Holliday Kathryn, Horner Rebecca, Ramesh Pavanasam, Bebbington Mark B, Kanaris Constantinos
Children's Intensive Care Unit, University Hospitals of North Midlands, Stoke-On-Trent, United Kingdom.
Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
J Pediatr Intensive Care. 2021 Aug 20;13(3):214-220. doi: 10.1055/s-0041-1733944. eCollection 2024 Sep.
To accommodate the unprecedented demand for critical care beds during the first surge of the coronavirus disease 2019 (COVID-19) pandemic in the United Kingdom, hospitals had to adapt, restructure, and collaborate to provide the best possible care for the pediatric and adult populations. This single-center experience outlines the considerations our hospital took into account when planning for this restructure and the steps taken to ensure a successful execution of the task. Cross-specialty collaboration between the pediatric and adult critical care teams adopted a unique approach to care for only critically ill COVID-19 positive adult patients in the pediatric intensive care unit (PICU), transferring out critically unwell children at an early stage before the adult intensive care unit (AICU) became overwhelmed (nonhybrid model). This was designed to be in a staggered fashion, before allowing the AICU to overflow. This approach enabled the adult critical care team to support pediatric colleagues in learning the nuances of looking after critically ill adults prior to the service being saturated by the predicted supersurge. The success of the operation hinged on two things. First, PICU staff continuing to work in a familiar environment with their usual clinical team and second, the gradual and controlled admission of adult patients into PICU before the peak in demand for critical care beds. This design helped protect staff morale and build confidence in their new clinical role. The overall case fatality of invasively ventilated patients with COVID-19 in our hospital during the first surge was 32%, which is lower than the global average of 45%. This serves as evidence that this nonhybrid model is safe and sustainable.
为了应对2019年冠状病毒病（COVID-19）大流行第一波期间对重症监护床位前所未有的需求，英国的医院不得不进行调整、重组和协作，以便为儿科和成人患者提供尽可能好的护理。本单中心经验概述了我们医院在规划此次重组时所考虑的因素，以及为确保任务成功执行而采取的步骤。儿科和成人重症监护团队之间的跨专业协作采用了一种独特的方法，即在儿科重症监护病房（PICU）仅护理COVID-19检测呈阳性的成年重症患者，在成人重症监护病房（AICU）不堪重负之前尽早将病情严重的儿童转出（非混合模式）。这一做法设计为分阶段进行，然后才允许AICU接收溢出患者。这种方法使成人重症监护团队能够在服务被预测的超级高峰淹没之前，支持儿科同事了解护理成年重症患者的细微差别。该行动的成功取决于两件事。第一，PICU工作人员继续在熟悉的环境中与他们通常的临床团队一起工作；第二，在对重症监护床位需求达到峰值之前，逐步且可控地将成年患者收治入PICU。这种设计有助于保护工作人员的士气，并增强他们对新临床角色的信心。在第一波疫情期间，我院接受有创通气的COVID-19患者的总体病死率为32%，低于45%的全球平均水平。这证明这种非混合模式是安全且可持续的。
