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Akinkugbe O, Dhanani S, Watad S, Aravind PD, Pereira M, Dryden-Palmer K, Alnaji F, Bell C, Devine L, Fan E, Guerguerian AM, Helmers A, Lavigne M, Lee C, Maratta C, McKinnon NK, Neilipovitz D, Gilfoyle E. The care of critically ill adults with COVID-19 in Ontario pediatric intensive care units. Can J Anaesth 2023; 70:1660-1668. [PMID: 37537325 DOI: 10.1007/s12630-023-02535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE To describe and review the experience of two pediatric intensive care units (PICUs) in Ontario, Canada, adapting and providing care to critically ill adults during the COVID-19 pandemic. CLINICAL FEATURES At a time of extreme pressure to adult intensive care unit (ICU) capacity, two PICUs provided care to critically ill adults with COVID-19 pneumonia. Substantial yet rapid planning was required to facilitate safe delivery of critical care to adult patients while maintaining PICU services, including thoughtful development of care pathways and patient selection. To prepare clinical staff, several communication strategies, knowledge translation, skill consolidation, and system-adaptation mechanisms were developed. There was iterative adaptation of operational processes, including staffing models, specialist consultation, and the pharmacy. Care provided by the interprofessional teams was reoriented as appropriate to the needs of critically ill adults in close collaboration with adult ICU teams. Forty-one adults were admitted to the two PICUs over a 12-week period. In total, 36 patients (88%) received invasive ventilation, eight patients (20%) were supported with venovenous extracorporeal membrane oxygenation, and six patients (15%) received continuous renal replacement therapy. Four died in the PICU during this period. Feedback from staff included anxiety around reorienting practice to the care of critically ill adults, physical exhaustion, and psychological distress. Importantly, staff also reported a renewed sense of purpose with participation in the program. CONCLUSION Though challenging, the experience has provided opportunity to enhance collaboration with partner institutions and improve the care of older children and adolescents in the PICU.
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Affiliation(s)
- Olugbenga Akinkugbe
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
| | - Sonny Dhanani
- Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Salmas Watad
- Department of Pediatric Cardiac Critical Care Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Prasant D Aravind
- Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Myra Pereira
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Karen Dryden-Palmer
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Fuad Alnaji
- Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Chaim Bell
- Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Luke Devine
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eddy Fan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne-Marie Guerguerian
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Helmers
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Melanie Lavigne
- Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Christie Lee
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Christina Maratta
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicole K McKinnon
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Neilipovitz
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Elaine Gilfoyle
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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