PDF herunterladen
J Pediatr Intensive Care 2023; 12(02): 087-093
DOI: 10.1055/s-0041-1723036
Review Article

Respiratory Care in Children with COVID-19

Shalu Gupta 
1   Department of Pediatric, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
,
Suresh K. Angurana
2   Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Virendra Kumar
3   Department of Pediatric, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

The novel coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is causing significant morbidity and mortality worldwide. The common presentations in children include involvement of respiratory system leading to pneumonia and acute respiratory distress syndrome, as well as multiorgan dysfunction syndrome and multisystem inflammatory syndrome in children (MIS-C). Pediatric COVID-19 is a milder disease as compared with the adults. Also, there is rise in MIS-C cases which is a hyperinflammatory condition temporally associated with SARS-CoV-2. Since respiratory system is predominantly involved, few of these critically ill children often require respiratory support which can range from simple oxygen delivery devices, high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), invasive mechanical ventilation, and extracorporeal membrane oxygenation (ECMO). Most of the oxygen delivery devices and respiratory interventions generate aerosols and pose risk of transmission of virus to health care providers (HCPs). The use of HFNC and NIV should be limited to children with mild respiratory distress preferably in negative pressure rooms and with adequate personal protective equipment (PPE). However, there should be low thresholds for intubation and invasive mechanical ventilation in the event of clinical deterioration while on any respiratory support. The principle of providing respiratory support requires special droplet and air-borne precautions to limit exposure or transmission of virus to HCPs and at the same time ensuring safety of the patient.

Keywords

COVID-19 - noninvasive ventilation - high-flow nasal cannula - personal protective equipment - mechanical ventilation

Authors' Contributions

S.G. and S.K.A. reviewed the literature and prepared the initial draft. V.K. critically evaluated and modified the manuscript. S.G. will act as guarantor of the paper.




