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Practice Guideline
. 2020 Nov;88(5):705-716.
doi: 10.1038/s41390-020-1053-9. Epub 2020 Jul 7.

COVID-19 PICU guidelines: for high- and limited-resource settings

Saraswati Kache  1 , Mohammod Jobayer Chisti  2 , Felicity Gumbo  3 , Ezekiel Mupere  4 , Xia Zhi  5 , Karthi Nallasamy  6 , Satoshi Nakagawa  7 , Jan Hau Lee  8 , Matteo Di Nardo  9 , Pedro de la Oliva  10 , Chhavi Katyal  11 , Kanwaljeet J S Anand  12 , Daniela Carla de Souza  13 , Vanessa Soares Lanziotti  14 , Joseph Carcillo  15
Affiliations
Practice Guideline

COVID-19 PICU guidelines: for high- and limited-resource settings

Saraswati Kache et al. Pediatr Res. 2020 Nov.

Abstract

Background: Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients requiring care in the pediatric ICU.

Methods: An international collaboration was formed to review the available evidence and develop evidence-based guidelines for the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with consensus-based guidelines.

Results: This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or anti-thrombotic therapies are also described.

Conclusion: Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill children with COVID-19 receive across the world.

Impact: At the time of publication, this is the latest evidence for managing critically ill children infected with SARS-CoV-2. Referring to these guidelines can decrease the morbidity and potentially the mortality of children effected by COVID-19 and its sequalae. These guidelines can be adapted to both high- and limited-resource settings.

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Conflict of interest statement

The authors declare no competing interests.

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References

    1. Coronavirus COVID-19 global cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). https://coronavirus.jhu.edu/map.html (2020).
    1. Dong, Y. et al. Epidemiology of COVID-19 among children in China. Pediatrics145, 1–10 (2020). - PubMed
    1. C. D. C. COVID-19 Response Team et al. Coronavirus disease 2019 in children—United States, February 12–April 2, 2020. MMWR Morb. Mortal. Wkly. Rep. 2020;69:422–426. - PMC - PubMed
    1. Ogimi C, et al. Characteristics and outcomes of coronavirus infection in children: the role of viral factors and an immunocompromised state. J. Pediatr. Infect. Dis. Soc. 2019;8:21–28. - PMC - PubMed
    1. Lu X, et al. SARS-CoV-2 infection in children. N. Engl. J. Med. 2020;382:1663–1665. - PMC - PubMed

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