CHEST Guidelines-Response_chest

Response_chest - 3

Pdf Summary

In response to comments from Decembrino and colleagues, an article published in the journal "CHEST" highlights the role of adult Intensive Care Units (ICUs) in the care of critically ill children during public health emergencies when healthcare systems are overwhelmed. While the authors of the article acknowledge the importance of pediatric care being managed by specialists, they suggest that, during crises, flexibility in age-based admission criteria could help relieve burdened parts of the health system. They cite research showing that adults with COVID-19 treated in Pediatric Intensive Care Units (PICUs) experienced outcomes comparable to adults treated in dedicated adult ICUs.<br /><br />The study by Cogo et al., which focuses on the outcomes of children under 14 admitted to adult ICUs, indicated poorer results compared to those treated in pediatric units. However, recent data from the UK suggests that children aged around 12 have similar outcomes whether they are admitted to adult or pediatric units, though results may vary depending on the child's diagnosis.<br /><br />The article also notes the disparity in ICU bed availability: approximately 23,000 neonatal ICU beds, 75,000 adult ICU beds, and 5,000 PICU beds exist in the U.S. Given that COVID-19 has had a more muted impact on children compared to adults, the piece speculates on scenarios where higher pediatric care demand could necessitate support from neonatal and adult ICUs to manage critically ill children effectively.<br /><br />The overall message emphasizes the necessity of flexible healthcare resource allocation during emergencies, with the aim of maintaining patient care quality across all age groups. The discussion reflects insights from the authors, Ryan C. Maves, MD, and Mary A. King, MD, MPH, associated with Wake Forest University School of Medicine and the University of Washington School of Medicine, respectively.

Keywords

ICU

pediatric care

public health emergencies

COVID-19

healthcare systems

admission criteria

patient outcomes

ICU bed availability

healthcare resource allocation

critical care