Gist Ramon E, Pinto Rohit, Kissoon Niranjan, Ahmed Youssef E, Daniel Pia, Hamele Mitchell
Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
Department of Pediatrics and Emergency Medicine, British Columbia Children's Hospital and Sunny Hill Health Centre for Children, Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
Front Pediatr. 2021 May 14;9:665350. doi: 10.3389/fped.2021.665350. eCollection 2021.
The ongoing coronavirus 2019 (COVID-19) pandemic is disproportionally impacting the adult population. This study describes the experiences after repurposing a PICU and its staff for adult critical care within a state mandated COVID-19 hospital and compares the outcomes to adult patients admitted to the institution's MICU during the same period. A retrospective chart review was performed to analyze outcomes for the adults admitted to the PICU and MICU during the 27-day period the PICU was incorporated into the institution's adult critical care surge plan. Tertiary care state University hospital. Critically ill adult patients with proven or suspected COVID-19. To select the most ideal adult patients for PICU admission a tiered approach that incorporated older patients with more comorbidities at each stage was implemented. There were 140 patients admitted to the MICU and 9 patients admitted to the PICU during this period. The mean age of the adult patients admitted to the PICU was lower (49.1 vs. 63.2 = 0.017). There was no statistically significant difference in the number of comorbidities, intubation rates, days of ventilation, dialysis or LOS. Patients selected for PICU care did not have coronary artery disease, CHF, cerebrovascular disease or COPD. Mean admission Sequential Organ Failure Assessment (SOFA) score was lower in patients admitted to the PICU (4 vs. 6.4, = 0.017) with similar rates of survival to discharge (66.7 vs. 44.4%, = 0.64). Outcomes for the adult patients who received care in the PICU did not appear to be worse than those who were admitted to the MICU during this time. While limited by a small sample size, this single center cohort study revealed that careful assessment of critical illness considering age and type of co-morbidities may be a safe and effective approach in determining which critically ill adult patients with known or suspected COVID-19 are the most appropriate for PICU admission in general hospitals with primary management by its physicians and nurses.
持续的2019冠状病毒病（COVID-19）大流行对成年人群的影响尤为严重。本研究描述了在一家因应州政府要求设立的COVID-19医院中，将儿科重症监护病房（PICU）及其工作人员重新调配用于成人重症监护后的情况，并将结果与同期入住该机构内科重症监护病房（MICU）的成年患者进行比较。进行了一项回顾性病历审查，以分析在PICU纳入该机构成人重症监护应急计划的27天期间入住PICU和MICU的成年患者的治疗结果。三级医疗州立大学医院。确诊或疑似COVID-19的成年重症患者。为了选择最适合入住PICU的成年患者，实施了一种分级方法，在每个阶段纳入合并症更多的老年患者。在此期间，有140名患者入住MICU，9名患者入住PICU。入住PICU的成年患者的平均年龄较低（49.1岁对63.2岁，P = 0.017）。在合并症数量、插管率、通气天数、透析或住院时间方面没有统计学上的显著差异。被选入PICU治疗的患者没有冠状动脉疾病、心力衰竭、脑血管疾病或慢性阻塞性肺疾病。入住PICU的患者的平均入院序贯器官衰竭评估（SOFA）评分较低（4分对6.4分，P = 0.017），出院生存率相似（66.7%对44.4%，P = 0.64）。在此期间，在PICU接受治疗的成年患者的结果似乎并不比入住MICU的患者差。虽然受样本量小的限制，但这项单中心队列研究表明，在综合考虑年龄和合并症类型的情况下，仔细评估危重病可能是一种安全有效的方法，可用于确定在由其医生和护士进行主要管理的综合医院中，哪些确诊或疑似COVID-19的成年重症患者最适合入住PICU。