Publikationsverlauf

Eingereicht: 15. Oktober 2020

Angenommen: 20. Dezember 2020

Artikel online veröffentlicht:
11. Februar 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Mehta Y, Chaudhry D, Abraham OC. et al. Critical care for COVID-19 affected patients: position statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020; 24 (04) 222-241
    CrossrefPubMedGoogle Scholar
  • 2 Phua J, Weng L, Ling L. et al; Asian Critical Care Clinical Trials Group. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med 2020; 8 (05) 506-517
    CrossrefPubMedGoogle Scholar
  • 3 WHO–China Joint Mission. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). March 7, 2020 at: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf.Accessed
    PubMedGoogle Scholar
  • 4 Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020; 109 (06) 1088-1095
    CrossrefPubMedGoogle Scholar
  • 5 Lu X, Zhang L, Du H. et al; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med 2020; 382 (17) 1663-1665
    CrossrefPubMedGoogle Scholar
  • 6 Dong Y, Mo X, Hu Y. et al. Epidemiology of COVID -19 among children in China. Pediatrics 2020; 145 (06) e20200702
    CrossrefPubMedGoogle Scholar
  • 7 Cao Q, Chen YC, Chen CL, Chiu CH. SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics. J Formos Med Assoc 2020; 119 (03) 670-673
    CrossrefPubMedGoogle Scholar
  • 8 Ong JSM, Tosoni A, Kim Y, Kissoon N, Murthy S. Coronavirus disease 2019 in critically ill children: a narrative review of the literature. Pediatr Crit Care Med 2020; 21 (07) 662-666
    CrossrefPubMedGoogle Scholar
  • 9 Parri N, Lenge M, Buonsenso D. Coronavirus Infection in Pediatric Emergency Departments (CONFIDENCE) Research Group. Children with COVID-19 in pediatric emergency departments in Italy. N Engl J Med 2020; 383 (02) 187-190
    CrossrefPubMedGoogle Scholar
  • 10 CDC COVID-19 Response Team. Corona virus disease 2019 in children — United States, February 12–April 2, 2020. MMWR 2020; 69 (14) 422-426
    PubMedGoogle Scholar
  • 11 Tagarro A, Epalza C, Santos M. et al. Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr 2021; 175 (03) 316-317
    CrossrefPubMedGoogle Scholar
  • 12 Castagnoli R, Votto M, Licari A. et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr 2020; 174 (09) 882-889
    CrossrefPubMedGoogle Scholar
  • 13 Chen F, Liu ZS, Zhang FR. et al. [First case of severe childhood novel coronavirus pneumonia in China] (in Chinese). Zhonghua Er Ke Za Zhi 2020; 58 (03) 179-182
    PubMedGoogle Scholar
  • 14 Stanton BA, Hampton TH, Ashare A. The pathophysiology of COVID-19 and SARS-CoV-2 infection. Am J Physiol Lung Cell Mol Physiol 2020; 319 (03) L408-L415
    PubMedGoogle Scholar
  • 15 Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395 (10237): 1607-1608
    CrossrefPubMedGoogle Scholar
  • 16 Feldstein LR, Rose EB, Horwitz SM. et al; Overcoming COVID-19 Investigators, CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383 (04) 334-346
    CrossrefPubMedGoogle Scholar
  • 17 Belot A, Antona D, Renolleau S. et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020. Euro Surveill 2020; 25 (22) 2001010
    CrossrefPubMedGoogle Scholar
  • 18 Dufort EM, Koumans EH, Chow EJ. et al; New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem inflammatory syndrome in children in New York State. N Engl J Med 2020; 383 (04) 347-358
    CrossrefPubMedGoogle Scholar
  • 19 Davies P, Evans C, Kanthimathinathan HK. et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health 2020; 4 (09) 669-677
    CrossrefPubMedGoogle Scholar
  • 20 Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A systematic review of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. Pediatr Infect Dis J 2020; 39 (11) e340-e346
    CrossrefPubMedGoogle Scholar
  • 21 Aronoff SC, Hall A, Del Vecchio MT. The natural history of SARS-Cov-2 related multisystem inflammatory syndrome in children (MIS-C): a systematic review. J Pediatric Infect Dis Soc 2020; 112: 1-6
    PubMedGoogle Scholar
  • 22 Ahmed M, Advani S, Moreira A. et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine 2020; 26: 100527
    CrossrefPubMedGoogle Scholar
  • 23 Jain S, Sen S, Lakshmivenkateshiah S. et al. Multisystem inflammatory syndrome in children with COVID-19 in Mumbai, India. Indian Pediatr 2020; 57 (11) 1015-1019
    CrossrefPubMedGoogle Scholar
  • 24 Dhanalakshmi K, Venkataraman A, Balasubramanian S. et al. Epidemiological and clinical profile of pediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS) in Indian children. Indian Pediatr 2020; 57 (11) 1010-1014
    CrossrefPubMedGoogle Scholar
  • 25 Williams V, Dash N, Suthar R. et al. Clinico-laboratory profile, intensive care needs, treatment details, and outcome of Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): A systematic review and Meta-analysis. medRxiv 2020; DOI: 10.1101/2020.10.21.20217034.
    CrossrefPubMedGoogle Scholar
  • 26 Duan YN, Zhu YQ, Tang LL, Qin J. CT features of novel coronavirus pneumonia (COVID-19) in children. Eur Radiol 2020; 30 (08) 4427-4433
    CrossrefPubMedGoogle Scholar
  • 27 Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol 2020; 55 (05) 1169-1174
    CrossrefPubMedGoogle Scholar
  • 28 Merkus PJFM, Klein WM. The value of chest CT as a COVID-19 screening tool in children. Eur Respir J 2020; 55 (06) 200124
    PubMedGoogle Scholar
  • 29 Kulkarni S, Down B, Jha S. Point-of-care lung ultrasound in intensive care during the COVID-19 pandemic. Clin Radiol 2020; 75 (09) 710.e1-710.e4
    CrossrefPubMedGoogle Scholar
  • 30 Soldati G, Smargiassi A, Inchingolo R. et al. Is there a role for lung ultrasound during the COVID-19 pandemic?. J Ultrasound Med 2020; 39 (07) 1459-1462
    CrossrefPubMedGoogle Scholar
