COVID-19 PICU guidelines: for high- and limited-resource settings: Pediatric Research

S. Kache, M.J. Chisti, F. Gumbo, E. Mupere, X. Zhi, K. Nallasamy, S. Nakagawa, J.H. Lee, M. Di Nardo, P. de la Oliva, C. Katyal, K.J.S. Anand, D.C. de Souza, V.S. Lanziotti, J. Carcillo

Research output: Contribution to journalArticlepeer-review


Background: Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients requiring care in the pediatric ICU. Methods: An international collaboration was formed to review the available evidence and develop evidence-based guidelines for the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with consensus-based guidelines. Results: This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or anti-thrombotic therapies are also described. Conclusion: Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill children with COVID-19 receive across the world. Impact: At the time of publication, this is the latest evidence for managing critically ill children infected with SARS-CoV-2.Referring to these guidelines can decrease the morbidity and potentially the mortality of children effected by COVID-19 and its sequalae.These guidelines can be adapted to both high- and limited-resource settings. © 2020, The Author(s).
Original languageEnglish
Pages (from-to)705-716
Number of pages12
JournalPediatr. Res.
Issue number5
Publication statusPublished - 2020


  • antivirus agent
  • adolescent
  • adult respiratory distress syndrome
  • Africa
  • artificial ventilation
  • Asia
  • Betacoronavirus
  • child
  • comorbidity
  • complication
  • Coronavirus infection
  • cross infection
  • Europe
  • extracorporeal oxygenation
  • female
  • human
  • infant
  • infection control
  • intensive care
  • male
  • multimodality cancer therapy
  • newborn
  • pandemic
  • pediatric intensive care unit
  • practice guideline
  • preschool child
  • procedures
  • resuscitation
  • shock
  • systemic inflammatory response syndrome
  • virus pneumonia
  • Western Hemisphere
  • Adolescent
  • Americas
  • Antiviral Agents
  • Cardiopulmonary Resuscitation
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Comorbidity
  • Coronavirus Infections
  • Critical Care
  • Cross Infection
  • Extracorporeal Membrane Oxygenation
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Infection Control
  • Intensive Care Units, Pediatric
  • Male
  • Pandemics
  • Pneumonia, Viral
  • Respiration, Artificial
  • Respiratory Distress Syndrome, Adult
  • Shock
  • Systemic Inflammatory Response Syndrome


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