Preparedness for an Isolation Unit during Covid-19 Pandemic in PICU of Minia University Hospital: Practical Considerations and Outcomes

Background: Admission to the pediatric intensive care unit (PICU) is compulsory for children with a severely complicated form of COVID-19, who are hemodynamically unstable. Our study determined the degree to which our PICU preparedness measures impacted patient outcomes and infection control management within the PICU of Minia University Hospital in Egypt. Methods: 179 pediatric patients, admitted to the PICU isolation unit with suspected or confirmed diagnosis of COVID-19, were studied retrospectively. We conducted descriptive analyses on the patients' characteristics and outcomes and the basic concepts and procedures for PICU readiness are discussed. Results: The patients ranged in age from one month to sixteen years, with an average age of 8.60 +/- 4.84 years, 44.69 % of whom were males. Fever, shortness of breath, and cough were the most common symptoms on admission. The most common comorbidities were neurological disorders, heart disease, and respiratory disease, with percentages of 27 %, 25 %, and 23 %, respectively. Overall, mortality was 22.9 %. Only 21 (0.5%) of the hospital's healthcare staff were infected. The infection did not spread to other non-COVID parts of the hospital. Conclusion: Our PICU strategies and preparation ensured adequate prevention of infection spreading to other units and HWCs, as well as lowering mortality and improving COVID-19 patients' outcomes.

Relationship between parental stress and post-traumatic stress disorder: The moderating effect of visitation restrictions in paediatric intensive care units during COVID-19.

BACKGROUND: Visitation restrictions due to COVID-19 kept parents from being with their children who were hospitalized in the PICU and from meeting with professional staff. AIM: This study examined the moderating effect of COVID-19-induced visitation restrictions on the relationship between stress and post-traumatic stress disorder in parents of children admitted to the paediatric intensive care unit. STUDY DESIGN: We conducted a descriptive, exploratory study involving 93 parents of children hospitalized in the paediatric intensive care unit using the Korean version of the Parental Stressor Scale: Paediatric Intensive Care Unit and the Revised Impact of Events Scale. Descriptive, Pearson's correlation, and logistic regression analyses were used to investigate the data. Self-reported survey questionnaires were provided for parents to complete in a separate area of the outpatient clinic when they visited for follow-up care after their children were discharged from the paediatric intensive care unit. RESULTS: Mothers showed significantly higher post-traumatic stress disorder scores than fathers. The relationship between all the sub-domains of perceived stress and post-traumatic stress disorder was statistically significant. Visitation restrictions because of the COVID-19 pandemic had significant moderating effects on the relationship between perceived parental stress and post-traumatic stress disorder. Moreover, the moderating effects of COVID-19 were exhibited when the two sub-domains-hyperarousal and intrusion-were investigated. CONCLUSIONS: Paediatric intensive care unit visitation may be an important intervention for parental post-traumatic stress disorder. Parental visitation should be enabled, and alternative interventions should be developed in situations where visitation is prohibited. RELEVANCE TO CLINICAL PRACTICE: It is necessary to develop and apply various and effective alternatives visitation that can prepare hospitals for visiting restrictions during pandemic situations which could emerge in the future.

Mitigating the Burden of Severe Pediatric Respiratory Viruses in the Post-COVID-19 Era: ChatGPT Insights and Recommendations.

In the current post-pandemic era, the rapid spread of respiratory viruses among children and infants resulted in hospitals and pediatric intensive care units (PICUs) becoming overwhelmed. Healthcare providers around the world faced a significant challenge from the outbreak of respiratory viruses like respiratory syncytial virus (RSV), metapneumovirus, and influenza viruses. The chatbot generative pre-trained transformer, ChatGPT, which was launched by OpenAI in November 2022, had both positive and negative aspects in medical writing. Still, it has the potential to generate mitigation suggestions that could be rapidly implemented. We describe the generated suggestion from ChatGPT on 27 Feb 2023 in response to the question "What's your advice for the pediatric intensivists?" We as human authors and healthcare providers, do agree with and supplement with references these suggestions of ChatGPT. We also advocate that artificial intelligence (AI)-enabled chatbots could be utilized in seeking a vigilant and robust healthcare system to rapidly adapt to changing respiratory viruses circulating around the seasons, but AI-generated suggestions need experts to validate them, and further research is warranted.

