Engels, Bernadette

Kneyber, Martin C J

van der Voort, Peter H J

English

ARTS repository - University of Groningen

   University of GroningenPaediatric and adult critical care medicineKneyber, Martin C J; Engels, Bernadette; van der Voort, Peter H JPublished in:Critical care (London, England)DOI:10.1186/s13054-020-03074-3IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Kneyber, M. C. J., Engels, B., & van der Voort, P. H. J. (2020). Paediatric and adult critical care medicine:joining forces against Covid-19. Critical care (London, England), 24(1), Article 350.https://doi.org/10.1186/s13054-020-03074-3CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 10-09-2023LETTER Open AccessPaediatric and adult critical care medicine:joining forces against Covid-19Martin C. J. Kneyber1,2*, Bernadette Engels1 and Peter H. J. van der Voort2,3The increasing number of COVID-19 intensive careunit (ICU) admissions in our hospital necessitated in-creasing the number of physical ICU beds and staff-ing. This could be done by redeploying paediatriccritical care physicians and nurses to adult ICUs.However, paediatric ICUs (PICU) are exclusively lo-cated in university hospitals in the Netherlands, henceredeployment potentially could reduce capacity forcritically ill children [1]. We thus decided to maintainour current PICU capacity and to re-open, for adultCOVID-19 care, the part of our PICU that was closeddue nursing staff shortage [2].The main hurdle was how to staff the unit. PICUphysicians and nurses advocated to remain in theirenvironment and use the well-established working re-lationships within the PICU bedside team when car-ing for the adult COVID-19 patients because thegeneral principles of intensive care medicine wouldnot be different between children and adults [3]. Also,the clinical phenotype of adults with COVID-19matched perfectly the research focus of our PICU,providing opportunities to study respiratory systemmechanics in these adults [4]. To increase availabilityof PICU nurses, we upgraded their employment con-tract to 1 full-time equivalence, and all granted leavesof absence were revoked until further notice afterconsulting Human Resources and approval of theBoard of Directors.The entire nursing team was split into two. One groupof nurses originally coming from the adult ICU beforebecoming a PICU nurse were exclusively allocated to theCOVID-19 part of our PICU. These nurses and our ownPICU consultants were the primary care providers. Anadult intensive care unit consultant reviewed patientplans twice a day to guarantee quality of adult criticalcare [5].The 6-bedded Covid-19 unit located in the PICUopened at the end of March and remained open forsix weeks. Our ICUs admitted 98 adult COVID-19patients, 12 of them were treated in the PICU bypaediatric nurses and intensivists. All but one of these12 survived to PICU discharge (Table 1). Preservingthe PICU team ensured a rapid transition andboosted morale. This period proved to be a unique© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.