Monitoring of COVID19 in pediatric intensive care unit

Abstract

COVID19 in children may present with a heterogeneous clinical picture. The first serious childhood infection reported in Wuhan, China, started with gastrointestinal symptoms and did not show obvious respiratory symptoms, but quickly progressed to acute respiratory distress syndrome. Respiratory system involvement can range from mild upper respiratory tract symptoms to severe acute respiratory distress syndrome (ARDS). In addition, it has been reported that a multisystem inflammatory syndrome (MIS-C) associated with COVID19 developed in children from England and Italy and then from many countries towards the end of April 2020. MIS-C, which develops in children due to COVID19, is a rare but serious condition associated with COVID19. It is not known whether MIS-C is an infectious immune reaction or a new disease with abnormal development of acquired immunity. The clinical features of MIS-C may be similar to Kawasaki disease and toxic shock syndrome. These include laboratory findings associated with persistent fever, hypotension, gastrointestinal symptoms, rash, myocarditis, and increased inflammation; respiratory symptoms may not be present in all cases. Critical pediatric patients such as COVID19-associated septic shock, acute lung injury, need for mechanical ventilation, extracorporeal respiratory and / or circulatory support, acute renal damage, severe MIS-C, Kawasaki disease need to be followed up and treated in the pediatric intensive care unit. In this section, we planned to review the follow-up and treatment of critical COVID19 pediatric patients who may present with different clinical presentations in the pediatric intensive care unit in the light of current literature information.

Keywords

• pediatric intensive care
• COVID19
• pandemic

Project Number

yok

COVID19’un Çocuk Yoğun Bakımda İzlemi

Abstract

Çocuklarda COVID19 heterojen bir klinik tablo ile prezente olabilir. Çin'in Wuhan kentinde bildirilen ilk ciddi çocukluk çağı enfeksiyonu vakası, gastrointestinal semptomlarla başlayıp belirgin solunum belirtileri göstermemiş, ancak hızla akut solunum sıkıntısı sendromuna ilerlemiştir. Solunum sistemi tutulumu hafif üst solunum yolu bulgularından ağır akut solunum sıkıntısı sendromuna (ARDS) kadar değişkenlik gösterebilir. Ayrıca Nisan 2020’nin sonlarına doğru önce İngiltere ve İtalya sonrasında pek çok ülkeden çocuklarda COVID19 ilişkili bir multisistem inflamatuar sendrom (MIS-C) geliştiği bildirilmiştir. COVID19’a bağlı olarak çocuklarda gelişen MIS-C, COVID19 ile ilişkili nadir ancak ciddi bir durumdur. MIS-C'nin kazanılmış bağışıklığın anormal gelişimi ile enfeksiyöz bir bağışıklık reaksiyonu mu yoksa yeni bir hastalık mı olduğu bilinmemektedir. MIS-C'nin klinik özellikleri Kawasaki hastalığı ve toksik şok sendromuna benzer olabilir. Bunlar arasında sürekli ateş, hipotansiyon, gastrointestinal semptomlar, döküntü, miyokardit ve artmış inflamasyonla ilişkili laboratuvar bulguları bulunur; solunum semptomları her olguda olmayabilir. COVID19 ilişkili septik şok, akut akciğer hasarı, mekanik ventilasyon gereksinimi, ekstrakorporeal solunum ve / veya dolaşım desteği ihtiyacı, akut renal hasar, ağır MIS-C, Kawasaki hastalığı gibi kritik çocuk hastaların çocuk yoğun bakım ünitesinde takip ve tedavisi gerekmektedir. Biz bu bölümde farklı klinik tablolar ile prezente olabilen kritik COVID19 çocuk hastaların çocuk yoğun bakımdaki takip ve tedavisini güncel literatür bilgileri ışığında derlemeyi planladık.