Tackling the unseen virus at the unseen frontier

There has been widespread coverage, attention and discussion regarding the anxieties of COVID-19 pandemic in health and social care settings;however, compared to other healthcare environments, mental health care settings have not received a similar level of attention and concern. Interestingly there are unique challenges in mental health units and at the height of the pandemic there has been a significant impact on staff, patients and carers. Mental health staff have had to adapt their ways of working, focusing more on the physical health of patients and caring for COVID positive patients in a mental health unit. Anxiety about the infection spreading to other patients and to staff who interact very closely with patients were significant concerns, with the additional difficulties of accessing the appropriate PPE during the early stages of the outbreak. Some challenges are unique to mental health settings and become even more intense within a psychiatric intensive care unit (PICU). These include difficulties with isolation, social distancing and the reluctance of patients to wear masks. The lessons learnt caring for the most challenging patients in a PICU are explored. The adaptability, flexibility and commitment to providing kind, compassionate care at the height of the COVID pandemic is remarkable. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Coronavirus-19 and its Epidemiology in Children - An Ambispective Observational Study from Central India.

This ambispective observational study, was conducted at a tertiary care centre in Central India. Children aged <16 y who tested positive for SARS-CoV2 between 1st April 2020 to 30th April 2022 were included. The prevalence of coronavirus disease-19 (COVID-19) infection was 1.2%. Of 525 children, median age was 60 mo; 88 (16.7%) were infants. Comorbidities were noted in 89 (16.9%) children. About 59% (n=309) were asymptomatic. Among symptomatic (n=216) children, fever (57.9%) was the most common symptom followed by cough (37%), running nose (21.3%) and shortness of breath (13.9%). Forty-three (8.2%) children required pediatric intensive care unit (PICU) admission, among which 21 required invasive ventilation. Patients with comorbidities were independently associated with need for invasive mechanical ventilation. Among PICU admitted children, 20 patients died. In multivariate logistic regression, children presenting with fever, shortness of breath and vasoactive requirement were found to be significantly associated with mortality. As the number of waves progressed, number of admissions were less but severity, association with comorbidities, need of ICU, mechanical ventilation and death rate increased.

Impact of Covid-19-Related Restricted Family Presence Policies on Canadian Picu Clinicians: A Cross-Sectional Survey

BACKGROUND AND AIM: Widely-implemented restricted family presence (RFP) policies/practices during the COVID-19 pandemic were counter to family centered values embraced by many PICUs. This study explored the impact of implementing and enforcing these policies on Canadian PICU clinicians. METHOD(S): Cross-sectional survey of Canadian PICU clinicians. We developed an online, self-administered, survey to assess 1. Family presence policy and practice changes;2. Experience and opinions;3. Moral distress (Moral Distress Thermometer);and 4. Impact (Impact of Event Scale [IES] and attributable stress [5-point Likert scale]). Analysis included descriptive statistics, t-tests, one-way ANOVA;biand multi-variable stepwise regression assessed correlations. RESULT(S): Of 388 respondents representing 17/19 PICUs, 368 (94.1%) indicated that they experienced RFP policies and were predominantly female (n=333, 90.7%), English speaking (n=338, 91.8%), and RN (n=240, 65.2%). Incongruence between RFP policies/practices and PICU values was perceived by 66% (n=217). Most (n=235, 71%) felt their opinions were not valued when implementing policies. Though restrictions were perceived as beneficial to clinicians (n=252, 76%) and families (n=236, 75%), and 52% (n=171) felt RFP made their work easier, 57% (n=188) disagreed that their RFP experience was mainly positive. The median (IQR) reported moral distress was 5 (2-6) (n=307, scale 0-10);the strongest predictor was perception of differential impact of RFP on families. The mean (SD) total IES score (n=290, 78.8%) was 29.7 (10.5), suggesting moderate traumatic stress. For 56% (n=176) there was increased/significantly increased attributable stress. CONCLUSION(S): PICU-based RFP rules, designed and implemented without clinician input, caused increased emotional burden.

