Children's Hospital ICU Resource Allocation in an Adult Pandemic.

Abstract

* Abbreviation: COVID-19 — : coronavirus disease 2019 Imagine the following situation: A 25-year-old is intubated in the emergency department for coronavirus disease 2019 (COVID-19)–related acute respiratory distress syndrome. The adult ICU is full. The nearby PICU has many available beds and staff. The pediatric intensivist and their administrators must decide how to respond. Do ethical considerations permit, require, or forbid extending PICU care to this adult patient? Two features of the COVID-19 pandemic make situations like this increasingly likely. First, there is significant variation in disease incidence. Adults are at much higher risk of serious COVID-19–related illness requiring ICU care than are children.1,2 Children generally have had fewer infections and milder disease.3,4 Second, there is significant variation in available capacity. According to the Society of Critical Care Medicine, there are only 68 558 adult ICU beds, 5137 PICU beds, 22 901 NICU beds, 25 157 step-down beds, and 1183 burn beds in the United States today.5 In a moderate or severe outbreak, with tens of thousands of adults requiring ICU care,1 the need will quickly outstrip available resources.6 Children’s hospitals, by contrast, likely will have surplus capacity. We are at the end of the typical influenza and respiratory syncytial virus seasons. We have canceled nearly all elective surgery nationwide, easing demand for postoperative care in the PICU. This has left … Address correspondence to Ian D. Wolfe, PhD, RN, CCRN, Children’s Mercy Bioethics Center, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: wolfe370{at}umn.edu