Provision of intensive care for an adult with coronavirus disease 2019 at a freestanding children’s hospital

Abstract

In the middle of a pandemic wave of coronavirus disease 2019（COVID-19） with a resultant shortage of adult ICU beds in the region, we provided intensive care for an adult patient with COVID-19 at a freestanding children’s hospital. The patient was a 75-year-old man diagnosed with COVID-19 after febrile illness, who was admitted to another hospital for dyspnea. He was intubated for progressive respiratory failure and transferred to the PICU at our hospital for further intensive care. After 48-hour lung-protective ventilation with continuous neuromuscular blockade and prone positioning, oxygenation and compliance of the respiratory system had improved. However, because of concerns regarding a large tidal volume and ventilator-associated pneumonia, we carefully determined the timing of extubation in teleconsultation with adult ICU physicians. The patient was extubated five days after admission and transferred back to the referring institution seven days after admission. Accepting and providing care for this patient at the children’s hospital required meticulous planning, collaborations inside and outside of the hospital, and staff education to ensure the quality of adult care while maintaining smooth functioning of the children’s hospital.