* Correspondence: m.c.j.kneyber@umcg.nl1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands2Critical Care, Anaesthesiology, Peri-operative & Emergency Medicine (CAPE),University of Groningen, Groningen, The NetherlandsFull list of author information is available at the end of the articleKneyber et al. Critical Care          (2020) 24:350 https://doi.org/10.1186/s13054-020-03074-3collaboration between paediatric and adult intensivistsand unforgettable experience. It made PICU practi-tioners stronger in many ways and sets in motion astronger relationship between paediatric and adultcritical care medicine in our hospital. Also, PICU oc-cupancy remained > 80%, supporting our decision notto reduce PICU capacity and not to redeploy staff.AcknowledgementsNot applicable.Authors’ contributionsThe authors drafted the manuscript and approved the final version.FundingNot applicable.Availability of data and materialsNot applicable.Ethics approval and consent to participateNot applicable.Consent for publicationNot applicable.Competing interestsNone to disclose for both authors.Author details1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands. 2Critical Care, Anaesthesiology, Peri-operative & EmergencyMedicine (CAPE), University of Groningen, Groningen, The Netherlands.3Department of Critical Care, University Medical Center Groningen, Universityof Groningen, Groningen, the Netherlands.Received: 29 May 2020 Accepted: 8 June 2020References1. Gemke RJ, van der Voort E, Bos AP. The necessity for centralization ofpediatric intensive care. Ned Tijdschr Geneeskd. 1997;141(48):2325–7.2. Yager PH, Whalen KA, Cummings BM. Repurposing a Pediatric ICU forAdults. N Engl J Med. 2020;382(22):e80.3. Epstein D, Brill JE. A history of pediatric critical care medicine. Pediatr Res.2005;58(5):987–96.4. Kneyber MCJ, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J,Hammer J, Macrae D, Markhorst DG, Medina A, et al. Recommendations formechanical ventilation of critically ill children from the Paediatricmechanical ventilation consensus conference (PEMVECC). Intensive CareMed. 2017;43(12):1764–80.5. Remy KE, Verhoef PA, Malone JR, Ruppe MD, Kaselitz TB, Lodeserto F,Hirshberg EL, Slonim A, Dezfulian C. Caring for critically ill adults withcoronavirus disease 2019 in a PICU: recommendations by dual trainedIntensivists. Pediatr Crit Care Med. 2020. E-pub ahead of print.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Table 1 Characteristics of 12 adult Covid-19 patients managed in the paediatric intensive care unit by the team of paediatric criticalcare physicians and paediatric critical care nurseAge (years);GenderBMI Ventilation time before PICU admission(days)PE Total ventilation time(days)PICU discharge64;M 26.8 4 No 10 Alive69;M 28.3 10 No 14 Alive71;M 26.2 12 No 6 Alive55;M 24.5 0 Yes 22 Alive60;M 25.1 2 No 8 Alive78;M 27.8 1 No 8 Died (treatment withdrawn)56;M 26.9 0 No 18 Alive71;M 26.6 13 No 13 Alive53;F 28.2 2 No 20 Alive53;M 26.5 1 No 14 Alive65;F 32.1 16 No 11 Alive65;M 23.7 3 Yes 30 Alive53;F 33.6 0 No 9 AliveKneyber et al. Critical Care          (2020) 24:350 Page 2 of 2

