Adult and pediatric ICUs partner up to alleviate pandemic pressures in Quebec

An ICU room at the Montreal Children's Hospital can be used to treat adult patients as well. SOURCE: The Children's

As Quebec enters the seventh wave ICU doctors at the MUHC’s adult hospitals say they’re better prepared to face future crises now thanks to the way their pediatric colleagues pitched in to help them during the darkest days of the pandemic.

They highlight in particular, how the Montreal Children’s Hospital (MCH) adopted an open door policy and unusually, admitted adult patients to compensate for a lack of beds.

“It was clear that our adult colleagues were struggling to provide services and were very overstretched,” in the fall of 2020, recalls Dr. Saleem Razack the Director of the ICU at the Montreal Children’s Hospital.

“We’re very thankful for the efforts,” said Royal Victoria Hospital (RVH) intensivist, Dr. Patrick Melanson, explaining that offering that “safety valve” was the Children’s initiative.

The idea proved to be a game-changer, easing the strain at a time when adult ICU doctors were faced with the most difficult of decisions - who might live and who might die.

“There was a possibility that the capability for ICU beds would be overwhelmed in the province and that we would have to give those beds to those who had the greatest chance of survival,” recalls Melanson, referring to the government’s ICU prioritization protocols.

“So when this project came along it was very reassuring to us that we were doing everything that we could to maximize our capabilities,” he said.

AGES 27-75, TREATED AT THE CHILDREN’S

Ultimately, 13 critically ill adults were treated by pediatric intensivists and nine were tended to by general pediatricians.

A portion of the patients had illnesses other than COVID-19, while others had COVID and were intubated.

“We chose patients really carefully to make sure these are problems we would be comfortable dealing with,” Razack said.

“And I do like to joke a little that surprise, surprise, the enzymes and the drugs don’t change miraculously when you turn 18 so that there is a lot of overlap in the way care is done and the way diseases work.”

The patients ranged in age from 27-75, which did require a change in some bedside habits.

“It was kind of funny, like I would normally refer to the patient’s family member who’s there, I’d say that’s mom but it wasn't mom, it was wife,” said Razack.

What didn’t change in the MCH, however, was the level of medical care the adult patients received.

“When we started out the project some of us went over here to sort of give them (pediatric specialists) information sessions about what they could expect and what they could look out for,” Melanson said.

But it “became clear they could do it…it worked out very well,” he said.

The two teams set up open lines of communication, including with the sub-specialists and spoke daily to review any concerns.

“I have seen into their world and I have learned a fair bit,” Razack said, and “there’s room for a lot more collaboration.”

One example both men cite is the need for both hospital communities to help improve the care for chronically ill patients who are transitioning from the pediatric to the adult sector.

“Bridges that we built allow for better communication and better transition hopefully,” Melanson said.

Near the end of the fourth wave, the adult ICU team was able to reciprocate when respiratory syncytial virus (RSV) returned and infected a higher number of children than expected.

The RVH took on two teenage patients for about two months.

“In a lot of ways it feels like we went through a war together all of us,” Razack said.

They have all emerged “strengthened,” said Melanson.