Characteristics of Children with Paediatric Inflammatory Multisystem Syndrome Hospitalized in a Paediatric Intensive Care Unit during the Coronavirus Disease 2019 Pandemic

BACKGROUND AND AIM: Coronavirus disease was thought to affect children less severely. However, a post viral immune mediated inflammatory process with an unclear pathogenesis has been reported also known as Paediatric Inflammatory Multisystem Syndrome (PIMS). Aim of this study is to describe the characteristics of a series of cases of PIMS hospitalized in a Pediatric Intensive Care Unit (PICU) in Athens, Greece. METHOD(S): Patients' files were reviewed from March 2020 until December 2021 to define PIMS cases as described by World Health Organization. RESULT(S): During the reviewed period, 25 cases of PIMS were admitted to our hospital. 8 were transferred in PICU and included in our study. Median age was 7.25 years. 6 patients were male. 1 had diabetes type I and 4 were obese. Presenting symptoms are shown in table 1. All patients showed increased levels of C-reactive protein, d-dimers, ferritin as well as anemia. 6 had lymphopenia, 4 hyponatremia and 3 hypoalbuminemia. All had negative PCR for Sars- Cov-2. 3 had respiratory failure and 1 required intubation. All showed elevated cardiac markers and 5 had reduced left ventricular ejection fraction that was eventually normalized. 3 were supported with inotropes and/or vasopressors and 1 with extracorporeal membrane oxygenation. Treatment was based on immunoglobulin (100%), glucocorticoids (100%) and/or biologic drugs (50% received interleukin [IL]-1 antagonists and 12% IL-6 receptor blockers). Mortality rate was 0%. CONCLUSION(S): Although PIMS following exposure to Sars-Cov-2 is a clinical syndrome with severe presentation, prognosis is good with appropriate and early treatment.

A Case Series of Non-Traumatic Pediatric Intracerebral Hemorrhage Hospitalized in Picu within a 10-Year Period

BACKGROUND AND AIM: Intracerebral hemorrhage (ICH) accounts for about half of all childhood strokes and is a notable contributor to childhood morbidity and mortality. The aim of this study is to describe the characteristics of cases of ICH that were hospitalized in a PICU during a 10-year period. METHOD(S): Patients' files between 2011-2021 were studied retrospectively. Cases with non-traumatic intracerebral hemorrhage were included in the study. RESULT(S): 18 patients were examined (38.8% male) with a median age of 7 years (3 months-14 years). 83% were of Greek origin and mean duration was 6.3 days. Half of our patients were hospitalized between 2020-2021 (see image 1.). 33.3% had relevant comorbidities such as arteriovenous malformation (AVM), hemangiomas and neurofibromatosis type. Presenting symptoms were headache (55.5%), nausea and emesis (66.6%), seizures (27.7%), altered level of consciousness (65.5%), paresis (22%). Glasgow Coma Scale at admission was 13-15 in 66.6%, 9-12 in 22.2% and < 9 in 5%. Diagnosis was made using CT (88,9%) and MRI scans (11.1%). 61% needed surgery while 72% underwent digital subtraction angiography (DSA) and 38.4% of them were embolized. Vascular malformations were the main causes: AVM (38.8%), aneurysm (5%), pseudoaneurysm (5%), hemangioma (5%) but 46,2% remained unidentified. No patient died but 33.3% showed neurological deficits after discharge CONCLUSION(S): Intracerebral Hemorrhage in children is an urgent situation that needs collaboration between intensivists and neurosurgeons. The increase in frequency during COVID-19 pandemic is remarkable and needs further studying to determine a possible causative relation.