Paediatric and adult critical care medicine:joining forces against Covid-19

   University of GroningenPaediatric and adult critical care medicineKneyber, Martin C J; Engels, Bernadette; van der Voort, Peter H JPublished in:Critical care (London, England)DOI:10.1186/s13054-020-03074-3IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Kneyber, M. C. J., Engels, B., & van der Voort, P. H. J. (2020). Paediatric and adult critical care medicine:joining forces against Covid-19. Critical care (London, England), 24(1), Article 350.https://doi.org/10.1186/s13054-020-03074-3CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 11-09-2023LETTER Open AccessPaediatric and adult critical care medicine:joining forces against Covid-19Martin C. J. Kneyber1,2*, Bernadette Engels1 and Peter H. J. van der Voort2,3The increasing number of COVID-19 intensive careunit (ICU) admissions in our hospital necessitated in-creasing the number of physical ICU beds and staff-ing. This could be done by redeploying paediatriccritical care physicians and nurses to adult ICUs.However, paediatric ICUs (PICU) are exclusively lo-cated in university hospitals in the Netherlands, henceredeployment potentially could reduce capacity forcritically ill children [1]. We thus decided to maintainour current PICU capacity and to re-open, for adultCOVID-19 care, the part of our PICU that was closeddue nursing staff shortage [2].The main hurdle was how to staff the unit. PICUphysicians and nurses advocated to remain in theirenvironment and use the well-established working re-lationships within the PICU bedside team when car-ing for the adult COVID-19 patients because thegeneral principles of intensive care medicine wouldnot be different between children and adults [3]. Also,the clinical phenotype of adults with COVID-19matched perfectly the research focus of our PICU,providing opportunities to study respiratory systemmechanics in these adults [4]. To increase availabilityof PICU nurses, we upgraded their employment con-tract to 1 full-time equivalence, and all granted leavesof absence were revoked until further notice afterconsulting Human Resources and approval of theBoard of Directors.The entire nursing team was split into two. One groupof nurses originally coming from the adult ICU beforebecoming a PICU nurse were exclusively allocated to theCOVID-19 part of our PICU. These nurses and our ownPICU consultants were the primary care providers. Anadult intensive care unit consultant reviewed patientplans twice a day to guarantee quality of adult criticalcare [5].The 6-bedded Covid-19 unit located in the PICUopened at the end of March and remained open forsix weeks. Our ICUs admitted 98 adult COVID-19patients, 12 of them were treated in the PICU bypaediatric nurses and intensivists. All but one of these12 survived to PICU discharge (Table 1). Preservingthe PICU team ensured a rapid transition andboosted morale. This period proved to be a unique© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.* Correspondence: m.c.j.kneyber@umcg.nl1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands2Critical Care, Anaesthesiology, Peri-operative & Emergency Medicine (CAPE),University of Groningen, Groningen, The NetherlandsFull list of author information is available at the end of the articleKneyber et al. Critical Care          (2020) 24:350 https://doi.org/10.1186/s13054-020-03074-3collaboration between paediatric and adult intensivistsand unforgettable experience. It made PICU practi-tioners stronger in many ways and sets in motion astronger relationship between paediatric and adultcritical care medicine in our hospital. Also, PICU oc-cupancy remained > 80%, supporting our decision notto reduce PICU capacity and not to redeploy staff.AcknowledgementsNot applicable.Authors’ contributionsThe authors drafted the manuscript and approved the final version.FundingNot applicable.Availability of data and materialsNot applicable.Ethics approval and consent to participateNot applicable.Consent for publicationNot applicable.Competing interestsNone to disclose for both authors.Author details1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands. 2Critical Care, Anaesthesiology, Peri-operative & EmergencyMedicine (CAPE), University of Groningen, Groningen, The Netherlands.3Department of Critical Care, University Medical Center Groningen, Universityof Groningen, Groningen, the Netherlands.Received: 29 May 2020 Accepted: 8 June 2020References1. Gemke RJ, van der Voort E, Bos AP. The necessity for centralization ofpediatric intensive care. Ned Tijdschr Geneeskd. 1997;141(48):2325–7.2. Yager PH, Whalen KA, Cummings BM. Repurposing a Pediatric ICU forAdults. N Engl J Med. 2020;382(22):e80.3. Epstein D, Brill JE. A history of pediatric critical care medicine. Pediatr Res.2005;58(5):987–96.4. Kneyber MCJ, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J,Hammer J, Macrae D, Markhorst DG, Medina A, et al. Recommendations formechanical ventilation of critically ill children from the Paediatricmechanical ventilation consensus conference (PEMVECC). Intensive CareMed. 2017;43(12):1764–80.5. Remy KE, Verhoef PA, Malone JR, Ruppe MD, Kaselitz TB, Lodeserto F,Hirshberg EL, Slonim A, Dezfulian C. Caring for critically ill adults withcoronavirus disease 2019 in a PICU: recommendations by dual trainedIntensivists. Pediatr Crit Care Med. 2020. E-pub ahead of print.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Table 1 Characteristics of 12 adult Covid-19 patients managed in the paediatric intensive care unit by the team of paediatric criticalcare physicians and paediatric critical care nurseAge (years);GenderBMI Ventilation time before PICU admission(days)PE Total ventilation time(days)PICU discharge64;M 26.8 4 No 10 Alive69;M 28.3 10 No 14 Alive71;M 26.2 12 No 6 Alive55;M 24.5 0 Yes 22 Alive60;M 25.1 2 No 8 Alive78;M 27.8 1 No 8 Died (treatment withdrawn)56;M 26.9 0 No 18 Alive71;M 26.6 13 No 13 Alive53;F 28.2 2 No 20 Alive53;M 26.5 1 No 14 Alive65;F 32.1 16 No 11 Alive65;M 23.7 3 Yes 30 Alive53;F 33.6 0 No 9 AliveKneyber et al. Critical Care          (2020) 24:350 Page 2 of 2

