The following is a summary of “Learning from the COVID-19 pandemic: IMCU as a more efficient model of pediatric critical care organization,” published in the February 2023 issue of Emergency Medicine by Brisca, et al.

The Pediatric intensive care unit (ICU) had admitted a sizable percentage of children with SARs-CoV-2-related diseases, but frequently for closer monitoring or due to worries about comorbidities or young age. It could have led to unwarranted ICU hospitalizations, resource waste, congestion in the ICU, and stress for the young patients and caregivers. The Pediatric Intermediate Care Unit (IMCU) could be a good place to care for kids whose monitoring and treatment requirements exceed what a typical pediatric ward can provide but do not require critical care. Research on pediatric IMCUs and statistics on their effectiveness, however, were extremely few.

A 12-bed pediatric IMCU that was recently created at Gaslini Hospital in Genoa, Italy, with acute COVID-19 or multisystem inflammatory syndrome in children (MIS-C), was the subject of the single-center retrospective analysis. The study period was from March 1, 2020, to January 31, 2022. Each IMCU room was equipped with a multiparameter monitor that was connected to a control station and may function as an ICU room if further care, including ECMO assistance, was required. In addition, due to their close proximity and shared floor, the IMCU and ICU may quickly transition from intermediate to critical care, with staff changes taking place without the need for patient transfers.

106 patients (19.2%, 80 with acute COVID-19 and 26 with MIS-C) out of 550 hospitalized for acute COVID-19 or MIS-C were admitted to the intensive care unit. Three of them (2.8%) needed to be upgraded to critical care due to their conditions worsening. 47 patients (44%) were sent home from the IMCU, and 57 (55%) were sent to low-intensity care facilities when their conditions improved. 

Compared to the findings from the literature, the requirement for pediatric ICU hospitalization in the research was minimal for both acute COVID-19 patients (0.8%) and MIS-C patients (3.1%). To minimize ICU congestion and the waste of financial and logistical resources, the IMCU served as an appropriate environment for children with COVID-19-related illnesses who require a higher level of care but lack stringent criteria for ICU admission. More research was required to more accurately determine how an IMCU affects hospital expenses, ICU activity, and long-term psychological effects on children and their families.

Reference: sciencedirect.com/science/article/pii/S0735675722007513