Picu Services in Developing Countries Where We Are? Where Should We Go from Here? Sudan Experiences

BACKGROUND AND AIM: Critical care specialties have become a backbone of the health care system and all medical subspecialties. This review aims to report on the current status of paediatric intensive care in Sudan. During the COVID-19 pandemic, high needs emerged concerning national health systems based on well-established critical care services. METHOD(S): Recent Findings The lack of essential health care resources remains the main problem in hindering the development of sustainable health care services. In Sudan, despite many humanitarian and governmental efforts to establish some units in the leading Khartoum hospitals, there is no sustainability in these services. Due to the delay in children's diagnosis, lack of facilities and with their late presentation to hospitals, associated complications can arise beyond the capacities of available PICU units. There is no sustainability in these services for many reasons. There is a deficiency in welltrained graduated respiratory therapists and an absence of trained pediatric ICU nurses. PICUs are considered to be poorly set up regarding equipment and advanced monitoring systems. Other important factors that contribute to the mortality and morbidity of children with critical illnesses are their co-morbidities like malnutrition, recurrent protozoal infections, illiteracy, and low socioeconomic status. RESULT(S): Summary Sudan's PICU capacity remains largely undocumented and occasional. Efforts should be cantered on documenting the current capability and lobbying for human resource training and retention to reform and expand the available units. CONCLUSION(S):.A proper universal global plan that develops standardized equipped units in the presence of qualified physicians and allied health workers should also be developed.

Parental Distress during Separation from Their Critically Ill Child

BACKGROUND AND AIM: A child's critical illness is a stressful event for the entire family, causing significant emotional distress among parents and changes to family functioning. Family-centered care (FCC) has been endorsed by major professional organizations. The SARS-CoV-2 pandemic has abruptly caused modifications in visitation policies of PICUs in many countries. We hypothesized that caregivers with no or severely restricted access to PICUs would demonstrate elevated psychological distress compared to those who had limitless access to PICU. METHOD(S): Sociodemographics variables, levels of psychological distress, family functioning and ability to cope with stressful events were collected with an online survey in a group of caregivers (N=43) after their child hospitalization. A Pediatric Risk of Mortality-II (PRISM-II) score was calculated at child admission. Ratings of psychological distress were compared between caregivers with no/severely restricted (NA) and with limitless access (LA) to PICUs. All data were analyzed in the context of the Generalized Linear Model (GLZM). RESULT(S): Levels of depression, anxiety and the global severity index of psychological distress were significantly higher in NA with respect to LA (respectively LR chi2=9.885, p=0.001, LR chi2=5.54 p=0.08, LR chi2=6.928 p=0.008), correcting for gender, age, PRISM-II levels and personal ability to cope with stressful events. No significant effect of family functioning scores or other sociodemographic variables was found. CONCLUSION(S): Restrictions imposed to visitation policies in PICU during the pandemic negatively impacted on families' psychological well-being. A balance between safety of patients, families and health care professionals and meeting the needs of families is of utmost importance.

The Impact of Steroids on Outcomes of Children Admitted to the Hospital with Non Misc Covid19: An Analysis from the Sccm Discovery Network Virus Registry

BACKGROUND AND AIM: Evidence for therapies for pediatric COVID-19 is limited. Primary aim was to study the effect of steroid administration within 2 days of admission for pediatric non-MIS-C-COVID-19 on hospital and ICU length of stay (LOS). The secondary aim was to study its effect on inflammation and fever defervescence. METHOD(S): A retrospective study of 1163 children hospitalized with non-MISC-COVID-19, from 03/20 to 09/21, from 58 hospitals (7 countries, 92% US), in the Viral Infection and Respiratory Illness Universal Study (VIRUS) registry. Effect of steroid administration <= 2 days of admission on hospital and ICU LOS was studied using intention to treat analysis, adjusted for confounders by multivariable mixed linear regression. RESULT(S): Median age was 7(IQR 0.9,14.3) years. 184(15.8%) children who received steroids within <= 2 days were compared to 979 (84.1%) children who did not. 56.5% (n=658) required respiratory support. Patients in the steroid group were older, with higher severity of illness. A greater proportion required respiratory and vasoactive support. On multivariable linear regression with random intercept for site (Table), there was no significant difference in hospital LOS (exponentiated [exp] co-efficient 0.92, 95%CI = 0.77, 1.10, p=0.374) or ICU LOS (exp co-efficient 1.02, 95%CI = 0.78, 1.34, p=0.864) between the groups. There was no significant difference in time to fever defervescence and normalization of inflammatory mediators by Day 3. CONCLUSION(S): In pediatric non-MIS-C COVID-19, steroid treatment <= 2 days of hospital admission did not show a statistically significant effect on hospital or ICU LOS. (Table Presented).

