Consensus statement of the Colombian Association of Critical Medicine and Intensive Care (AMCI) for the care and management of the paediatric patient with suspicion or confirmation of severe infection by SARS-CoV-2

ABSTRACT

A new pandemic was recently declared by the World Health Organisation due to the SARS-CoV-2 virus. This virus is characterised by being highly transmissible, lethal, and affecting all age groups. This declaration led to the activation, in all countries, of emergency mechanisms to deal with this public health crisis that has exposed the weaknesses of the health systems and the deficit of beds in adult intensive care (UCIA) and paediatric intensive care units (PICU). Colombia has a reduced number of PICU beds compared to other low- and middle-income countries. For this reason, we must optimise resources, anticipate severe cases, and understand the behaviour of the disease caused by the SARS-CoV-2 virus (called COVID-19) in paediatrics, especially in severe forms of presentation in children. The severity and degree of involvement by the virus in all countries has been very similar, with a greater severity and frequency of infection in the adult population, particularly in people over 60 years of age, and with comorbidities (obesity, hypertension, diabetes, among others). However, severe cases requiring advanced interventions in intensive care have also been reported in the paediatric population, including a form of presentation with a large inflammatory response in children, called multi-systemic inflammatory syndrome (MIS-C). The Colombian Association of Critical Medicine and Intensive Care (AMCI) convened a multidisciplinary team of experts in paediatric critical medicine to establish a consensus statement of good clinical practice for the care of children with severe COVID-19 requiring care in intermediate care or paediatric intensive care. The objective of this consensus statement is to facilitate and standardise decision making in the most relevant aspects of care and to carry out a comprehensive approach to the paediatric patient based on the best available evidence and the opinion of experts in paediatric intensive care with at least 10 years of work experience in the area. Additionally, it was sought to involve those Paediatric Intensivists who have to directly care for children with COVID-19, and belong to reference or university hospitals and have a proven track record in research and teaching in paediatric critical care. This consensus statement will seek to update, as often as necessary, according to the change in the best available evidence, which will enable physicians who care for critical children with COVID-19 to provide comprehensive and adequate care according to the best available literature. © 2020 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo