Adult Admissions to a Canadian PICU during the COVID-19 Pandemic

Abstract

In response to the burden of coronavirus disease 2019 (COVID-19) and overwhelmed intensive care unit (ICU) resources, some pediatric intensive care units (PICUs) have had to adapt. The purpose of this study was to assess the criticality, scope of diagnosis, and outcomes of an adult cohort admitted to a Canadian PICU. A retrospective chart review was completed on all patients between 17 and 50 years of age admitted to the PICU between June 2020 and December 2021. Admission data included body mass index (BMI), admission sequential organ failure assessment score (SOFA), COVID-19 status, diagnosis, and comorbidities. The duration of ventilatory support, PICU and hospital admission, and mortality and discharge disposition were assessed. Discrete variables were reported as percentages and continuous data as means with standard deviations or medians with interquartile range. Sixty-five adult patients were admitted to the PICU for a total of 437 days, with a mean SOFA score of 6.6 and the overall mortality rate of 4.6%. Six patients were diagnosed with COVID-19 pneumonia, were admitted with a mean SOFA score of 11.8 and a BMI of 38.3 kg/m², and all were discharged to the ward. During the COVID-19 pandemic, pediatric intensivists in a Canadian PICU managed adult patients up to 50 years of age with high criticality and broad-ranging diagnoses with a low mortality rate. PICUs may be a safe critical care decompression option for adult ICUs during future endemics or pandemics.

Keywords

adult - Canada - COVID-19 pandemic - critically ill - pediatric intensive care unit - staffing

Publication History

Received: 06 January 2022

Accepted: 06 March 2022

Article published online:
20 June 2022

• References

• 1 Arabi YM, Azoulay E, Al-Dorzi HM. et al. How the COVID-19 pandemic will change the future of critical care. Intensive Care Med 2021; 47 (03) 282-291
• 2 Remy KE, Verhoef PA, Malone JR. et al. Caring for critically ill adults with coronavirus disease 2019 in a PICU: recommendations by dual trained intensivists. Pediatr Crit Care Med 2020; 21 (07) 607-619
• 3 Coetzee M. Are children really different from adults in critical care settings?. SAJCC 2005; 21: 70-76
• 4 Hernandez-Platero L, Sole-Ribalta A, Pons M, Jordan I, Cambra FJ. A paediatric intensive care unit's experience in managing adult patients with COVID-19 disease. An Pediatr (Engl Ed) 2021; (e-pub ahead of print) DOI: 10.1016/j.anpedi.2021.01.012.
• 5 Fernandes ND, Cummings BM, Naber CE. et al. Adult COVID-19 patients cared for in a pediatric ICU embedded in a regional biothreat center: disease severity and outcomes. Health Secur 2021; 19 (04) 442-446
• 6 Gist RE, Pinto R, Kissoon N, Ahmed YE, Daniel P, Hamele M. 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. Front Pediatr 2021; 9: 665350
• 7 Sinha R, Aramburo A, Deep A. et al. Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future. Arch Dis Child 2021; 106 (06) 548-557
• 8 Valiani S, Terrett L, Gebhardt C, Prokopchuk-Gauk O, Isinger M. Development of a framework for critical care resource allocation for the COVID-19 pandemic in Saskatchewan. CMAJ 2020; 192 (37) E1067-E1073
• 9 Isinger M, Hodgson-Viden H, Hansen G. Pediatric critical care resource allocation framework. Saskatchewan Health Authority 2020. Accessed February 8, 2022 at: https://www.saskhealthauthority.ca/sites/default/files/2021-10/Pediatric%20Critical%20Care%20Resource%20Allocation%20Framework%202021_0.pdf
• 10 Vincent JL, Moreno R, Takala J. et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996; 22 (07) 707-710
• 11 Sakr Y, Lobo SM, Moreno RP. et al; SOAP Investigators. Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome. Crit Care 2012; 16 (06) R222
• 12 Angus DC, Linde-Zwirble WT, Sirio CA. et al. The effect of managed care on ICU length of stay: implications for medicare. JAMA 1996; 276 (13) 1075-1082
• 13 Wu AW, Pronovost P, Morlock L. ICU incident reporting systems. J Crit Care 2002; 17 (02) 86-94
• 14 Young MP, Birkmeyer JD. Potential reduction in mortality rates using an intensivist model to manage intensive care units. Eff Clin Pract 2000; 3 (06) 284-289
• 15 Wang Y, Lu X, Li Y. et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med 2020; 201 (11) 1430-1434
• 16 Richardson S, Hirsch JS, Narasimhan M. et al; the Northwell COVID-19 Research Consortium. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020; 323 (20) 2052-2059
• 17 Chomton M, Marsac L, Deho A. et al; Robert-Debré University Hospital Study Group. Transforming a paediatric ICU to an adult ICU for severe Covid-19: lessons learned. Eur J Pediatr 2021; 180 (07) 2319-2323