Clinical and Diagnostic Characteristics of Children with Sars-Cov2 Infection at a Picu in a Tertiary Hospital in Colombia: It Is Better a Two-Step Diagnostic Strategy?

BACKGROUND AND AIM: Children affected with COVID-19 infection are less likely to develop severe disease. The burden of disease and allocated resources make diagnosis and management differ among centers. Missed cases could be reduced if a second test is carried out in those with an initial negative assay. AIM: To describe the clinical characteristics, imaging finding and outcomes of COVID-19 disease in children admitted to a Pediatric Intensive Care Unit (PICU). METHOD(S): Retrospective, single-center study in patients (0-18 years) with confirmed COVID-19 infection, during one year of the SARS-CoV-2 outbreak. RESULT(S): Twenty-four patients were included, with respiratory disease (n=12, 52%), sepsis (n=5, 22%), MIS-C (n=4, 17%) and non-Covid related diagnosis (brain trauma, status epilepticus and abdominal mass). Seventeen patients (71%) had an initial positive COVID-19 test. The other seven (29%) were detected with a second RT-PCR. Supportive treatment included vasopressors (n=4), steroids (n=3), dialysis (n=2), high flow nasal cannula (n=3) and mechanical ventilation (n=9). The mean PICU length of stay was 3 days (IQR 1.5-16). Patterns in chest x-rayincluded: interstitial (n=11, 50%), alveolar (n=4, 18%) and atelectasis (n=4, 18%). Two patients died (8%), one immunocompromised with sepsis and the other because of intracranial bleeding. CONCLUSION(S): This study describes the clinical and radiological characteristics of severe COVID-19 infection in children and highlights the value of a second diagnostic test to decrease the false negative rate. Further investigation is warranted in order to evaluate the impact of this approach in terms of cost, isolation measures and inpatient infection rates. (Table Presented).

Consequences of Social Distancing Measures during the Covid-19 Pandemic First Wave on the Epidemiology of Children Admitted to Pediatric Intensive Care Units: A Systematic Review

BACKGROUND AND AIM: To synthesize knowledge describing the impact of social distancing measures (SDM) during the first wave of the COVID-19 pandemic on acute illness in children by focusing on the admission to pediatric emergency departments (PED) and intensive care units (PICU). METHOD(S): We searched Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, EPOC Register, MEDLINE, Evidence-Based Medicine Reviews, EMBASE, WHO database on COVID-19, Cochrane Resources on COVID-19, Oxford COVID-19 Evidence Service, Google Scholar for literature on COVID-19 in December 2020. We did not apply study design filtering. The primary outcomes of interest were the global incidence of admission to PICU and PED, disease etiologies, and elective/emergency surgeries. RESULT(S): We identified 6,660 records and eighty-seven articles met our inclusion criteria. All the studies were with before and after study design compared with the historical data, with an overall high risk of bias. The median daily PED admissions decreased to 65% in 39 included studies and a 54% reduction in PICU admission in eight studies. There was a significant decline reported in acute respiratory illness and LRTI in five studies with a median decrease of 63%. We did not find a consistent trend in the incidence of poisoning, but there was an increasing trend in burns, DKA, and a downward trend in trauma and unplanned surgeries. CONCLUSION(S): SDMs in the first wave of the COVID-19 pandemic reduced the global incidence of pediatric acute illnesses. Continual effort and research into the subject should be essential for us to protect the well-being of children.

