Clinical and Organizational Framework of Conversion of Pediatric to Adult Critical Care in a Limited Resource Setting: Lessons of a General Urban Hospital to the First Wave of COVID-19 Pandemic

Background: Usual guidelines for disaster and emergency management did not fit in COVID-19. Many PICUs participated in increasing bed-capacity during COVID-19 surge, but the clinical/administrative framework for adult patient care in units intended for critically ill children is limited. We aim to describe the action plan and clinical results of a COVID-19 unit for critically ill adults managed by the PICU service. Methods: We reviewed the preparedness of PICU team before the surge of cases of COVID-19 and the organizational/administrative issues to increase critical beds. We analyzed the prospectively collected data regards demographic, clinical characteristics, and outcomes of severe COVID-19 cases in our service, on April 1st and September 30th, 2020 during the peak of pandemic. Findings: We describe a 6-step preparedness plan: recruitment and education, admission criteria, children diversion, team hierarchy and general and respiratory equipment. We detailed the expansion from a 6-bed PICU to a mixed pediatric and adult unit and then a 23-bed adult ICU for severe COVID-19, managed by PICU service. 136 patients were admitted, median age 59(51,65) years-old, 68% were male and 63% had P/F≤100. 48% received MV, median length of stay was 7(3,17) and in-hospital mortality was 15%. Interpretation: We propose an organizational framework for the role of PICU in the hospital action plan to increase adult critical beds. The cohort of patients admitted to a PICU repurposed as a COVID-19 ICU had good outcomes These data are valuable to plan coordinated actions of healthcare system for future scenarios. Funding: None to declare. Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: This report was approved by Comite Etico Cientifico of Servicio de Salud Metropolitano Central, Santiago de Chile (Acta 423/2021).