PICS and the Intensive Care Society (ICS) have been in discussion over the past few days regarding the current covid-19 pandemic and management of critically ill patients (adults and children). Below is a Joint Position Statement that has agreed by ICS and PICS.
The rapid increase in covid-19 cases seen in the UK over the past week indicates that the demand for ICU beds is likely to rise sharply. Some parts of the country have already seen critically ill adults with covid-19-associated respiratory failure. In contrast, data available so far from China, Italy and other parts of the world indicates that the number of children requiring critical care with covid-19 infection is very small.
PICS and ICS are aware that some tertiary hospitals have already started making plans for their PICUs to admit young adults with non-covid-19 diagnoses to ease demand on their adult ICUs. PICS and ICS Councils have been in discussion regarding how professionals from the two societies can support each other. In addition, PICS and ICS are liaising closely with the NHS England EPRR team to establish anticipated covid-19 modelling requirements for critical care support.
The position statement below, supported by the NHS England national EPRR team, has been put together by PICS and ICS to provide preliminary guidance to their members in order for preparatory planning to occur.
- The primary responsibility of paediatric critical care units and associated operational delivery networks is the management of critically ill children.
- However, should the demand for adult ICU beds become unsustainable, then PICS recognises that some groups of young adult patents may be suitable for admission to PICU beds. This might include those under the age of 25 years with conditions familiar to PICU staff (such as overdose, head injury, trauma, sepsis) or those recently transitioned from paediatric care (e.g. GUCH patients). PICS and ICS supports the flexible use of PICU beds in such circumstances.
- PICS and ICS emphasise that decisions about admitting adults in PICU beds should be taken at a local/regional level based on PICU bed availability, expected demand for ICU beds, and practicalities on the ground such as availability of appropriately trained staff, equipment and clinical care protocols. These decisions should involve the Leads (or delegates) and Matrons (or equivalent) of both the PICU and the adult ICU as well as hospital management.
- Inter-hospital transfer of adult ICU patients should be avoided as far as possible, by creating additional capacity at each hospital (e.g. by converting operating theatres and recovery areas into ICU beds staffed by anaesthetists and other professionals). If transfers are required for capacity reasons, they should preferentially be to other adult ICUs. If all adult ICUs and their overflow areas in the region are also full, there may be a role for liaison with the regional PICU via the appropriate PICU retrieval teams.
PICS/ ICS will aim to continue to work together closely and produce relevant guidance for its members as required.
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