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COVID-19 PICU guidelines: for high- and limited-resource settings.
Pediatr Res. 2020 11; 88(5):705-716.PR

Abstract

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.

Authors+Show Affiliations

Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. skache@stanford.edu.Intensive Care Unit and Clinical Research, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.Department of Pediatrics and Child Health, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe.Department of Pediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda.Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan City, Hubei Province, China.Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India.Critical Care Medicine, National Center for Child Health & Development, Tokyo, Japan.Children's Intensive Care Unit, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore, Singapore.Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, Rome, Italy.Pediatric Intensive Care Department, Hospital Universitario La Paz, Department of Pediatrics Medical School, Universidad Autónoma de Madrid, Madrid, Spain.Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.Department of Pediatrics, Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.Pediatric Intensive Care Unit, University of São Paulo & Hospital Sírio Libanês-, São Paulo, Brazil.Pediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil.Departments of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Pub Type(s)

Journal Article
Practice Guideline

Language

eng

PubMed ID

32634818

Citation

Kache, Saraswati, et al. "COVID-19 PICU Guidelines: for High- and Limited-resource Settings." Pediatric Research, vol. 88, no. 5, 2020, pp. 705-716.
Kache S, Chisti MJ, Gumbo F, et al. COVID-19 PICU guidelines: for high- and limited-resource settings. Pediatr Res. 2020;88(5):705-716.
Kache, S., Chisti, M. J., Gumbo, F., Mupere, E., Zhi, X., Nallasamy, K., Nakagawa, S., Lee, J. H., Di Nardo, M., de la Oliva, P., Katyal, C., Anand, K. J. S., de Souza, D. C., Lanziotti, V. S., & Carcillo, J. (2020). COVID-19 PICU guidelines: for high- and limited-resource settings. Pediatric Research, 88(5), 705-716. https://doi.org/10.1038/s41390-020-1053-9
Kache S, et al. COVID-19 PICU Guidelines: for High- and Limited-resource Settings. Pediatr Res. 2020;88(5):705-716. PubMed PMID: 32634818.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 PICU guidelines: for high- and limited-resource settings. AU - Kache,Saraswati, AU - Chisti,Mohammod Jobayer, AU - Gumbo,Felicity, AU - Mupere,Ezekiel, AU - Zhi,Xia, AU - Nallasamy,Karthi, AU - Nakagawa,Satoshi, AU - Lee,Jan Hau, AU - Di Nardo,Matteo, AU - de la Oliva,Pedro, AU - Katyal,Chhavi, AU - Anand,Kanwaljeet J S, AU - de Souza,Daniela Carla, AU - Lanziotti,Vanessa Soares, AU - Carcillo,Joseph, Y1 - 2020/07/07/ PY - 2020/04/26/received PY - 2020/06/22/accepted PY - 2020/06/19/revised PY - 2020/7/8/pubmed PY - 2020/10/31/medline PY - 2020/7/8/entrez SP - 705 EP - 716 JF - Pediatric research JO - Pediatr Res VL - 88 IS - 5 N2 - 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. SN - 1530-0447 UR - https://www.unboundmedicine.com/medline/citation/32634818/COVID_19_PICU_guidelines:_for_high__and_limited_resource_settings_ L2 - https://doi.org/10.1038/s41390-020-1053-9 DB - PRIME DP - Unbound Medicine ER -