University of Groningen

University of GroningenPaediatric and adult critical care medicineKneyber, Martin C J; Engels, Bernadette; van der Voort, Peter H JPublished in:Critical care (London, England)DOI:10.1186/s13054-020-03074-3IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Kneyber, M. C. J., Engels, B., & van der Voort, P. H. J. (2020). Paediatric and adult critical care medicine:joining forces against Covid-19. Critical care (London, England), 24(1), Article 350.https://doi.org/10.1186/s13054-020-03074-3CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 31-12-2025LETTER Open AccessPaediatric and adult critical care medicine:joining forces against Covid-19Martin C. J. Kneyber1,2*, Bernadette Engels1 and Peter H. J. van der Voort2,3The increasing number of COVID-19 intensive careunit (ICU) admissions in our hospital necessitated in-creasing the number of physical ICU beds and staff-ing. This could be done by redeploying paediatriccritical care physicians and nurses to adult ICUs.However, paediatric ICUs (PICU) are exclusively lo-cated in university hospitals in the Netherlands, henceredeployment potentially could reduce capacity forcritically ill children [1]. We thus decided to maintainour current PICU capacity and to re-open, for adultCOVID-19 care, the part of our PICU that was closeddue nursing staff shortage [2].The main hurdle was how to staff the unit. PICUphysicians and nurses advocated to remain in theirenvironment and use the well-established working re-lationships within the PICU bedside team when car-ing for the adult COVID-19 patients because thegeneral principles of intensive care medicine wouldnot be different between children and adults [3]. Also,the clinical phenotype of adults with COVID-19matched perfectly the research focus of our PICU,providing opportunities to study respiratory systemmechanics in these adults [4]. To increase availabilityof PICU nurses, we upgraded their employment con-tract to 1 full-time equivalence, and all granted leavesof absence were revoked until further notice afterconsulting Human Resources and approval of theBoard of Directors.The entire nursing team was split into two. One groupof nurses originally coming from the adult ICU beforebecoming a PICU nurse were exclusively allocated to theCOVID-19 part of our PICU. These nurses and our ownPICU consultants were the primary care providers. Anadult intensive care unit consultant reviewed patientplans twice a day to guarantee quality of adult criticalcare [5].The 6-bedded Covid-19 unit located in the PICUopened at the end of March and remained open forsix weeks. Our ICUs admitted 98 adult COVID-19patients, 12 of them were treated in the PICU bypaediatric nurses and intensivists. All but one of these12 survived to PICU discharge (Table 1). Preservingthe PICU team ensured a rapid transition andboosted morale. This period proved to be a unique© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.* Correspondence: m.c.j.kneyber@umcg.nl1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands2Critical Care, Anaesthesiology, Peri-operative & Emergency Medicine (CAPE),University of Groningen, Groningen, The NetherlandsFull list of author information is available at the end of the articleKneyber et al. Critical Care          (2020) 24:350 https://doi.org/10.1186/s13054-020-03074-3collaboration between paediatric and adult intensivistsand unforgettable experience. It made PICU practi-tioners stronger in many ways and sets in motion astronger relationship between paediatric and adultcritical care medicine in our hospital. Also, PICU oc-cupancy remained > 80%, supporting our decision notto reduce PICU capacity and not to redeploy staff.AcknowledgementsNot applicable.Authors’ contributionsThe authors drafted the manuscript and approved the final version.FundingNot applicable.Availability of data and materialsNot applicable.Ethics approval and consent to participateNot applicable.Consent for publicationNot applicable.Competing interestsNone to disclose for both authors.Author details1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands. 2Critical Care, Anaesthesiology, Peri-operative & EmergencyMedicine (CAPE), University of Groningen, Groningen, The Netherlands.3Department of Critical Care, University Medical Center Groningen, Universityof Groningen, Groningen, the Netherlands.Received: 29 May 2020 Accepted: 8 June 2020References1. Gemke RJ, van der Voort E, Bos AP. The necessity for centralization ofpediatric intensive care. Ned Tijdschr Geneeskd. 1997;141(48):2325–7.2. Yager PH, Whalen KA, Cummings BM. Repurposing a Pediatric ICU forAdults. N Engl J Med. 2020;382(22):e80.3. Epstein D, Brill JE. A history of pediatric critical care medicine. Pediatr Res.2005;58(5):987–96.4. Kneyber MCJ, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J,Hammer J, Macrae D, Markhorst DG, Medina A, et al. Recommendations formechanical ventilation of critically ill children from the Paediatricmechanical ventilation consensus conference (PEMVECC). Intensive CareMed. 2017;43(12):1764–80.5. Remy KE, Verhoef PA, Malone JR, Ruppe MD, Kaselitz TB, Lodeserto F,Hirshberg EL, Slonim A, Dezfulian C. Caring for critically ill adults withcoronavirus disease 2019 in a PICU: recommendations by dual trainedIntensivists. Pediatr Crit Care Med. 2020. E-pub ahead of print.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Table 1 Characteristics of 12 adult Covid-19 patients managed in the paediatric intensive care unit by the team of paediatric criticalcare physicians and paediatric critical care nurseAge (years);GenderBMI Ventilation time before PICU admission(days)PE Total ventilation time(days)PICU discharge64;M 26.8 4 No 10 Alive69;M 28.3 10 No 14 Alive71;M 26.2 12 No 6 Alive55;M 24.5 0 Yes 22 Alive60;M 25.1 2 No 8 Alive78;M 27.8 1 No 8 Died (treatment withdrawn)56;M 26.9 0 No 18 Alive71;M 26.6 13 No 13 Alive53;F 28.2 2 No 20 Alive53;M 26.5 1 No 14 Alive65;F 32.1 16 No 11 Alive65;M 23.7 3 Yes 30 Alive53;F 33.6 0 No 9 AliveKneyber et al. Critical Care          (2020) 24:350 Page 2 of 2

