Indian Pediatr. Novel Coronavirus 2019 (2019-nCoV) Infection: Part I - Preparedness and Management in the Pediatric Intensive Care Unit in Resource-l

[tetano]

Indian Pediatr. 2020 Mar 29. pii: S097475591600151. [Epub ahead of print]
Novel Coronavirus 2019 (2019-nCoV) Infection: Part I - Preparedness and Management in the Pediatric Intensive Care Unit in Resource-limited Settings.


Ravikumar N[SUP]1[/SUP], Nallasamy K[SUP]1[/SUP], Bansal A[SUP]2[/SUP], Angurana SK[SUP]1[/SUP], Basavaraja GV[SUP]3[/SUP], Sundaram M[SUP]4[/SUP], Lodha R[SUP]5[/SUP], Gupta D[SUP]6[/SUP], Jayashree M[SUP]1[/SUP]; For Intensive Care Chapter Of Indian Academy Of Pediatrics.

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Abstract

First reported in China, the 2019 novel coronavirus has been spreading across globe. Till 26 March, 2020, 416,686 cases have been diagnosed and 18,589 have died the world over. The coronavirus disease mainly starts with a respiratory illness and about 5%-16% require intensive care management for acute respiratory distress syndrome (ARDS) and multi-organ dysfunction. Children account for about 1%-2% of the total cases, and 6% of these fall under severe or critical category requiring pediatric intensive care unit (PICU) care. Diagnosis involves a combination of clinical and epidemiological features with laboratory confirmation. Preparedness strategies for managing this pandemic are the need of the hour, and involve setting up cohort ICUs with isolation rooms. Re-allocation of resources in managing this crisis involves careful planning, halting elective surgeries and training of healthcare workers. Strict adherence to infection control like personal protective equipment and disinfection is the key to contain the disease transmission. Although many therapies have been tried in various reigns, there is a lack of strong evidence to recommend anti-virals or immunomodulatory drugs.



PMID:32238612

 

[tetano]

Indian Pediatr. 2020 Mar 29. pii: S097475591600152. [Epub ahead of print]
Novel Coronavirus 2019 (2019-nCoV) Infection: Part II - Respiratory Support in the Pediatric Intensive Care Unit in Resource-limited Settings.


Sundaram M[SUP]1[/SUP], Ravikumar N[SUP]2[/SUP], Bansal A[SUP]3[/SUP], Nallasamy K[SUP]2[/SUP], Basavaraja GV[SUP]4[/SUP], Lodha R[SUP]5[/SUP], Gupta D[SUP]6[/SUP], Odena MP[SUP]7[/SUP], Ashwath RNR[SUP]8[/SUP], Jayashree M[SUP]2[/SUP]; For Intensive Care Chapter Of Indian Academy Of Pediatrics.

Author information




Abstract

The 2019-novel coronavirus predominantly affects the respiratory system with manifestations ranging from upper respiratory symptoms to full blown acute respiratory distress syndrome (ARDS). It is important to recognize the risk factors, categorize severity and provide early treatment. Use of high flow devices and non-invasive ventilation has been discouraged due to high chances of aerosol generation. Early intubation and mechanical ventilation are essential to prevent complications and worsening, especially in resource-limited settings with very few centers having expertise to manage critical cases. Hydrophobic viral filter in the ventilator circuit minimizes chances of transmission of virus. Strategies to manage ARDS in COVID-19 include low tidal volume ventilation with liberal sedation-analgesia. At the same time, prevention of transmission of the virus to healthcare workers is extremely important in the intensive care setting dealing with severe cases and requiring procedures generating aerosol. We, herein, provide guidance on non-invasive respiratory support, intubation and management of ARDS in a child with COVID-19.



PMID:32238613