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Mar 13, 2021 Uncategorized

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cash advance In the future, airlines and other bailed out companies won’t have a choice. Market indices are shown in real time, except for the DJIA, which is delayed by two minutes. All times are ET. Twenty adults died in PICU (14%).Conclusion In a rapid and unprecedented effort during the first wave of the COVID 19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.epidemiologymicrobiologyThis article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid 19 pandemic or until otherwise determined by BMJ.Surge critical care beds were created in theatres and recovery areas and respiratory wards, and in some parts of the country, in paediatric intensive care units (PICUs).There is a lack of national data on the extent to which PICUs were transformed to manage adult patients and how critical care services for children were maintained nationally.What this study addsSeven PICUs in England repurposed their space, equipment and staff to care for 145 critically ill adults during the first wave of the pandemic.Modelling based on historic national clinical audit data was used to predict national demand for PICU beds to maintain adequate provision for critically ill children in other units.Repurposed PICUs cared for nearly one in five adults needing critical care within their own hospitals.IntroductionOn 11 March 2020, WHO declared the COVID 19 outbreak a pandemic.1 Experience from China and Italy indicated that 98% of all infections were in adults, and at least 5% of infected adults required critical care admission. Only 2% of infections were in children, of whom just 1% 2% required paediatric intensive care unit (PICU) admission.2 5National and international modelling, together with early clinical experience, indicated that the demand for adult intensive care unit (AICU) beds during the pandemic was likely to rapidly outstrip bed capacity several fold.6 9 Increasing AICU surge capacity during pandemics and other mass casualty disasters has been the subject of much discussion.10 12 Since there are far fewer critical care beds for children than for adults, the use of AICU beds for critically ill/injured children has been an important consideration in pandemic plans (including during the H1N1 influenza pandemic in 2009), whereas the opposite scenario (utilisation of PICU beds for critically ill adults) has not featured heavily.13 14In England, paediatric intensive care is a centralised, nationally commissioned service, comprising PICUs based in tertiary hospitals and associated specialist retrieval teams.15 Prior to the COVID 19 pandemic, there were 312 PICU beds in 22 hospitals (2.7 beds per 100000 children aged 16 17 English PICUs admit around 15000 children each year, nearly 10000 of them being unplanned admissions.18 Importantly, demand for PICU beds follows a seasonal pattern, with a 30% increase in unplanned respiratory admissions over winter.19 While many PICUs supported adult critical care expansion through loan of space and equipment during the COVID 19 pandemic, single centre reports from Europe and the USA describe how they repurposed their entire PICUs, including staff, to care for critically ill adults20 21; however, there is a dearth of national data on this topic.The National Health Service declared a level 4 incident in early March 2020.22 Plans to rapidly increase AICU bed capacity were implemented initially by cancelling elective surgery, then creation of additional critical care beds outside AICU areas through stepwise escalation high dependency units, operating theatres and recovery areas, followed by other acute wards and finally, the newly built Nightingale hospitals.23 24 Since surge planning occurred at a regional and individual hospital level, plans to use PICU beds to care for adult patients featured in some regions and not in advance

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