  • 31 Mohamed MFH, Al-Shokri S, Yousaf Z. et al. Frequency of abnormalities detected by point-of-care lung ultrasound in symptomatic COVID-19 patients: Systematic review and meta-analysis. Am J Trop Med Hyg 2020; 103 (02) 815-821
    CrossrefPubMedGoogle Scholar
  • 32 Gu H, Xie Z, Li T. et al. Angiotensin-converting enzyme 2 inhibits lung injury induced by respiratory syncytial virus. Sci Rep 2016; 6: 19840
    CrossrefPubMedGoogle Scholar
  • 33 Jiehao C, Jin X, Daojiong L. et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis 2020; 71 (06) 1547-1551
    CrossrefPubMedGoogle Scholar
  • 34 Widders A, Broom A, Broom J. SARS-CoV-2: the viral shedding vs infectivity dilemma. Infect Dis Health 2020; 25 (03) 210-215
    CrossrefPubMedGoogle Scholar
  • 35 Xu CLH, Raval M, Schnall JA, Kwong JC, Holmes NE. Duration of respiratory and gastrointestinal viral shedding in children with SARS-CoV-2: a systematic review and synthesis of data. Pediatr Infect Dis J 2020; 39 (09) e249-e256
    CrossrefPubMedGoogle Scholar
  • 36 Santos VS, Gurgel RQ, Cuevas LE, Martins-Filho PR. Prolonged fecal shedding of SARS-CoV- 2 in pediatric patients: a quantitative evidence synthesis. J Pediatr Gastroenterol Nutr 2020; 71 (02) 150-152
    CrossrefPubMedGoogle Scholar
  • 37 Posfay-Barbe KM, Wagner N, Gauthey M. et al. COVID-19 in children and the dynamics of infection in families. Pediatrics 2020; 146 (02) e20201576
    CrossrefPubMedGoogle Scholar
  • 38 Edelson DP, Sasson C, Chan PS. et al; American Heart Association ECC Interim COVID Guidance Authors. Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID-19: from the emergency cardiovascular care committee and get with the guidelines-resuscitation adult and pediatric Task Forces of the American Heart Association. Circulation 2020; 141 (25) e933-e943
    CrossrefPubMedGoogle Scholar
  • 39 Alhazzani W, Møller MH, Arabi YM. et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Intensive Care Med 2020; 46 (05) 854-887
    CrossrefPubMedGoogle Scholar
  • 40 Kache S, Chisti MJ, Gumbo F. et al. COVID-19 PICU guidelines: for high- and limited-resource settings. Pediatr Res 2020; 88 (05) 705-716
    CrossrefPubMedGoogle Scholar
  • 41 Sundaram M, Ravikumar N, Bansal A. et al; Intensive Care Chapter of Indian Academy of Pediatrics. Novel coronavirus 2019 (2019-nCoV) infection: part II - respiratory support in the pediatric intensive care unit in resource-limited settings. Indian Pediatr 2020; 57 (04) 335-342
    CrossrefPubMedGoogle Scholar
  • 42 Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7 (04) e35797
    CrossrefPubMedGoogle Scholar
  • 43 Simonds AK, Hanak A, Chatwin M. et al. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess 2010; 14 (46) 131-172
    Google Scholar
  • 44 Castro-Codesal ML, Olmstead DL, MacLean JE. Mask interfaces for home non-invasive ventilation in infants and children. Paediatr Respir Rev 2019; 32: 66-72
    CrossrefPubMedGoogle Scholar
  • 45 Ramirez A, Khirani S, Aloui S. et al. Continuous positive airway pressure and noninvasive ventilation adherence in children. Sleep Med 2013; 14 (12) 1290-1294
    CrossrefPubMedGoogle Scholar
  • 46 Hui DS, Chow BK, Lo T. et al. Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks. Eur Respir J 2019; 53 (04) 1802339
    CrossrefPubMedGoogle Scholar
  • 47 Leung CCH, Joynt GM, Gomersall CD. et al. Comparison of high-flow nasal cannula versus oxygen face mask for environmental bacterial contamination in critically ill pneumonia patients: a randomized controlled crossover trial. J Hosp Infect 2019; 101 (01) 84-87
    CrossrefPubMedGoogle Scholar
  • 48 Raboud J, Shigayeva A, McGeer A. et al. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada. PLoS One 2010; 5 (05) e10717
    CrossrefPubMedGoogle Scholar
  • 49 Rochwerg B, Granton D, Wang DX. et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med 2019; 45 (05) 563-572
    PubMedGoogle Scholar
  • 50 Agarwal A, Basmaji J, Muttalib F. et al. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Can J Anaesth 2020; 67 (09) 1217-1248
    CrossrefPubMedGoogle Scholar
  • 51 Frat JP, Thille AW, Mercat A. et al; FLORALI Study Group, REVA Network. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015; 372 (23) 2185-2196
    Google Scholar
  • 52 Alraddadi BM, Qushmaq I, Al-Hameed FM. et al; Saudi Critical Care Trials Group. Noninvasive ventilation in critically ill patients with the Middle East respiratory syndrome. Influenza Other Respir Viruses 2019; 13 (04) 382-390
    CrossrefPubMedGoogle Scholar
  • 53 Brochard L, Lefebvre JC, Cordioli RL, Akoumianaki E, Richard JC. Noninvasive ventilation for patients with hypoxemic acute respiratory failure. Semin Respir Crit Care Med 2014; 35 (04) 492-500
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 54 Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth 2020; 67 (05) 568-576
    CrossrefPubMedGoogle Scholar
  • 55 Rimensberger PC, Cheifetz IM. Pediatric Acute Lung Injury Consensus Conference Group. Ventilatory support in children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05, Suppl 1): S51-S60
    CrossrefPubMedGoogle Scholar
  • 56 Alhazzani W, Alshahrani M, Jaeschke R. et al. Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2013; 17 (02) R43
    CrossrefPubMedGoogle Scholar
  • 57 Munshi L, Del Sorbo L, Adhikari NKJ. et al. Prone position for acute respiratory distress syndrome. a systematic review and meta-analysis. Ann Am Thorac Soc 2017; 14 (Suppl. 04) S280-S288
    CrossrefPubMedGoogle Scholar
  • 58 Tiwari L, Taneja LN, Gupta S. and Other Expert Committee Members. IAP ALS update on resuscitation guidelines during COVID-19 pandemic. Indian J Pediatr 2020; 27: 1-7
    PubMedGoogle Scholar