Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists

Pediatr Crit Care Med. 2020 Jul;21(7):607-619. doi: 10.1097/PCC.0000000000002429.


Objective: In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add "surge capacity" has been the use of PICU beds and physicians to care for these critically ill adults.

Design: Narrative review/perspective.

Setting: Not applicable.

Patients: Not applicable.

Interventions: None.

Measurements and main results: The virus's high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common "adult" issues that may be encountered in the care of these patients and how they can best be managed in a PICU.

Conclusions: This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advanced Cardiac Life Support / instrumentation
  • Betacoronavirus
  • COVID-19
  • Clinical Competence
  • Comorbidity
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / therapy*
  • Critical Illness / therapy
  • Equipment and Supplies, Hospital
  • Humans
  • Intensive Care Units, Pediatric / organization & administration*
  • Intensive Care Units, Pediatric / standards
  • Pandemics
  • Patient Positioning / standards
  • Pediatricians / organization & administration*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / therapy*
  • Prescription Drugs / administration & dosage
  • Prescription Drugs / supply & distribution
  • Referral and Consultation / organization & administration
  • Respiration, Artificial / instrumentation
  • Respiration, Artificial / methods
  • SARS-CoV-2
  • Surge Capacity / organization & administration*
  • United States / epidemiology


  • Prescription Drugs