Clinico-Laboratory Profile, Intensive Care Needs and Short-Term Outcome of Multisystem Inflammatory Syndrome in Children (Mis-C): Experience during First and Second Waves from India

BACKGROUND AND AIM: The multisystem inflammatory syndrome in children (MIS-C) is a new entity and needs data to study its evolution. To describe the clinicolaboratory profile, intensive care needs, and outcome of MIS-C during the first and second waves. METHOD(S): Retrospective analysis of 122 children with MIS-C admitted to Pediatric emergency and PICU of a tertiary-teaching hospital during first and second wave of Covid-19. RESULT(S): Median (IQR) age was 7 (4-10) years with 67% boys. Common manifestations included fever (99%), abdominal symptoms (81%), rash (66%), conjunctival injection (65%), oral mucosa and respiratory involvement (43% each). Elevated CRP (97%), D-dimer (89%), procalcitonin (80%), IL-6 (78%), ferritin (56%), NT-pro- BNP (84%), and positive SARS-CoV-2 antibody (81%) were common laboratory abnormalities. Cardiovascular manifestations included myocardial dysfunction (55%), shock (48%), and coronary artery changes (10%). The treatment included intensive care support (57%), non-invasive (33%) and invasive (18%) ventilation, vasoactive drugs (47%), IVIG (83%), steroids (85%), and aspirin (87%). Mortality was 5% (n=6). Duration of hospital stay was 5 (3-8) days. During second wave, significantly higher proportion had positive SARS-CoV-2 antibody, contact with COVID-19 case, and oral mucosal changes;lower markers of inflammation (CRP, procalcitonin, ferritin, and IL-6);lower rates of shock, myocardial dysfunction, and coronary artery changes;lesser need of PICU, vasoactive drugs, and IVIG;and shorter hospital stay. CONCLUSION(S): MIS-C is febrile multisystemic disease characterized by hyperinflammation, cardiovascular involvement, relationship to SARS-CoV-2, and good outcome with immunomodulation and intensive care. During the second wave, the severity of illness, degree of inflammation, and intensive care needs was lesser.

Four Months Physical, Psychosocial, and Neurocognitive Follow-up of Multisystemic Inflammatory Syndrome in Children (Mis-C) after Picu Admission: A National Prospective Cohort Study

BACKGROUND AND AIM: Outcome of the novel COVID-19 related disease "Multisystemic Inflammatory Syndrome in Children (MIS-C)" is still largely unknown. We aimed to assess physical, psychosocial, and neurocognitive functioning in MIS-C survivors after PICU admission. METHOD(S): A national prospective cohort study including MIS-C children (0-17 years) admitted to one of the 7 PICUs in The Netherlands. Children were tested 3-6 months after PICU admission in a multidisciplinary follow-up program through a semi-structured interview, validated questionnaires for psychosocial outcomes, in both children and their parents, and validated neurocognitive tests in children. RESULT(S): Between March 2020 and June 2021, 49 MIS-C children attended follow-up after median 4 months (IQR 3-5) at median age 11.6 years (IQR 9.3-15.6). At follow-up, PCPC and POPC scores were normal in all children, 21 (43%) children reported impaired exercise intolerance and 20% worsening sleeping behaviour. Physical and school functioning quality of life scores were worse compared with norm data. General intelligence and verbal memory scores were comparable to norm data (N=44), whereas visual memory, sustained attention, and planning were significantly lower in a subgroup of 29 patients. Parents reported less posttraumatic stress and depressive symptoms compared with norms. CONCLUSION(S): After PICU admission, exercise intolerance, sleeping, physical and school functioning problems were reported. Overall intelligence and neurocognitive scores were normal, with subtle deviants in some neurocognitive functions indicating integration and sustained attention problems. This yields for a longer-term follow-up to assess MIS-C survivors functioning.

