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  • Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

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Original research
Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future
  1. Ruchi Sinha1,
  2. Angela Aramburo2,
  3. Akash Deep3,
  4. Emma-Jane Bould4,
  5. Hannah L Buckley5,
  6. Elizabeth S Draper6,
  7. Richard Feltbower7,
  8. Rebecca Mitting1,
  9. Sarah Mahoney8,
  10. John Alexander9,
  11. Stephen Playfor10,
  12. Amy Chan-Dominy2,11,
  13. Simon Nadel1,
  14. Ganesh Suntharalingam12,13,
  15. James Fraser14,15,
  16. Padmanabhan Ramnarayan1,15,16
  1. 1 Department of Paediatric Intensive Care, Division of Women and Children’s Services, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Paediatric Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  3. 3 Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
  4. 4 Paediatric Intensive Care Unit, Barts Health NHS Trust, London, UK
  5. 5 PICANet, School of Medicine, University of Leeds, Leeds, UK
  6. 6 Health Sciences, University of Leicester, Leicester, UK
  7. 7 Division of Epidemiology, University of Leeds, Leeds, UK
  8. 8 Paediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  9. 9 Paediatric Intensive Care Unit, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  10. 10 PICU, Royal Manchester Children's Hospital, Manchester, UK
  11. 11 Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
  12. 12 Adult Intensive Care Unit, North West London Hospitals NHS Trust, Harrow, UK
  13. 13 Intensive Care Society, London, UK
  14. 14 Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK
  15. 15 Paediatric Intensive Care Society, London, UK
  16. 16 Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR Biomedical Research Centre, London, UK
  1. Correspondence to Dr Padmanabhan Ramnarayan, Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; p.ramnarayan{at}gosh.nhs.uk

Abstract

Objective To describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic.

Design Descriptive study.

Setting Seven PICUs in England.

Main outcome measures (1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs.

Results Seven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280–307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50–62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%).

Conclusion In a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.

  • epidemiology
  • microbiology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/archdischild-2020-320962

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors Conception of study: RS, AA, AC-D and PR. Data analysis and modelling: HLB, ESD and RF. Data collection and analysis: RS, AA, AC-D, AD, E-JB, SP, SM, RM, SN and JA. Data interpretation: GS and JF. PR acts as guarantor for the data. All authors were involved in drafting the manuscript, and all authors approved the final submitted version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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