Prepare for a Surge of Pediatric Patients With COVID-19

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With children going back to school, continued outbreaks of respiratory syncytial virus (RSV), and the upcoming flu season, it is important to prepare for potential surges of pediatric patients with COVID-19.

As the delta variant of COVID-19 continues to spread, more children are being admitted to hospitals and intensive care units in the United States. Over 50,000 children younger than 17 have been hospitalized since August 2020, according to the Centers for Disease Control and Prevention’s COVID Data Tracker.
 
With children going back to school, continued outbreaks of respiratory syncytial virus (RSV), the upcoming flu season, and the continued increased numbers of children with behavioral health issues, it is important to prepare for potential surges of pediatric patients with COVID-19. Triage protocols, resource allocation, active drug shortages, and visitation plans should all be considered to prepare for a surge of patients, said SCCM Council member Thomas A. Nakagawa, MD, FAAP, FCCM.

Triage Protocols

Wolfson Children’s Hospital and the Baptist Medical System in Jacksonville, Florida, is in a COVID-19 hot spot. “We have worked to try and prepare ourselves for the surge and the capacity issues, which we anticipated based upon modeling. The overflow of adult patients into other units including post-anesthesia care units, other patient care areas, and field hospitals has occurred as we follow our triage protocols,” said Dr. Nakagawa. “Hospital staff need to think about the number of isolation rooms that they have. They need to figure out where they’re going to put infectious versus noninfectious patients and consider how canceling elective surgeries will impact the system.”

Resource Allocation and Supply

Hospitals should plan for additional ventilators and high-flow devices for children who require noninvasive ventilation. Hospitals should consider the allocation of resources and any supply shortages they may face with a surge in patients. “There are supply chain issues that one has to anticipate,” said Dr. Nakagawa. “We have had problems trying to get and maintain our oxygen supply. Supplies like chest tubes have been on backorder. Biologics used to treat COVID-19 are also in short supply. So, things that we use every day in our practice in critical care are backordered, and we’re getting small trickles of supplies in. But stock is not normal and supply chains have been disrupted. Even if we get through this COVID surge, I’m concerned about increased numbers of MIS-C cases in the upcoming weeks that will continue to tax our system.”

Visitation Issues

A byproduct of a surge in pediatric patients is the unique visitation issues that arise, according to Dr. Nakagawa. Hospitals should consider how to manage visitation and how to help accommodate families. They should plan for parents who have other children to care for and COVID-19-positive parents who risk spreading the disease to others in the hospital. “It’s a moving target and tends to change every day depending on the dynamics. But there are issues that we run into in the ICU because our visitation is somewhat restricted compared to the general care areas,” said Dr. Nakagawa. “For instance, the single parent who has another child, what does the parent do with the other kids if their support system is limited? So those things weigh heavy on us because we have to think about protecting our staff. But we also have to think about the needs of the patient and the parent.”

“I encourage ICU leadership to work with hospital leadership in an effort to plan on how to overcome some of these challenges and what they’re going to do when these challenges arise,” said Dr. Nakagawa. “It’s not just taking care of kids, it’s also about taking care of yourself. It’s about taking care of your staff and making sure that we can continue to work together as a multidisciplinary team to care for these patients and families.”

Flu Season

Lauren R. Sorce, PhD, RN, CPNP-AC/PC, FCCM, shares other ways critical care clinicians can prepare for children returning to school and the upcoming flu season.  

More Resources

• Access pediatric microlearning and education from the COVID-19 Rapid Resource Center
• Review the characterization and outcomes of hospitalized children with COVID-19 in this Critical Care Medicine article
• Review risk factors for critical COVID-19 and mortality in hospitalized young adults in this Critical Care Explorations article.
• Take advantage of free resources from SCCM’s Critical Care for the Non-ICU Clinician Training to help those who may not typically work with pediatric patients

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Posted: 8/26/2021 | 0 comments