COVID-19 PICU guidelines: for high- and limited-resource settings
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Date
2020-07-07Author
Kache, Saraswati
Chisti, Mohammod Jobayer
Gumbo, Felicity
Mupere, Ezekiel
Zhi, Xia
Nallasamy, Karthi
Nakagawa, Satoshi
Lee, Jan Hau
Di Nardo, Matteo
De la Oliva, Pedro
Katyal, Chhavi
Anand, Kanwaljeet J. S.
De Souza, Daniela Carla
Soares Lanziotti, Vanessa
Carcillo, Joseph
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Background
Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients requiring care in the pediatric ICU.
Methods
An international collaboration was formed to review the available evidence and develop evidence-based guidelines for the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with consensus-based guidelines.
Results
This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or anti-thrombotic therapies are also described.
Conclusion
Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill children with COVID-19 receive across the world.
Impact
At the time of publication, this is the latest evidence for managing critically ill children infected with SARS-CoV-2.
Referring to these guidelines can decrease the morbidity and potentially the mortality of children effected by COVID-19 and its sequalae.
These guidelines can be adapted to both high- and limited-resource settings.
Palabras clave
PICU; multisystem inflammatory syndrome; pediatric ICU; pediatric COVID-19 patientsLink to resource
https://www.nature.com/articles/s41390-020-1053-9#auth-9Collections
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