Adapting a picu to the first COVID-19 pandemic wave

AIMS & OBJECTIVES: the COVID-19 pandemic has posed an unprecedented challenge for adult ICUs With children relatively spared from the disease, pediatric intensive care resources have provided invaluable support We describe the interventions carried out in a PICU and hypothesize they will be useful in the next pandemic wave METHODS: description of interventions in a tertiary center PICU with 3036 COVID-19 patients admitted (283 to ICU) and 648 deaths until May 30th RESULTS: interventions during the pandemic focused on: 1) protecting patients and healthcare workers within the picu: open windows, rational PPE use and SARSCoV-2 testing, safety simulation-training (donning-doffing, video-assisted orotracheal intubation, bronchoalveolar lavage, communication in protected code blue), service rearrangement and teleworking to reduce exposure, differentiation of COVID-19 and COVID-19-free areas and limitation of aerosol-generating practices;2) allocation of the PICU medical team (18 attendings, 9 residents) in three different areas working in collaboration with adult intensivists and anesthesiologists: 6 attendings deployed to the adult ICU full time, 12 attendings worked in fixed teams and covered a 16-bed COVID-19 PICU (12 adult, 4 pediatric beds) and a 9-bed reanimation unit with non-COVID-19 critically ill children Elective surgeries were canceled but emergency surgeries and transplants were performed One full-time visitor per children was allowed Table 1 shows relevant characteristics of patients admitted in this period No-one from the medical team and 6/78 nurses resulted infected, all asymptomatic CONCLUSIONS: although the first pandemic wave has impacted PICUs worldwide, an anticipated and multicomponent adaptive strategy may help optimize patient care and reduce healthcare worker infection rates