LEARNING FROM COVID-19 PANDEMIC: IMCU AS A OR EFFICIENT MODEL OF PEDIATRIC CRITICAL CARE ORGANIZATION

Brisca G, Tardini G, Pirlo D, Romanengo M, Buffoni I, Mallanaci M, Carrato V, Lionetti B, Molteni M, Castagnola E, Moscatelli A. Am J Emerg Med. 2023;64:169-173.

In this retrospective single-center study, researchers sought to gather information on the use of pediatric intermediate care unit's (IMCU's) admissions in relation to pediatric intensive care unit (PICU) admissions. The researchers noted that a significant number of children with severe acute respiratory syndrome coronavirus 2-related illness had been admitted to PICUs who required monitoring and treatments that could not be provided on a general pediatric unit but did not meet the requirements of a PICU admission. This, in turn, may have resulted in PICU overcrowding, waste of resources, increase cost, and stress for the child and their caregivers.

The researchers evaluated patients aged 0 to 18 years who had acute COVID-19 or multisystem inflammatory syndrome in children (MIS-C). Of patients (n = 550) who were admitted to the hospital for acute COVID-19 (coronavirus disease 2019) or MIS-C, 106 of these patients were admitted to a newly developed IMCU adjacent to the PICU to allow for timely escalation if needed for elevation to PICU status if the condition warranted. Among the 550 patients admitted to the IMCU, it was found that 2.8% (-3) required PICU services, 44% (n = 47) were discharged home from the IMCU, and the remaining 55% (n = 57) were transferred to low-intensity care units after clinical improvement.

The researcher found that the need for PICU admissions was lower for COVID-19 and MIS-C patients in their facility than findings from the literature. They found the IMCU was an acceptable alternative for COVID-19-related illness that needed a higher level of care but did not meet the criteria for a PICU admission. This prevented ICU overcrowding and wasting of economic and logistical resources. They also recommend further studies to assess the impact of IMCU's on hospital costs, ICU overcrowding, and the long-term effects on patients and their caregivers.