Chomton Maryline, Marsac Lucile, Deho Anna, Maroni Arielle, Geslain Guillaume, Frannais-Haverland Karine, Nicolas-Robin Armelle, Levy Michaël
Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Anesthesiology Department, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Eur J Pediatr. 2021 Jul;180(7):2319-2323. doi: 10.1007/s00431-021-03992-6. Epub 2021 Feb 26.
During the first Covid-19 wave, our paediatric intensive care unit (PICU), like many others across the globe, was transformed into an adult ICU for patients with severe Covid-19, due to a shortage of adult ICU beds. Here, we provide a comprehensive description of all the conditions that must be fulfilled to successfully accomplish this transformation. Strong support from all hospital departments was crucial, as their activity was modified by the change. Healthcare workers from various units, notably the paediatric anaesthesiology department, worked in the adult ICU to ensure sufficient staffing. The number of physiotherapists and psychologists was increased. A support system for both healthcare workers and patients' relatives was set up with the help of the mobile paediatric palliative care and support team. Supplies suitable for adults were ordered. Protocols for numerous procedures were written within a few days. Video tutorials, checklists, and simulation sessions were circulated to the entire staff. The head nurses guided and supported the new staff and usual PICU staff. The transformation was achieved within a week. The main difficulties were healthcare worker stress, changes in recommendations over time, absence of visits from relatives, and specific adult issues that paediatricians are unfamiliar with.Conclusion: For the staff, caring for adult patients was made easier by working in their familiar unit instead of being moved to an adult hospital with unfamiliar staff members and equipment. Strong support from the hospital and the assistance of consultants from adult hospital departments were crucial. What is Known: • The dramatic spread across the world of coronavirus disease 2019 generated critical care needs that drastically exceeded resources in many countries worldwide. • Paediatric ICU activity during this period decreased due to lockdown measures and the fact that children rarely required ICU for coronavirus disease 2019. What is New: • We describe how an 18-bed adult Covid-19 ICU was successfully set up in a paediatric hospital during the first wave of the Covid-19 pandemic. • Specific requirements regarding supply, human resources, and procedures, as well as difficulties encountered, are described.
在新冠疫情的第一波高峰期，由于成人重症监护病房床位短缺，我们的儿科重症监护病房（PICU）和全球许多其他儿科重症监护病房一样，被改造成了收治重症新冠患者的成人重症监护病房。在此，我们全面描述了成功完成这一转变必须满足的所有条件。医院各科室的大力支持至关重要，因为转变改变了他们的工作。来自各个科室的医护人员，特别是儿科麻醉科的医护人员，在成人重症监护病房工作以确保充足的人员配备。物理治疗师和心理医生的数量增加了。在移动儿科姑息治疗和支持团队的帮助下，建立了针对医护人员和患者家属的支持系统。订购了适合成人使用的物资。在几天内就制定了众多操作流程的规范。视频教程、检查表和模拟培训课程分发给了全体员工。护士长指导并支持新员工和儿科重症监护病房的常规员工。一周内就完成了转变。主要困难包括医护人员的压力、建议随时间的变化、亲属无法探视以及儿科医生不熟悉的特定成人问题。结论：对于工作人员来说，在熟悉的科室照顾成人患者比转移到一个有陌生工作人员和设备的成人医院更容易。医院的大力支持以及成人医院科室顾问的协助至关重要。已知信息：• 2019年冠状病毒病在全球的急剧传播产生了重症监护需求，在全球许多国家，这一需求大大超过了资源供应。• 在此期间，由于封锁措施以及儿童很少因2019年冠状病毒病需要重症监护病房，儿科重症监护病房的业务量减少。新内容：• 我们描述了在新冠疫情第一波期间，一家儿童医院如何成功设立了一个拥有18张床位的成人新冠重症监护病房。• 描述了在物资供应、人力资源和操作流程方面的具体要求以及遇到的困难。