The Clinical Effectiveness of Dynamic Electronic Tracking and Escalation to Reduce Critical Care Transfers (the Detect Study)

BACKGROUND AND AIM: Physiological surveillance systems significantly reduced adult mortality in two large UK hospitals. In hospitalised children mortality is low, but there may be potential to reduce the morbidity associated with critical deterioration (CD). However, the risk models for adults are unsuitable for use in children because the signs associated with deterioration [heart rate, breathing rate, blood pressure], alter significantly across the age range. The aim is to evaluate whether this technology improves clinical outcomes for in-hospital deterioration, including sepsis in children. METHOD(S): ISRCTN61279068. https://bit.ly/36HtEGF Participants: Paediatric in-patients, aged less than 18 years at a tertiary hospital (240 beds). Intervention(s): Careflow Vitals and Connect app platform configured to incorporate the Alder Hey age-specific Paediatric Early Warning score (PEWS) and modified National Institute of Health and Clinical Excellence (NICE) Sepsis screening. The documentation of vital signs and clinical observations occur at the patient's bedside at intervals determined by the PEWS risk model. PEWS categorised CD risk as low, moderate, high and critical and provided targeted escalation advice and automated alerts to the Nurse in Charge of the shift and the responsible Clinical Teams. Primary Outcome:Emergency transfers to Critical Care (PICU/ HDU). RESULT(S): Prospective data collection baseline year March 2018 - February 2019 compared with 2 years postintervention March 2020-February 2022 (Extended due to COVID). Summary of results in Figure 1. CONCLUSION(S): The absolute number of CD and patients affected reduced by 29%. Associated review of the cases using the Predictability/Preventability framework showed reduction in the late recognition and CD with modifiable factors. (Figure Presented).

Characteristics and predictors of outcomes of critically Ill children with SARS-CoV-2 infection - the PICU experience.

OBJECTIVE: To describe the clinical characteristics, laboratory parameters, treatment, and predictors of an unfavorable outcome of critically ill children with SARS-CoV-2 infection. METHOD: This was a prospective observational study performed in a pediatric intensive care unit (PICU) of a tertiary care COVID referral hospital among critically ill children in the age group 1 month - 12 years admitted due to SARS-CoV-2 infection from June to December 2020. Demographic, clinical profile, pSOFA and PRISM III scores, laboratory parameters, treatment, and outcomes of the patients were recorded. Children who had a prolonged PICU stay (>14 days) or died were compared with those who were discharged from PICU within 14 days to assess predictors of unfavorable outcomes. RESULTS: PICU admission rate among hospitalized SARS-CoV-2 infected children was 22.1% (92/416). Infants comprised the majority of the ICU population. Invasive mechanical ventilation and inotropic support were required for 28.3% and 37% of patients, respectively. Remdesivir, IVIg, and steroids were administered to 15.2%, 26.1%, and 54.3% of the subjects, respectively. The mortality rate was 7.6 %. MIS-C patients were older, less comorbid, and required less ventilator support but more inotrope support than acute severe COVID-19 patients. Predictors of unfavorable outcomes were age < 1 year, fever duration > 5 days, respiratory distress, shock, comorbidity, elevated CRP (> 50 mg/L), procalcitonin (> 6 ng/L), D-dimer (> 6 µg/L) and arterial lactate (> 2 mmol/L). CONCLUSION: Critically ill children with unfavorable outcomes were predominantly infants, comorbid, prolonged fever, respiratory distress, shock and elevated inflammatory markers, D-dimer and lactate. These factors may be useful for watchful monitoring and early intervention.

