Children in Critical Care Due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Experience in a Spanish Hospital
Children in Critical Care Due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Experience in a Spanish Hospital
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DOI：
10.1097/pcc.0000000000002475
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发表时间：
2020-08-01
影响因子：
4.1
通讯作者：
Serrano-Gonzalez, Ana
中科院分区：
文献类型：
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作者：
Garcia-Salido, Alberto;Leoz-Gordillo, Ines;Serrano-Gonzalez, Ana
目的：西班牙一直是2019年受冠状病毒病影响最严重的国家之一。本研究旨在描述2019年因冠状病毒感染而住进PICU的一系列儿童。设计：前瞻性观察研究。地点：西班牙马德里三级医院。患者：2020年3月1日至2020年4月15日在PICU住院的严重急性呼吸综合征冠状病毒2型(严重急性呼吸综合征冠状病毒2)感染的儿童。干预：观察性研究。测量和主要结果：流行病学数据、既往临床特征、需要的支持治疗、影像测试、入院时的实验室观察和药物治疗。有11名儿童住进了PICU，怀疑患有2019年冠状病毒病；聚合酶链式反应检测呈阳性的有7名。中位年龄为100.7个月(范围0.5-162个月)。其中5人来自急诊科，2人来自病房。儿科序贯器官衰竭评估评分为3分(范围0-9)，儿科死亡风险II评分为4分(范围0-16)。除一名儿童(异基因造血干细胞移植)外，所有儿童以前都是健康的。呼吸道症状和发烧很普遍。胸部X光片诊断为肺炎。并不是所有的患者在入院时都表现为淋巴细胞减少。d-二聚体和铁蛋白升高。所有患者都需要通过鼻插管进行氧疗；5名患者接受了高流量鼻插管治疗，其中4名患者后来被无创呼吸机取代。2例患者在PICU入院的第一天就需要机械通气。两名儿童需要机械通气和正性肌力支持。托西珠单抗应用于2例插管患儿。此外，四名儿童接受了肝素治疗。无一例死亡。结论：总体来说，这些儿童以前是健康的，并且都在1岁以上。呼吸系统症状是PICU入院的主要原因，使呼吸支持成为主要治疗方法。需要机械通气的患者在入院第一天就表现出恶化。这些儿童似乎需要密切监测，多中心研究是必要的。
Objectives: Spain has been one of the countries most severely affected by the coronavirus disease 2019. This study aims to describe a series of children admitted to a PICU due to coronavirus disease 2019 infection.Design: Prospective observational study.Setting: Tertiary hospital in Madrid, Spain.Patients: Children admitted to the PICU with severe acute respiratory syndrome coronavirus 2 (severe acute respiratory syndrome coronavirus 2) infection, from March 1, 2020, to April 15, 2020.Interventions: Observational study.Measurements and Main Results: Epidemiologic data, previous clinical characteristics, support therapy needed, imaging tests, laboratory observations on admission, and pharmacologic therapy. Eleven children were admitted to the PICU, with suspected coronavirus disease 2019; the polymerase chain reaction test was positive in seven. The median age was 100.7 months (range, 0.5-162). Five were admitted from the emergency department and two from the ward. The Pediatric Sequential Organ Failure Assessment score was 3 (range, 0-9), and Pediatric Risk of Mortality II score was 4 (range, 0-16). All children were previously healthy except one (allogeneic hematopoietic stem cell transplantation). Respiratory symptoms and fever were prevalent. A chest radiograph led to a pneumonia diagnosis. Not all patients presented with lymphopenia on admission.d-Dimer and ferritin were elevated. All patients needed oxygen therapy through a nasal cannula; five patients received high-flow nasal cannula therapy, which was later substituted with noninvasive ventilation in four. Mechanical ventilation was necessary in two patients on the first day of PICU admission. Two children required mechanical ventilation and inotropic support. Tocilizumab was applied in two intubated children. Also, four children received heparin. No patients died.Conclusions: On the whole, the children were previously healthy and are more than 1 year old. Respiratory symptoms were the leading cause of PICU admission, making respiratory support the principal therapy. Patients requiring mechanical ventilation showed deterioration on the first day of admission. These children seemed to require close monitoring, and multicenter studies are necessary.