The Pediatric Intensive Care Unit as a Critical Care Setting for Adults during the COVID-19 Pandemic: A Service Evaluation.

One strategy to expand critical care capacity during the coronavirus disease 2019 (COVID-19) pandemic within the United Kingdom has been to repurpose other clinical departments, including the pediatric intensive care unit (PICU) and pediatric multidisciplinary team, to accommodate critically unwell adult patients. While multiple PICUs have treated adult patients with COVID-19, there is an absence of data on the characteristics of patients transferred to pediatric care and their resulting outcomes in comparison to standard adult intensive care unit (AICU) provision. Data were collected for all adult COVID-19 intensive care admissions between March and May 2020, in three ICUs within a single center: PICU, AICU, and theater recovery ICU (RICU). Patient characteristics, severity of illness, and outcomes were described according to the ICU where most of their bed-days occurred. Outcomes included duration of organ support and ICU admission, and mortality at 30 days. Mortality was compared between patients in PICU and the other adult ICUs, using a logistic regression model, adjusting for known confounding variables. Eighty-eight patients were included: 15 (17.0%) in PICU, 57 (64.7%) in AICU, and 16 (18.1%) in RICU. Patients' characteristics and illness severity on admission were comparable across locations, with similar organ support provided. Ten (66.7%) patients survived to hospital discharge from PICU, compared with 27 (47.4%) and nine (56.3%) patients from AICU and RICU, respectively, with no significant difference in 30-day mortality (OR 0.46, 95% CI 0.12-1.85; p = 0.276). Our analysis illustrates the feasibility of evaluating outcomes of patients who have been cared for in additional, emergency ICU beds, whilst demonstrating comparable outcomes for adults cared for in pediatric and adult units.

Rapidly progressive Bronchiolitis Obliterans Organising Pneumonia presenting with pneumothorax, persistent air leak, acute respiratory distress syndrome and multi-organ dysfunction: a case report.

INTRODUCTION: Bronchiolitis Obliterans Organising Pneumonia (BOOP) may often present initially as a recurrent spontaneous pneumothorax and then develop multi-system complications. CASE PRESENTATION: A 17-year-old boy presented with a pneumothorax, which developed into rapidly progressive Bronchiolitis Obliterans Organising Pneumonia (BOOP). He developed multi-organ dysfunction (including adult respiratory distress syndrome, oliguric renal failure, acute coronary syndrome, cardiac failure and a right atrial thrombus) which necessitated prolonged intensive care. Diagnosis was confirmed on open lung biopsy and he responded well to treatment with corticosteroids. CONCLUSION: BOOP is exquisitely sensitive to oral corticosteroids but if the diagnosis is not considered in such patients and appropriate treatment instituted early, BOOP may often lead to prolonged hospital admission with considerable morbidity.