The Pediatric Tracheostomy Practice During COVID-19 Pandemic at a PICU

Introduction: To evaluate pediatric tracheostomies performed at a tertiary care pediatric intensive care unit (PICU) before and after the Coronavirus disease-2019 (COVID-19) pandemic. Methods: A total of 57 pediatric tracheostomy patients performed at a tertiary care PICU were included. Prognostic scores including pediatric risk of mortality 2, pediatric index of mortality 2 and pediatric logistic organ dysfunction scores, the family education process and time to home discharge were evaluated according to time of tracheostomy (pre-pandemic vs. after pandemic) and responsible surgeon (pediatric surgeon vs. otolaryngologist). MedCalc® Statistical Software version 19.7.2 (MedCalc Software Ltd, Ostend, Belgium;https: //www.medcalc.org;2021) was used for statistical analysis. Results: A non-significant tendency for higher rate of pediatric surgery-based tracheostomies was noted after the pandemic (76.0 vs. 24.0%, p=0.134). No significant difference was noted between tracheostomies performed before vs. after the COVID-19 pandemic and those performed by otolaryngologists vs. pediatric surgeons in terms of prognostic scores and time to home discharge. Conclusion: Our findings emphasize the maintenance of high quality patient care for pediatric tracheostomy patients in accordance with standardized tracheostomy protocols and policies during the pandemic period with no significant difference between tracheostomies performed before and after the COVID-19 pandemic and those performed by pediatric surgeons vs. otolaryngologists in terms of prognostic scores and time to home discharge. © 2022, Galenos Publishing House. All rights reserved.

Effectiveness of simulation based educational intervention on pediatric nurses' practice about tracheal intubation in Covid-19 pediatric Intensive Care Unit

Nursing interventions have an explicit impact on the clinical pediatric mechanically ventilated children' outcomes. Despite some existing protocols, guidelines and standards, nurses still use it inexpediently in covid-19 pediatric and neonatal patient groups. Therefore, Simulation-based education has been regarded as a tool to cope with the fast changes in care methods and improving nursing professional standards. The present study aimed to investigate the effect of simulation-based education regarding endotracheal intubation on knowledge and practice of pediatric nurses of covid-19 pediatric intensive care unit. A comparative study of intervention and control groups quasi experimental design was used. Pediatric nurses (120) who were working in pediatric intensive care unit of Tanta Main University Hospital, Tanta city, Egypt and pediatric intensive care unit at Damanhour National medical Institute, Buheira, Egypt, who accepted to participate in the study. The simulation education program included online interactive lectures, and skill training, team-based practice. Two tools were utilized for data collection including knowledge test and observational checklist, which were completed before the program, immediate and 3 months after its completion. After simulation program, there was a significant improvement in the nurses' knowledge and clinical proficiency in regard to end tracheal intubation at (P<0.001) in the intervention group, while the control group didn't indicate any statistical differences across the three study periods regarding their total knowledge of intubation scores (p=0.233) Simulation education effectively improved the pediatric nurses' knowledge and clinical competency of the pediatric intubation. Based on this program the participated nurses will educate and transfer information to their colleagues that might advance clinical nursing education.

Impact of the COVID-19 Outbreak on Disease Spectrum of Pediatric Intensive Care Units.

Purpose: We aimed to analyze the changes in the disease spectrum data of a pediatric intensive care unit (PICU) in Nanjing, China, during the COVID-19 outbreak and explore a feasible plan for the treatment of critically ill children. Methods: This retrospective study used data from our PICU from 1 January 2018 to 31 December 2020. Patient demographics, distribution of disease spectrum, results of etiological examinations, and the PICU length of stay (LOS) were compared during the COVID-19 period (2020) and the previous years (2018 and 2019). Results: In 2020, the number of PICU admissions was 46.8 and 47.8% lower than that in 2018 and 2019, respectively. There were significant differences in the number of patients in PICU among different age groups, and these differences were mainly found in children aged <4 years and older than 14 years. The percentage of the number of patients in PICU with respiratory diseases decreased significantly, while those with hematological diseases, poisoning, and rare diseases increased significantly. Moreover, the number of patients with rare diseases increased significantly, while the number of patients with mitochondrial diseases exceeded that of those with autoimmune encephalitis. The PICU LOS in 2020 was higher than that observed in 2018 and 2019, indicating that the changes in the PICU disease spectrum did not directly affect the PICU LOS. Etiological examinations revealed that during the COVID-19 period, the number of patients in PICU with bacterial infections increased, and those with viral infections decreased, although not statistically significant. Conclusions: A striking decrease in the number of PICU admissions was observed during the COVID-19 outbreak, which caused a significant change in the PICU disease spectrum. Changes in the number and characteristics of patients admitted to PICUs should be considered for facilitating the effective working of PICUs during the COVID-19 pandemic.