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The Pediatric Intensive Care Unit as a Critical Care Setting for Adults during the COVID-19 Pandemic: A Service
Elizabeth J A Fitchett1,2, Matthew Rubens1, Katherine Styles1
1Pediatric Intensive Care Unit, Division of Women's, Children's and Clinical Support, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Insights
Adult COVID-19 patients treated in pediatric intensive care units (PICUs) had comparable outcomes to those in adult intensive care units (AICUs). This study shows the feasibility of repurposing PICUs for adult critical care during pandemics.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pandemic Response
Background:
- The COVID-19 pandemic necessitated expanding critical care capacity in the UK.
- Repurposing pediatric intensive care units (PICUs) for adult COVID-19 patients was a strategy employed.
- Limited data existed on the characteristics and outcomes of adult patients transferred to PICUs compared to standard adult intensive care units (AICUs).
Purpose of the Study:
- To evaluate the characteristics and outcomes of adult COVID-19 patients admitted to a PICU.
- To compare outcomes of adult patients treated in PICUs versus AICUs and theater recovery ICUs (RICUs).
- To assess the feasibility of utilizing non-traditional intensive care settings during a public health crisis.
Main Methods:
- Retrospective data collection of adult COVID-19 intensive care admissions between March and May 2020.
- Analysis of patient characteristics, illness severity, organ support duration, ICU stay, and 30-day mortality.
- Comparison of outcomes between PICU, AICU, and RICU using logistic regression, adjusting for confounders.
Main Results:
- Eighty-eight adult COVID-19 patients were included: 15 in PICU, 57 in AICU, and 16 in RICU.
- Patient characteristics and illness severity were comparable across the three intensive care unit types.
- No significant difference in 30-day mortality was observed between adult patients in PICU versus AICU/RICU (OR 0.46, 95% CI 0.12-1.85; p=0.276).
Conclusions:
- Repurposing PICUs for adult COVID-19 care is feasible and demonstrates comparable outcomes to AICUs.
- Pediatric intensive care units can serve as viable alternative critical care spaces during pandemics.
- This strategy highlights the adaptability of healthcare systems to manage surges in critical care demand.
Abstract:
One strategy to expand critical care capacity during the coronavirus disease 2019 (COVID-19) pandemic within the United Kingdom has been to repurpose other clinical departments, including the pediatric intensive care unit (PICU) and pediatric multidisciplinary team, to accommodate critically unwell adult patients. While multiple PICUs have treated adult patients with COVID-19, there is an absence of data on the characteristics of patients transferred to pediatric care and their resulting outcomes in comparison to standard adult intensive care unit (AICU) provision. Data were collected for all adult COVID-19 intensive care admissions between March and May 2020, in three ICUs within a single center: PICU, AICU, and theater recovery ICU (RICU). Patient characteristics, severity of illness, and outcomes were described according to the ICU where most of their bed-days occurred. Outcomes included duration of organ support and ICU admission, and mortality at 30 days. Mortality was compared between patients in PICU and the other adult ICUs, using a logistic regression model, adjusting for known confounding variables. Eighty-eight patients were included: 15 (17.0%) in PICU, 57 (64.7%) in AICU, and 16 (18.1%) in RICU. Patients' characteristics and illness severity on admission were comparable across locations, with similar organ support provided. Ten (66.7%) patients survived to hospital discharge from PICU, compared with 27 (47.4%) and nine (56.3%) patients from AICU and RICU, respectively, with no significant difference in 30-day mortality (OR 0.46, 95% CI 0.12-1.85; p = 0.276). Our analysis illustrates the feasibility of evaluating outcomes of patients who have been cared for in additional, emergency ICU beds, whilst demonstrating comparable outcomes for adults cared for in pediatric and adult units.
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