NARCIS 

Paediatric and adult critical care medicine: joining forces against Covid-19

   University of GroningenPaediatric and adult critical care medicineKneyber, Martin C J; Engels, Bernadette; van der Voort, Peter H JPublished in:Critical care (London, England)DOI:10.1186/s13054-020-03074-3IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Kneyber, M. C. J., Engels, B., & van der Voort, P. H. J. (2020). Paediatric and adult critical care medicine:joining forces against Covid-19. Critical care (London, England), 24(1), [350].https://doi.org/10.1186/s13054-020-03074-3CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 29-04-2023LETTER Open AccessPaediatric and adult critical care medicine:joining forces against Covid-19Martin C. J. Kneyber1,2*, Bernadette Engels1 and Peter H. J. van der Voort2,3The increasing number of COVID-19 intensive careunit (ICU) admissions in our hospital necessitated in-creasing the number of physical ICU beds and staff-ing. This could be done by redeploying paediatriccritical care physicians and nurses to adult ICUs.However, paediatric ICUs (PICU) are exclusively lo-cated in university hospitals in the Netherlands, henceredeployment potentially could reduce capacity forcritically ill children [1]. We thus decided to maintainour current PICU capacity and to re-open, for adultCOVID-19 care, the part of our PICU that was closeddue nursing staff shortage [2].The main hurdle was how to staff the unit. PICUphysicians and nurses advocated to remain in theirenvironment and use the well-established working re-lationships within the PICU bedside team when car-ing for the adult COVID-19 patients because thegeneral principles of intensive care medicine wouldnot be different between children and adults [3]. Also,the clinical phenotype of adults with COVID-19matched perfectly the research focus of our PICU,providing opportunities to study respiratory systemmechanics in these adults [4]. To increase availabilityof PICU nurses, we upgraded their employment con-tract to 1 full-time equivalence, and all granted leavesof absence were revoked until further notice afterconsulting Human Resources and approval of theBoard of Directors.The entire nursing team was split into two. One groupof nurses originally coming from the adult ICU beforebecoming a PICU nurse were exclusively allocated to theCOVID-19 part of our PICU. These nurses and our ownPICU consultants were the primary care providers. Anadult intensive care unit consultant reviewed patientplans twice a day to guarantee quality of adult criticalcare [5].The 6-bedded Covid-19 unit located in the PICUopened at the end of March and remained open forsix weeks. Our ICUs admitted 98 adult COVID-19patients, 12 of them were treated in the PICU bypaediatric nurses and intensivists. All but one of these12 survived to PICU discharge (Table 1). Preservingthe PICU team ensured a rapid transition andboosted morale. This period proved to be a unique© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.* Correspondence: m.c.j.kneyber@umcg.nl1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands2Critical Care, Anaesthesiology, Peri-operative & Emergency Medicine (CAPE),University of Groningen, Groningen, The NetherlandsFull list of author information is available at the end of the articleKneyber et al. Critical Care          (2020) 24:350 https://doi.org/10.1186/s13054-020-03074-3collaboration between paediatric and adult intensivistsand unforgettable experience. It made PICU practi-tioners stronger in many ways and sets in motion astronger relationship between paediatric and adultcritical care medicine in our hospital. Also, PICU oc-cupancy remained > 80%, supporting our decision notto reduce PICU capacity and not to redeploy staff.AcknowledgementsNot applicable.Authors’ contributionsThe authors drafted the manuscript and approved the final version.FundingNot applicable.Availability of data and materialsNot applicable.Ethics approval and consent to participateNot applicable.Consent for publicationNot applicable.Competing interestsNone to disclose for both authors.Author details1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands. 2Critical Care, Anaesthesiology, Peri-operative & EmergencyMedicine (CAPE), University of Groningen, Groningen, The Netherlands.3Department of Critical Care, University Medical Center Groningen, Universityof Groningen, Groningen, the Netherlands.Received: 29 May 2020 Accepted: 8 June 2020References1. Gemke RJ, van der Voort E, Bos AP. The necessity for centralization ofpediatric intensive care. Ned Tijdschr Geneeskd. 1997;141(48):2325–7.2. Yager PH, Whalen KA, Cummings BM. Repurposing a Pediatric ICU forAdults. N Engl J Med. 2020;382(22):e80.3. Epstein D, Brill JE. A history of pediatric critical care medicine. Pediatr Res.2005;58(5):987–96.4. Kneyber MCJ, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J,Hammer J, Macrae D, Markhorst DG, Medina A, et al. Recommendations formechanical ventilation of critically ill children from the Paediatricmechanical ventilation consensus conference (PEMVECC). Intensive CareMed. 2017;43(12):1764–80.5. Remy KE, Verhoef PA, Malone JR, Ruppe MD, Kaselitz TB, Lodeserto F,Hirshberg EL, Slonim A, Dezfulian C. Caring for critically ill adults withcoronavirus disease 2019 in a PICU: recommendations by dual trainedIntensivists. Pediatr Crit Care Med. 2020. E-pub ahead of print.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Table 1 Characteristics of 12 adult Covid-19 patients managed in the paediatric intensive care unit by the team of paediatric criticalcare physicians and paediatric critical care nurseAge (years);GenderBMI Ventilation time before PICU admission(days)PE Total ventilation time(days)PICU discharge64;M 26.8 4 No 10 Alive69;M 28.3 10 No 14 Alive71;M 26.2 12 No 6 Alive55;M 24.5 0 Yes 22 Alive60;M 25.1 2 No 8 Alive78;M 27.8 1 No 8 Died (treatment withdrawn)56;M 26.9 0 No 18 Alive71;M 26.6 13 No 13 Alive53;F 28.2 2 No 20 Alive53;M 26.5 1 No 14 Alive65;F 32.1 16 No 11 Alive65;M 23.7 3 Yes 30 Alive53;F 33.6 0 No 9 AliveKneyber et al. Critical Care          (2020) 24:350 Page 2 of 2

