key: cord-294992-p50jdpt7 authors: Levy, Yael; Bonnet, Marie‐Pierre; Chemam, Sarah; Sabourdin, Nada; Louvet, Nicolas; Constant, Isabelle title: Unexpected benefits of the COVID challenge: When critically ill adult patients are managed in a pediatric PACU date: 2020-09-22 journal: Paediatr Anaesth DOI: 10.1111/pan.13980 sha: doc_id: 294992 cord_uid: p50jdpt7 nan and gynecology department: we have no "on-site" adult ICU, cardiology, pneumology, and infectiology. Despite the local pediatric medical culture, the entire staff showed great motivation and enthusiasm to take up the challenge. As surgical procedures were restricted to emergency cases, we decided to locate the temporary COVID-ICU in the pediatric postanesthesia care unit (PACU). Partition walls were quickly built in this 180 m 2 open-space, allowing the creation of 6 ICU rooms, while ensuring a safe working space for healthcare providers. Glass doors delimited a special airlock containing FFP-2 masks, protective gowns, glasses, face shields, gloves, hoods, and hydro-alcoholic gel. This area was dedicated to staff preparation before entering or after leaving the ICU. To limit cross-transmission, COVID and non-COVID-specific care pathways had been defined previously in our hospital. As our standard equipment was mainly intended for small children, supplemental external supplies were necessary: that is, large tracheal tubes, central venous and arterial catheters, and adult-sized beds. Local drug supplies had to be increased; formulations and concentrations had to be adjusted to adult requirements. Ventilators, standard monitors, and syringe pumps were supplied by the anesthesiology department, and hemodynamic monitors were lent by manufacturers. Radiology, biochemistry, and pharmacy departments provided specific resources on site. A new dedicated medical and paramedical team had to be created. Doctors and nurses came mainly from the anesthesiology department. Three of the 10 physicians were recruited from the PICU and the pediatric emergency department. The paramedical team included 12 professionals: physiotherapists, nurse anesthetists, nurses from the operating rooms, PACU, and PICU. Three doctors (2 during the night shift), one medical student, 3 nurses, and 3 assistant nurses worked simultaneously in the ICU. Every professional was rapidly trained for the use of personal protection equipment. One of our physicians had worked for five years in adult critical care before joining the pediatric anesthesia team: She gathered resources from several adult ICUs, and coordinated the redaction of medical and paramedical protocols for our team. In addition, doctors were encouraged to use the online resources dedicated to COVID management: webinars, MOOCs…, etc A daily teleconference was held to exchange information, provide medical advice, and discuss cases between the different ICUs of Paris. Two simulation sessions for a caesarean section in emergency in the pediatric operating room as one of our patients were a pregnant woman. Our ICU was designed as a step-down unit, dedicated to the management of ventilated patients transferred from standard adult ICUs. Seven patients (38-77 years old) were admitted in this temporary unit. The most frequent comorbidities were hypertension (6/7), diabetes (4/7), and obesity (4/7). On admission in our ICU, all patients had been ventilated for at least 4 days in a different hospital, and still required mechanical ventilation. After the peak of the epidemic, the regional ICU bed capacity increased, allowing us to relocate our patients in adult hospitals. At this time, one patient had been successfully extubated, two patients had died, and 4 were still ventilated. One medical student was tested positive for COVID-19. This experience had several unexpected benefits. Managing critically ill COVID-19-infected adults was medically and scientifically challenging for our pediatric team. The multidisciplinary collaboration also allowed building solid relationships among caregivers from different departments of our institution, and from other regional ICUs. As pediatric hospitals were, at this moment, spared from the work overload observed in adult structures, all the professionals from our pediatric hospital were enthusiastic and proud to participate in this local adventure and national effort. Sincere thanks to all the staff of Trousseau COVID-19 critical care unit. Thank you for your dedication and courage. None financial or material support. The challenge of congenital heart disease worldwide: Epidemiologic and demographic facts Heart Care International website Children's HeartLink website Haiti Cardiac Alliance website HeartGift Foundation website Unexpected benefits of the COVID challenge: When critically ill adult patients are managed in a pediatric PACU | 959 Union/European Economic Area and the United Kingdom French pandemic resistance The authors report no conflict of interest.