Abstract
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.
Highlights
The ongoing coronavirus 2019 (COVID-19) pandemic, unlike previous respiratory pandemics, is disproportionally impacting adults as compared to children [1,2,3]
140 patients were admitted to the medical ICU (MICU) and 9 patients were admitted to the Pediatric Intensive Care Unit (PICU)
All patients in the PICU cohort were Black/African American compared to 87% in the MICU
Summary
The ongoing coronavirus 2019 (COVID-19) pandemic, unlike previous respiratory pandemics, is disproportionally impacting adults as compared to children [1,2,3]. Many jurisdictions throughout the United States have implemented crisis standards of care due to the tremendous surge of adults with COVID19 requiring Intensive Care Unit (ICU) admission This is concerning because crisis standards limit the ability to provide every therapeutic option and may result in increased mortality [2, 4]. Attention is directed to the use of Pediatric Intensive Care Unit (PICU) beds, which comprise roughly 7.5% of all ICU beds. [5, 6] Since children represent 1– 2% of COVID-19 cases, with only 0.58–2% of those requiring critical care, PICU assets may be best utilized to augment adult ICU capacity [7]. 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]
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