Keywords

• çocuk yoğun bakım
• COVID19
• pandem

Supporting Institution

yok

Project Number

yok

Thanks

Sayın editör; Derlememizi SDÜ Tıp Fakültesi Pediatri Anabilim Dalı Başkanı Prof. Dr. Hasan Çetin'in COVID19 ve Çocuk başlıklı özel sayısı için talebi üzerine yazıp derginize gönderdik. Bize bu fırsat verdiğiniz içi teşekkür ederiz. Saygılarımla Doç. Dr. Nagehan ASLAN

References

1. 1. Sankar J, Dhochak N, Kabra SK, Lodha R. COVID-19 in Children: Clinical Approach and Management. Indian J Pediatr 2020; 87(6): 433-42.
2. 2. Patel NA. Pediatric COVID-19: Systematic review of the literature. Am J Otolaryngol 2020; 41(5): 102573.
3. 3. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395(10237): 1607-8.
4. 4. Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation 2020; 142(5): 429-36.
5. 5. Ong JSM, Tosoni A, Kim Y, Kissoon N, Murthy S. Coronavirus Disease 2019 in Critically Ill Children: A Narrative Review of the Literature. Pediatr Crit Care Med 2020; 21(7): 662-6.
6. 6. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020; 145(6): e20200702.
7. 7. Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J, et al. Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 at a Tertiary Care Medical Center in New York City. J Pediatr 2020; 223: 14-19.
8. 8. Rimensberger PC, Kneyber MCJ, Deep A, Bansal M, Hoskote A, Javouhey E, at al. European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Scientific Sections’ Collaborative Group. Caring for Critically Ill Children With Suspected or Proven Coronavirus Disease 2019 Infection: Recommendations by the Scientific Sections' Collaborative of the European Society of Pediatric and Neonatal Intensive Care. Pediatr Crit Care Med 2021 Jan 1;22(1):56-67.

