COVID-19 PICU guidelines: for high- and limited-resource settings

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Public health

Background:

• COVID-19 affects children differently than adults, with some developing critical illness.
• Multisystem inflammatory syndrome in children (MIS-C) is a serious condition requiring intensive care.
• Children with co-morbidities are at higher risk for severe COVID-19 outcomes.

Purpose of the Study:

• To develop evidence-based guidelines for the intensive care of critically ill children with SARS-CoV-2 infection.
• To address gaps in evidence with consensus-based recommendations.
• To harmonize pediatric COVID-19 intensive care strategies globally.

Main Methods:

• International collaboration to review existing evidence on pediatric COVID-19.
• Development of consensus-based guidelines where evidence was lacking.
• Inclusion of data summaries from different global regions.

Main Results:

• 44 recommendations generated for pediatric COVID-19 patients with respiratory failure, sepsis, cardiac arrest, MIS-C, and those needing adjuvant therapies or ECMO.
• Evidence on milder pediatric disease patterns and potential therapeutic uses (repurposed antivirals, anti-inflammatories, anti-thrombotics) is discussed.
• Guidelines are adaptable for both high- and limited-resource settings.

Conclusions:

• These guidelines represent the latest evidence for managing critically ill children with SARS-CoV-2.
• Adherence to these guidelines can reduce morbidity and mortality in pediatric COVID-19 cases.
• The recommendations aim to standardize and improve intensive care for children worldwide.