Repurposing a PICU for Adult Care in a State Mandated COVID-19 Only Hospital: Outcome Comparison to the MICU Cohort to Determine Safety and Effectiveness
Open Access
- 14 May 2021
- journal article
- research article
- Published by Frontiers Media SA in Frontiers in Pediatrics
- Vol. 9, 665350
- https://doi.org/10.3389/fped.2021.665350
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.This publication has 21 references indexed in Scilit:
- Clinical Characteristics of Coronavirus Disease 2019 in ChinaThe New England Journal of Medicine, 2020
- Double Environmental Injustice — Climate Change, Hurricane Dorian, and the BahamasThe New England Journal of Medicine, 2020
- Growth and Changing Characteristics of Pediatric Intensive Care 2001–2016Critical Care Medicine, 2019
- Age Limit of PediatricsPEDIATRICS, 2017
- Critical Care Bed Growth in the United States. A Comparison of Regional and National TrendsAmerican Journal of Respiratory and Critical Care Medicine, 2015
- Pandemic H1N1 in Children Requiring Intensive Care in Australia and New Zealand During Winter 2009PEDIATRICS, 2011
- Epidemiology of 2009 Pandemic Influenza A (H1N1) Deaths in the United States, April-July 2009Clinical Infectious Diseases, 2010
- Derivation and validation of Spo2/Fio2 ratio to impute for Pao2/Fio2 ratio in the respiratory component of the Sequential Organ Failure Assessment score*Critical Care Medicine, 2009
- A National Survey of Pediatric Critical Care Resources in the United StatesPEDIATRICS, 2005
- Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care unitsCritical Care Medicine, 1998