Evaluation of COVID-19 Patients in The Pediatric Critical Care Unit

Abstract

Objective: Few cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in children compared with the total number of cases in the general population. No pediatric studies (or cases) have evaluated extracorporeal techniques in severe coronavirus disease 2019 (COVID-19) patients. In this article, we aimed to describe the clinical features, treatments, and outcomes of four children with COVID‐19 who were treated with therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) in our pediatric intensive care unit (PICU). Materials and Methods: The children with COVID 19 pneumonia admitted to the PICUs from March 23, and May 6, 2020 were collected. Demographic data and reason for hospitalization were recorded. Vital and laboratory findings were examined in children with extracorporeal treatments. Results: Noninvasive mechanical ventilation, antiviral and antibacterial therapy, supportive antioxidant treatments were administered for 11 children. Respiratory failure and vital signs were more serious in four patients than in other patients. Therefore, we performed extracorporeal support treatments, TPE and CRRT. The patients showed a rapid clinical response to these treatments. Conclusion: TPE and CRRT can use for severe COVID-19 infection receiving other supportive and medical treatments in children.

Keywords

• COVID-19
• hemodiafiltration
• plasmapheresis

Pediatrik Yoğun Bakım Ünitesindeki COVID-19 Hastalarının Değerlendirilmesi

Abstract

Amaç: Genel popülasyondaki toplam vaka sayısı ile karşılaştırıldığında, çocuklarda az sayıda ağır akut solunum sendromu koronavirüs 2 (SARS-CoV-2) enfeksiyonu bildirilmiştir. Hiçbir çocuk çalışması (veya vaka) ağır koronavirüs hastalığı (COVID-19) hastalarında ekstrakorporeal teknikleri değerlendirmemiştir. Bu yazıda, çocuk yoğun bakım ünitemizde (ÇYBÜ) terapötik plazma değişimi (TPD) ve sürekli renal replasman tedavisi (SRRT) ile tedavi edilen dört COVID‐19 çocuğun klinik özelliklerini, tedavilerini ve sonuçlarını tanımlamayı amaçladık. Materyal ve Methot: 23 Mart ve 6 Mayıs 2020 itibaren ÇYBÜ’ne kabul edilen COVID-19 pnömonisi olan çocuklar toplandı. Demografik veriler ve hastaneye yatış nedeni kaydedildi. Ekstrakorporeal tedavi uygulanan çocuklarda yaşamsal ve laboratuvar bulguları incelendi. Bulgular: Noninvaziv mekanik ventilasyon, antiviral ve antibakteriyel tedavi, destekleyici antioksidan tedaviler 11 çocuğa uygulandı. Diğer hastalara göre dört hastada solunum yetmezliği ve vital bulguları daha ciddiydi. Bu nedenle ekstrakorporeal destek tedavileri, TPD ve SRRT uyguladık. Hastalar bu tedavilere hızlı bir klinik yanıt gösterdi. Sonuç : TPD ve SRRT, çocuklarda diğer destekleyici ve tıbbi tedaviler alan ağır COVID-19 enfeksiyonu için kullanılabilir.

Keywords

• COVID-19
• hemodiyafiltrasyon
• plazmaferez

References

1. Paules CI, Marston HD, Fauci AS. Coronavirus infections more than just the common cold. JAMA. 2020; 323(8):707-708.
2. Worldometer. COVID-19 coronavirus pandemic. https://www.worldometers.info/coronavirus. Accesed date 10 April 2020.
3. American Academy of Pediatrics. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf. Accesed date 16 March 2020.
4. Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020; 382(17):1663-1665.
5. Hong H, Wang Y, Chung HT, Chen CJ. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatrics & Neonatology. 2020;61(2):131-132.
6. Aygün F, Varol F, Durak C, et al. Evaluation of continuous renal replacement therapy and therapeutic plasma exchange, in severe sepsis or septic shock in critically ill children. Medicina. 2019;55(7):350.
7. Sun D, Li H, Lu XX, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center’s observational study. World Journal of Pediatrics. 2020;16(3):251-259.
8. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020; 296(2):E32-40.

9. Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020;8(5):506-517.
10. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242.
11. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). Stat Pearls Publishing 2020 Mar 20. [https://www.ncbi.nlm.nih.gov/books/NBK554776/. Accessed date 13 April 2020.
12. Patel P, Nandwani V, Vanchiere J, Conrad SA, Scott LK. Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza A--an associated respiratory failure and hemodynamic shock. Pediatr Crit Care Med. 2011;12(2):87-89.
13. Cheungpasitporn W, Zand L, Dillon JJ, Qian Q, Leung N. Lactate clearance and metabolic aspects of continuous high-volume hemofiltration. Clinical Kidney Journal. 2015;8(4):374-377.
14. Yang W, Hong J, Zeng Q, et al. Improvement of oxygenation in severe acute respiratory distress syndrome with high-volume continuous veno-venous hemofiltration. Glob Pediatr Health. 2016;3:2333794X16645699. doi:10.1177/2333794X16645699