Learning from pandemic: IMCU as a more efficient model of pediatric critical care organization

Abstract

Purpose:A variable proportion of children with COVID-19-related illness required pediatric intensive care admission (ICU), although, in many cases, only for monitoring, frequent and complex therapies, or for concerns related to relevant comorbidities or young age. This may have determined inappropriate admissions, waste of resources, ICU overcrowding and psychological effects on children and families. Pediatric Intermediate Care Unit (IMCU) may represent an appropriate unit to care for children who need monitoring and treatment beyond what can be offered in a general pediatric floor but do not qualify for pediatric ICU admission. Methods:We conducted a single-center retrospective study of all patients aged 0-18 with acute COVID-19 or meeting diagnostic criteria for multisystem inflammatory syndrome in children, admitted to a newly established pediatric IMCU at Gaslini Hospital, Genoa, Italy, between 1 March 2020 and 31 January 2022. Results:Among 550 patients hospitalized for acute COVID-19 or MIS-C, 106 (19.2%) were admitted to IMCU. Three patients (2.8%) needed escalation to intensive care. Overall, the need for pediatric ICU admission was considerably low for both acute COVID-19 patients (0.8%) and MIS-C patients (3.1%) compared to literature data. Conclusions: The IMCU represented an adequate setting for COVID-19 children who needed a higher level of care, but not requiring critical care, thus allowing better ICU bed utilization and cost savings. Further studies are needed to better assess the impact of an IMCU on hospital costs, ICU activity, and long-term psychological effect among children and their families.