

“…Prolonged LoS in an ICU is associated with ICU-acquired weakness (“deconditioning”) which can result in profound functional impairment [ 41 ], and so the higher incidence of discharge to rehabilitation facilities in the Expansion-ICU population might reasonably be expected. Our results are a clear demonstration that “repurposing” of resources can in fact provide safe and effective care, and support in principle the approach advocated by Diaz et al for repurposing pediatric ICUs to adult critical care units [ 42 ].…”

Pediatric capacity crisis: A framework and strategies to prepare for a pediatric surge

“…During the COVID‐19 pandemic, United States hospitals expanded credentialing to enable pediatricians to care for adults with COVID‐19 17 . In other countries, national exceptions facilitated pediatricians caring for adult patients 18 . Similarly, during times of pediatric capacity crisis, national exceptions could enable clinicians with only adult training to be quickly credentialed to care for children, particularly older adolescents.…”

“…During the early COVID‐19 pandemic as there were surges in adult volumes, many hospitals converted PICU beds to adult ICUs 18,35,36 . However, nationally, only approximately 6% of non‐neonatal ICU beds are PICU beds 37 .…”

Infancia y COVID-19: Los efectos indirectos de la pandemia COVID-19 en el bienestar de niños, niñas y adolescentes

“…El aumento de recursos monetarios, humanos y tecnológicos para el manejo de casos de COVID-19 en adultos con falla respiratoria en la red integrada público/privada, estuvo acompañada de cierre de servicios de urgencia pediátricos, centros ambulatorios de pediatría general, especialidades y Unidades de Cuidados Intensivos 28 . Afortunadamente, las medidas de distanciamiento físico produjeron una gran caída de las enfermedades infecciosas infantiles, disminuyendo las consultas en los servicios de urgencia y las hospitalizaciones pediátricas 1,3,4,28 . En paralelo, los NNA con enfermedades crónicas tuvieron un pobre control con profesionales de la salud, como pacientes con diabetes mellitus tipo I y epilepsia, produciendo descompensaciones por falta de supervisión y disponibilidad oportuna de medicamentos.…”