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BACKGROUND AND AIM: Admission to PICU due to SARS-CoV2 infection in children is unfrequent. However there are few pediatric patients who may require intensive care management. The aim of our study was to describe characteristics and evolution of those patients admitted to Spanish PICUs due to SARS-CoV2 infection. METHOD(S): A multicentre nationwide prospective registry involving all Spanish PICUs was carried out between 1st of march 2020 and 30 November 2021. RESULT(S): During the study period 299 patients where admitted to the participating units. Median age was 8.9 years (IQR 4.4 -12.2). 208 patients (69,6%) where diagnosed of Multisystem Inflamatory Syndrome associated to SARS-CoV2 (MIS-C). 225 patients (75.3%) where previously healthy. Main reason for admission was shock (which was present in 55.9% of patients). Respiratory difficulty was present only in 40.8% of patients. 50.5% of patients required vasoactive drugs, which was more frequent among those presenting with MIS-C (66.5% vs 20.9%, p<0.001). Only 17.4% of patients required mechanical ventilation, which was less frequent in patients with MIS-C (11.1% vs 34.1% p<0.001). 9 patients (3%) included in the registry died. Death was more frequent among patients with previous diseases (9.6% vs 0.9%, p<0.001) and less frequent in those admitted due to MIS-C (0.5% vs 9.3%, p<0.001). CONCLUSION(S): MIS-C was the most frequent cause of admission to PICU in Spain related to SARS-CoV2 infection. Most patients were admitted presenting shock and required vasoactive drugs, but only a few mechanical ventilation. Mortality rate was low. Prognosis was more favourable in those admitted due to MIS-C.
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AIMS & OBJECTIVES: the COVID-19 pandemic has posed an unprecedented challenge for adult ICUs. With children relatively spared from the disease, pediatric intensive care resources have provided invaluable support. We describe the interventions carried out in a PICU and hypothesize they will be useful in the next pandemic wave. METHODS: description of interventions in a tertiary center PICU with 3036 COVID-19 patients admitted (283 to ICU) and 648 deaths until May 30th. RESULTS: interventions during the pandemic focused on: 1) protecting patients and healthcare workers within the PICU: open windows, rational PPE use and SARSCoV-2 testing, safety simulation-training (donning-doffing, video-assisted orotracheal intubation, bronchoalveolar lavage, communication in protected code blue), service rearrangement and teleworking to reduce exposure, differentiation of COVID-19 and COVID-19-free areas and limitation of aerosol-generating practices;2) allocation of the PICU medical team (18 attendings, 9 residents) in three different areas working in collaboration with adult intensivists and anesthesiologists: 6 attendings deployed to the adult ICU full time, 12 attendings worked in fixed teams and covered a 16-bed COVID-19 PICU (12 adult, 4 pediatric beds) and a 9-bed reanimation unit with non-COVID-19 critically ill children. Elective surgeries were canceled but emergency surgeries and transplants were performed. One full-time visitor per children was allowed. Table 1 shows relevant characteristics of patients admitted in this period. No-one from the medical team and 6/78 nurses resulted infected, all asymptomatic. CONCLUSIONS: although the first pandemic wave has impacted PICUs worldwide, an anticipated and multicomponent adaptive strategy may help optimize patient care and reduce healthcare worker infection rates.
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AIMS & OBJECTIVES: multisystem inflammatory syndrome in children (MIS-C) is a concerning entity associated to SARS-CoV-2 infection. Reported hospital and pediatric intensive care unit (PICU) admission rates are as high as 88% and 80% respectively. Cardiovascular involvement including shock, ventricular systolic dysfunction or coronary artery (CA) anomalies has been reported as a feature of MIS-C. Our objective is to describe the cardiovascular features of children with severe MIS-C during their admission PICU admission and up to 3-months follow-up. METHODS: single center observational retrospective study. RESULTS: seven children (1/7 female, median age of 10.6 years and range 4.8-13.8) were admitted between April 16th and May 5th 2020. SARS-CoV-2 infection diagnosis was made by respiratory reverse transcriptase polymerase chain reaction or serological tests. All children had shock that was treated with intravenous fluids (median 15 mL/Kg, range 10-30) and norepinephrine infusions (median dose 0.16 mcg/Kg, range 0.05-0.33). Left ventricular dysfunction on echocardiogram defined as a left ventricular ejection fraction (LVEF) < 55% was present in 2/7 patients during PICU admission and 4/7 had CA anomalies. 2/7 patients had altered EKGs (diffuse altered repolarization and prolonged PR interval). Troponin-I was elevated in 7/7 (median 107.3 ng/L, range 30-355) as was N-terminal pro-brain natriuretic peptide (median 12,033 pg/mL, range 1071-34547). All patients had normal LVEF and CAs at 1, 2 and 3-months follow-up. 1/7 patient had an altered EKG at 1-month follow-up that resolved later. CONCLUSIONS: cardiac involvement in severe MIS-C appears to be common and severe but limited in time and with good outcomes.
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INTRODUCTION: In April 2020, the COVID-19 pandemic saw a rise in the number of children with a multi-system hyperinflammatory disease with myocardial involvement and characteristics of toxic shock syndrome, Kawasaki Disease Shock Syndrome, atypical Kawasaki disease. Clinicians turned to social media to discuss what they were seeing and several names for this new syndrome were used, including Paediatric Multisystem Inflammatory Syndrome - Temporally Associated with SARSCoV- 2 and MIS-C. The use of these different names and hashtags may have affected the discussion and ability to share information. Our goal was to examine the real-time conversation on Twitter related to the discovery of this new syndrome. METHODS: We examined conversations occurring on Twitter in the pediatric critical care (PCC) community by examining hashtags associated with #PedsICU. Symplur Signals was used to identify the MIS-C related hashtags. We examined the digital footprint containing those hashtags including stakeholders, frequency of use, and the most commonly tweeted links. RESULTS: Between April 1st and July 21st 2020, there were 50,628 tweets by 13,411 users in the #PedsICU dataset resulting in 128,609,673 impressions. Thirteen new hashtags were identified related to MIS-C in 3664 tweets by 1391 users;#PIMSTS and #MISC were the most commonly used in 3085 (84%) of these tweets. Although #PIMSTS was promoted more in the UK and #MISC in the US, there were no significant differences in usage by country. Of the users tweeting with these MIS-C related hashtags, 39% were healthcare providers, 23% were physicians, and 6% were healthcare organizations. The five most commonly shared links were shared 248 times and included links to research articles, government guidelines, news articles, and a review blog. Peaks of usage of these hashtags coincided with the publication of research articles. CONCLUSIONS: New hashtags like #PIMSTS and #MISC have been used in the PCC community to focus and disseminate contents related to a novel pediatric syndrome related to COVID19. The evolving definitions and names used for this new entity are converging, but early confusion in names may have hampered discussion on Twitter and curation of reliable content.