9. 9. Sethuraman N, Jeremiah SS, Ryo A. Interpreting diagnostic tests for SARS-CoV-2. JAMA 2020; 323: 2249–51.
10. 10. Raoof S, Nava S, Carpati C, Hill NS. High-Flow, Noninvasive Ventilation and Awake (Nonintubation) Proning in Patients With Coronavirus Disease 2019 With Respiratory Failure. Chest 2020; 158(5): 1992-2002.
11. 11. Matava CT, Kovatsis PG, Lee JK, Castro P, Denning S, Yu J, et al. Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society. Anesth Analg. 2020; 131(1):61-73.
12. 12. Yıldızdaş D, Kendirli T, Dursun O, Akyildiz BN, Anil AB, Anil M, et al. Çocuk COVID19 hastasının acil havayolu yönetimi ve trakeal entübasyon için öneriler. J Pediatr Emerg Intensive Care Med 2020; 7(Suppl-1): 18-23.
13. 13. Yıldızdaş D, Kendirli T, Dursun O, Anil AB, Anil M, Citak A, et al. COVID19 Pediyatrik ARDS Protokolü. J Pediatr Emerg Intensive Care Med 2020; 7(Suppl-1): 34-44.
14. 14. García-Salido A, Leoz-Gordillo I, Martínez de Azagra-Garde A, Nieto-Moro M, Iglesias-Bouzas MI, García-Teresa MÁ, et al. Children in Critical Care Due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Experience in a Spanish Hospital. Pediatr Crit Care Med 2020; 21: 576-80.
15. 15. Chang SY, Dabbagh O, Gajic O, Patrawalla A, Elie MC, Talmor DS, et al. Contemporary Ventilator Management in Patients with and at risk of ALI/ARDS. Respir Care 2013; 58(4): 578-88.
16. 16. Cho YJ, Moon JY, Shin ES, Kim JH, Jung H, Park SY, et al; Korean Society of Critical Care Medicine.; Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group. Clinical Practice Guideline of Acute Respiratory Distress Syndrome. Tuberc Respir Dis (Seoul) 2016; 79(4): 214-33.
17. 17. Dalton HJ, Macrae DJ, Pediatric Acute Lung Injury Consensus Conference Group. Extracorporeal support in children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16(5 Suppl 1): S111-7.
18. 18. Emeriaud G, Newth CJ, Pediatric Acute Lung Injury Consensus Conference Group. Monitoring of children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16(5 Suppl 1): S86-101.
19. 19. Essouri S, Carroll C, Pediatric Acute Lung Injury Consensus Conference Group. Non-invasive support and ventilation for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16(5 Suppl 1): 102- 10.
20. 20. Flori H, Dahmer MK, Sapru A, Quasney MW, Pediatric Acute Lung Injury Consensus Conference Group. Comorbidities and assessment of severity of pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16(5 Suppl 1): S41-S50.
21. 21. Rimensberger PC, Cheifetz IM; Pediatric Acute Lung Injury Consensus Conference Group. Ventilatory support in children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16(5 Suppl 1): S51-60.
22. 22. Valentine SL, Nadkarni VM, Curley MA; Pediatric Acute Lung Injury Consensus Conference Group. Nonpulmonary treatments for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16(5 Suppl 1): S73-85.
23. 23. Bateman ST, Borasino S, Asaro LA, et al. Early high-frequency oscillatory ventilation in pediatric acute respiratory failure: a propensity score analysis. Am J Respir Crit Care Med 2016; 193(5): 495-503.
24. 24. Young D, Lamb SE, Shah S, Cheifetz IM, Diane S, Wypij D, et al. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med 2013; 368(9): 806-13.
25. 25. Ammar MA, Sacha GL, Welch SC, Bass SN, Kane-Gill SL, Duggal A, et al. Sedation, Analgesia, and Paralysis in COVID-19 Patients in the Setting of Drug Shortages. J Intensive Care Med 2021; 36(2): 157-74.
26. 26. Hartmann SM, Hough CL. Argument against the Routine Use of Steroids for Pediatric Acute Respiratory Distress Syndrome. Front Pediatr 2016; 4: 79.
27. 27. Amigoni A, Pettenazzo A, Stritoni V, Circelli M. Surfactants in Acute Respiratory Distress Syndrome in Infants and Children: Past, Present and Future. Clin Drug Investig 2017; 37(8): 729-36.
28. 28. Gebistorf F, Karam O, Wetterslev J, Afshari A. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) in children and adults. Cochrane Database Syst Rev 2016 Jun 27;2016(6):CD002787.
29. 29. Hunt JL, Bronicki RA, Anas N. Role of Inhaled Nitric Oxide in the Management of Severe Acute Respiratory Distress Syndrome. Front Pediatr 2016; 4: 74.
30. 30. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol 2020; 7: 438–40.
31. 31. Loi M, Branchford B, Kim J, Self C, Nuss R. COVID-19 anticoagulation recommendations in children. Pediatr Blood Cancer 2020; 67(9): e28485.
32. 32. Ramanathan K, Antognini D, Combes A, Paden M, Zakhary B, Ogino M, et al. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med. 2020; 8(5): 518-26.
33. 33. Tume LN, Valla FV, Joosten K, Jotterand Chaparro C, Latten L, Marino LV, et al: Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Med 2020; 46: 411–25.