   University of GroningenPaediatric and adult critical care medicineKneyber, Martin C J; Engels, Bernadette; van der Voort, Peter H JPublished in:Critical care (London, England)DOI:10.1186/s13054-020-03074-3IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2020Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Kneyber, M. C. J., Engels, B., & van der Voort, P. H. J. (2020). Paediatric and adult critical care medicine:joining forces against Covid-19. Critical care (London, England), 24(1), [350].https://doi.org/10.1186/s13054-020-03074-3CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 26-12-2020LETTER Open AccessPaediatric and adult critical care medicine:joining forces against Covid-19Martin C. J. Kneyber1,2*, Bernadette Engels1 and Peter H. J. van der Voort2,3The increasing number of COVID-19 intensive careunit (ICU) admissions in our hospital necessitated in-creasing the number of physical ICU beds and staff-ing. This could be done by redeploying paediatriccritical care physicians and nurses to adult ICUs.However, paediatric ICUs (PICU) are exclusively lo-cated in university hospitals in the Netherlands, henceredeployment potentially could reduce capacity forcritically ill children [1]. We thus decided to maintainour current PICU capacity and to re-open, for adultCOVID-19 care, the part of our PICU that was closeddue nursing staff shortage [2].The main hurdle was how to staff the unit. PICUphysicians and nurses advocated to remain in theirenvironment and use the well-established working re-lationships within the PICU bedside team when car-ing for the adult COVID-19 patients because thegeneral principles of intensive care medicine wouldnot be different between children and adults [3]. Also,the clinical phenotype of adults with COVID-19matched perfectly the research focus of our PICU,providing opportunities to study respiratory systemmechanics in these adults [4]. To increase availabilityof PICU nurses, we upgraded their employment con-tract to 1 full-time equivalence, and all granted leavesof absence were revoked until further notice afterconsulting Human Resources and approval of theBoard of Directors.The entire nursing team was split into two. One groupof nurses originally coming from the adult ICU beforebecoming a PICU nurse were exclusively allocated to theCOVID-19 part of our PICU. These nurses and our ownPICU consultants were the primary care providers. Anadult intensive care unit consultant reviewed patientplans twice a day to guarantee quality of adult criticalcare [5].The 6-bedded Covid-19 unit located in the PICUopened at the end of March and remained open forsix weeks. Our ICUs admitted 98 adult COVID-19patients, 12 of them were treated in the PICU bypaediatric nurses and intensivists. All but one of these12 survived to PICU discharge (Table 1). Preservingthe PICU team ensured a rapid transition andboosted morale. This period proved to be a unique© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.