1
|
Brisca G, Tardini G, Pirlo D, Romanengo M, Buffoni I, Mallamaci M, Carrato V, Lionetti B, Molteni M, Castagnola E, Moscatelli A. Learning from the COVID-19 pandemic: IMCU as a more efficient model of pediatric critical care organization. Am J Emerg Med 2023; 64:169-173. [PMID: 36563501 PMCID: PMC9758757 DOI: 10.1016/j.ajem.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A significant proportion of children with SARs-CoV-2-related illnesses have been admitted to the Pediatric intensive care unit (ICU), although often for closer monitoring or concerns related to comorbidities or young age. This may have resulted in inappropriate ICU admissions, waste of resources, ICU overcrowding, and stress for young patients and caregivers. The Pediatric Intermediate Care Unit (IMCU) may represent an appropriate setting for the care of children whose monitoring and treatment needs are beyond the resources of a general pediatric ward, but who do not qualify for critical care. However, research on pediatric IMCUs and data on their performance is very limited. METHODS We conducted a single-center retrospective study including all patients aged 0-18 with acute COVID-19 or multisystem inflammatory syndrome in children (MIS-C), admitted to a newly established stand-alone 12-bed pediatric IMCU at Gaslini Hospital, Genoa, Italy, between 1 March 2020 and 31 January 2022. Each IMCU room has a multiparameter monitor connected to a control station and can be equipped as an ICU room in case of need for escalation of care, up to ECMO support. IMCU and ICU are adjacent and located on the same floor, allowing a timely escalation from intermediate to critical care in the IMCU, with staff changes without the need for patient transfer. RESULTS Among 550 patients hospitalized for acute COVID-19 or MIS-C, 106 (19.2%, 80 with acute COVID-19, and 26 MIS-C) were admitted to IMCU. Three of them (2.8%) required escalation to critical care due to the worsening of their conditions. Forty-seven patients (44%) were discharged home from the IMCU, while the remaining 57 (55%) were transferred to low-intensity care units after clinical improvement. CONCLUSIONS In our study, the need for pediatric ICU admission was low for both acute COVID-19 patients (0.8%) and MIS-C patients (3.1%) compared to the literature data. The IMCU represented an adequate setting for children with COVID-19-related illness who need a higher level of care, but lack strict indications for ICU admission, thus preventing ICU overcrowding and wasting of economic and logistical resources. Further studies are needed to better assess the impact of an IMCU on hospital costs, ICU activity, and long-term psychological sequelae on children and their families.
Collapse
Affiliation(s)
- Giacomo Brisca
- Terapia Semintensiva, IRCCS Istituto Giannina Gaslini, Genoa, Italy,Corresponding author at: Terapia Semintensiva, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Giacomo Tardini
- Terapia Semintensiva, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniela Pirlo
- Terapia Semintensiva, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Romanengo
- Terapia Semintensiva, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Isabella Buffoni
- Terapia Semintensiva, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marisa Mallamaci
- Terapia Semintensiva, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Barbara Lionetti
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Marta Molteni
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Elio Castagnola
- Unità di Malattie Infettive, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Moscatelli
- Terapia Semintensiva, IRCCS Istituto Giannina Gaslini, Genoa, Italy,Terapia Intensiva Pediatrica e Neonatale, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| |
Collapse
|
2
|
Benhamou D, Fuchs F, Mercier FJ. Obstetric critical care patients in France: Admission shift from general intensive care units (ICU) to general high-dependency units (HDU) and now to obstetric high-dependency units (OHDU)? Anaesth Crit Care Pain Med 2020; 38:331-333. [PMID: 31345408 DOI: 10.1016/j.accpm.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- D Benhamou
- Département d'Anesthésie-Réanimation, Groupe Hospitalier (AP-HP) et Faculté de Médecine Paris Sud, Hôpital Bicêtre, 78 rue du Général Leclerc, Le Kremlin-Bicêtre cedex, 94270, France.
| | - F Fuchs
- Service de Gynécologie Obstétrique, CHU de Montpellier, Hôpital Arnaud de Villeneuve, 371, av. du Doyen Gaston Giraud, Montpellier cedex 5, 34295, France
| | - F J Mercier
- Département d'Anesthésie, Hôpital Antoine Béclère (Hôpitaux Universitaires Paris-Sud, AP-HP), 157, rue de la Porte de Trivaux, Clamart, 92140, France
| |
Collapse
|
3
|
Plate JDJ, Peelen LM, Leenen LPH, Hietbrink F. Validation of the VitalPAC Early Warning Score at the Intermediate Care Unit. World J Crit Care Med 2018; 7:39-45. [PMID: 30090705 PMCID: PMC6081388 DOI: 10.5492/wjccm.v7.i3.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/19/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the performance and clinical relevance of the Early Warning Scoring (EWS) system at the Intermediate Care Unit (IMCU).
METHODS This cohort study used all the VitalPAC EWS (ViEWS) scores collected during each nursing shift from 2014 through 2016 at the mixed surgical IMCU of an academic teaching hospital. Clinical deterioration defined as transfer to the Intensive Care Unit (ICU) or mortality within 24 h was the primary outcome of interest.
RESULTS A total of 9113 aggregated ViEWS scores were obtained from 2113 admissions. The incidence of the combined outcome was 272 (3.0%). The area under the curve of the ViEWS was 0.72 (CI: 0.69-0.75). Using a threshold value of six, the sensitivity was 68% with a positive predictive value of 5% and a number needed to trigger (e.g., false alarms) of 19%.
CONCLUSION The ViEWS at the IMCU has a discriminative performance that is considerably lower than at the hospital ward. The number of false alarms is high, which may result in alarm fatigue. Therefore, use of the ViEWS in its current form at the IMCU should be reconsidered.
Collapse
Affiliation(s)
- Joost DJ Plate
- Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
| | - Linda M Peelen
- Julius Center for Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
- Departments of Anaesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
| | - Luke PH Leenen
- Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
| | - Falco Hietbrink
- Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
| |
Collapse
|