34. 34. Ronco C, Reis T, Husain-Syed F: Management of acute kidney injury in patients with COVID-19. Lancet Respir Med 2020; 8:738–42.
35. 35. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with Coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77:683–90.
36. 36. Asadi-Pooya AA, Simani L. Central nervous system manifestations of COVID-19: A systematic review. J Neurol Sci 2020; 413:116832.
37. 37. Dugue R, Cay-Martínez KC, Thakur KT, Garcia JA, Chauhan LV, Williams SH, et al: Neurologic manifestations in an infant with COVID-19. Neurology 2020; 94:1100–2.
38. 38. Anıl AB, Küllüoğlu EP. Çocuk yoğun bakım ünitesinde COVİD-19 yönetimi. Tepecik Eğit. ve Araşt. Hast. Dergisi 2020; 30(Ek sayı): 156-67.
39. 39. Weiss SL, Peters M, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020; 21: e52-106.
40. 40. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med 2020; 48(6): e440-e69.
41. 41. Kendirli T, Yıldızdaş D, Dursun O ve ark. COVID19 İlişkili dolaşım bozukluğu olan çocuklarda şokun tanımlanması ve tedavi yönetimi. J Pediatr Emerg Intensive Care Med 2020; 7(Suppl-1): 59-63. 42. Rowley AH. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat Rev Immunol. 2020; 20(8): 453-4.
42. 43. Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management. Children (Basel). 2020; 7(7): 69.
43. 44. Deville JG, Song E, Ouelette CP. Coronavirus disease 2019 (COVID-19): Considerations in children. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-considerations-in-children.
44. 45. Gregorio-Hernández R, Escobar-Izquierdo AB, Cobas-Pazos J, Martínez-Gimeno A. Point-of-care lung ultrasound in three neonates with COVID-19. Eur J Pediatr. 2020; 179(8): 1279-85.
45. 46. Buonsenso D, Piano A, Raffaelli F, Bonadia N, de Gaetano Donati K, Franceschi F. Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak. Eur Rev Med Pharmacol Sci 2020; 24(5): 2776-80.
46. 47. Guitart C, Suárez R, Girona M, et al. KIDS-Corona study group, Kids Corona Platform. Lung ultrasound findings in pediatric patients with COVID-19. Eur J Pediatr 2020: 1–7.
47. 48. Lu W, Zhang S, Chen B, et al. A Clinical Study of Noninvasive Assessment of Lung Lesions in Patients with Coronavirus Disease-19 (COVID-19) by Bedside Ultrasound. Ultraschall Med. 2020; 41(3): 300-7.
48. 49. Alilio PM, Ebeling-Koning NE, Roth KR, Desai T. Lung point-of-care (POCUS) ultrasound in a pediatric COVID-19 case. Radiol Case Rep 2020; 15(11): 2314-8.
49. 50. Vetrugno L, Bove T, Orso D, et al. Our Italian experience using lung ultrasound for identification, grading and serial follow-up of severity of lung involvement for management of patients with COVID-19. Echocardiography 2020; 37(4): 625-7.
50. 51. Moore S, Gardiner E. Point of care and intensive care lung ultrasound: A reference guide for practitioners during COVID-19. Radiography (Lond) 2020; 26(4): 297-302.
51. 52. Yasukawa K, Minami T. Point-of-Care Lung Ultrasound Findings in Patients with COVID-19 Pneumonia. Am J Trop Med Hyg 2020; 102(6): 1198-202.
52. 53. Convissar DL, Gibson LE, Berra L, Bittner EA, Chang MG. Application of Lung Ultrasound During the COVID-19 Pandemic: A Narrative Review. Anesth Analg 2020; 131(2): 345-50.
53. 54. Lichter Y, Topilsky Y, Taieb P, et al. Lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Med 2020; 46(10): 1873-83.
54. 55. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020; 382: 1787–99.
55. 56. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: Different respiratory treatments for different phenotypes? Intensive Care Med 2020; 46:1099–102.
56. 57. Bhimraj A, Morgan RL, Hirsch Shumaker A, et al: Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. 2020. Available at:https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/.
57. 58. Colaneri M, Bogliolo L, Valsecchi P, Sacchi P, Zuccaro V, Brandolino F, et al. Tocilizumab for Treatment of Severe COVID-19 Patients: Preliminary Results from SMAtteo COvid19 REgistry (SMACORE). Microorganisms 2020; 8(5): 695.
58. 59. Guaraldi G, Meschiari M, Cozzi-Lepri A, Milic J, Tonelli R, Menozzi M, et al. Tocilizumab in patients with severe COVID-19: a retrospective cohort study. Lancet Rheumatol 2020; 2: 474-84.
59. 60. Diorio C, Anderson EM, McNerney KO, Goodwin EC, Chase JC, Bolton MJ, et al. Convalescent plasma for pediatric patients with SARS-CoV-2-associated acute respiratory distress syndrome. Pediatr Blood Cancer 2020; 67(11): 28693. 61. Figlerowicz M, Mania A, Lubarski K, Lewandowska Z, Służewski W, Derwich K, et al. First case of convalescent plasma transfusion in a child with COVID-19-associated severe aplastic anemia. Transfus Apher Sci 2020; 59(5): 102866.