* Correspondence: m.c.j.kneyber@umcg.nl1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands2Critical Care, Anaesthesiology, Peri-operative & Emergency Medicine (CAPE),University of Groningen, Groningen, The NetherlandsFull list of author information is available at the end of the articleKneyber et al. Critical Care          (2020) 24:350 https://doi.org/10.1186/s13054-020-03074-3collaboration between paediatric and adult intensivistsand unforgettable experience. It made PICU practi-tioners stronger in many ways and sets in motion astronger relationship between paediatric and adultcritical care medicine in our hospital. Also, PICU oc-cupancy remained > 80%, supporting our decision notto reduce PICU capacity and not to redeploy staff.AcknowledgementsNot applicable.Authors’ contributionsThe authors drafted the manuscript and approved the final version.FundingNot applicable.Availability of data and materialsNot applicable.Ethics approval and consent to participateNot applicable.Consent for publicationNot applicable.Competing interestsNone to disclose for both authors.Author details1Department of Paediatrics, division of Paediatric Critical Care Medicine,Beatrix Children’s Hospital, University Medical Center Groningen, University ofGroningen, Huispost CA62, P.O. Box 30.001, 9700, RB, Groningen, TheNetherlands. 2Critical Care, Anaesthesiology, Peri-operative & EmergencyMedicine (CAPE), University of Groningen, Groningen, The Netherlands.3Department of Critical Care, University Medical Center Groningen, Universityof Groningen, Groningen, the Netherlands.Received: 29 May 2020 Accepted: 8 June 2020References1. Gemke RJ, van der Voort E, Bos AP. The necessity for centralization ofpediatric intensive care. Ned Tijdschr Geneeskd. 1997;141(48):2325–7.2. Yager PH, Whalen KA, Cummings BM. Repurposing a Pediatric ICU forAdults. N Engl J Med. 2020;382(22):e80.3. Epstein D, Brill JE. A history of pediatric critical care medicine. Pediatr Res.2005;58(5):987–96.4. Kneyber MCJ, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J,Hammer J, Macrae D, Markhorst DG, Medina A, et al. Recommendations formechanical ventilation of critically ill children from the Paediatricmechanical ventilation consensus conference (PEMVECC). Intensive CareMed. 2017;43(12):1764–80.5. Remy KE, Verhoef PA, Malone JR, Ruppe MD, Kaselitz TB, Lodeserto F,Hirshberg EL, Slonim A, Dezfulian C. Caring for critically ill adults withcoronavirus disease 2019 in a PICU: recommendations by dual trainedIntensivists. Pediatr Crit Care Med. 2020. E-pub ahead of print.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Table 1 Characteristics of 12 adult Covid-19 patients managed in the paediatric intensive care unit by the team of paediatric criticalcare physicians and paediatric critical care nurseAge (years);GenderBMI Ventilation time before PICU admission(days)PE Total ventilation time(days)PICU discharge64;M 26.8 4 No 10 Alive69;M 28.3 10 No 14 Alive71;M 26.2 12 No 6 Alive55;M 24.5 0 Yes 22 Alive60;M 25.1 2 No 8 Alive78;M 27.8 1 No 8 Died (treatment withdrawn)56;M 26.9 0 No 18 Alive71;M 26.6 13 No 13 Alive53;F 28.2 2 No 20 Alive53;M 26.5 1 No 14 Alive65;F 32.1 16 No 11 Alive65;M 23.7 3 Yes 30 Alive53;F 33.6 0 No 9 AliveKneyber et al. Critical Care          (2020) 24:350 Page 2 of 2

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