Adult and Pediatric ICUs in Quebec Partner to Ease Pandemic Pressures

As Quebec enters the seventh wave, intensive care doctors at MUHC adult hospitals say they are better prepared to deal with future crises thanks to the way their pediatrician colleagues have stepped in to help them during the days the darkest of the pandemic.

In particular, they point to how the Montreal Children’s Hospital (The MCH) adopted an open-door policy and, exceptionally, admitted adult patients to compensate for the lack of beds.

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

“We are very grateful for the efforts made,” said Royal Victoria Hospital (RVH) intensive care physician Dr Patrick Melanson, explaining that the provision of this “safety valve” was the initiative of the children.

The idea proved to be a game-changer, easing tension at a time when adult doctors in intensive care were faced with the most difficult of decisions – who could live and who could die.

“It was possible that the capacity for intensive care beds was exceeded in the province and that we had to give these beds to those who had the best chance of survival,” Melanson recalled, referring to the protocols for prioritizing intensive care from the government.

“So when this project came to life, we were very reassured to know that we were doing everything we could to maximize our capabilities,” he said.

27-75 YEARS OLD, TREATED AT THE HOTEL DES ENFANTS

Ultimately, 13 critically ill adults were treated by pediatric resuscitators and nine by general pediatricians.

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

“We chose the patients very carefully to make sure they were issues we would be comfortable with,” Razack said.

“And I like to joke a little bit that surprise, surprise, the enzymes and the drugs don’t miraculously change when you hit 18, so there’s a lot of overlap in how the care is delivered and the functioning of diseases.

The patients ranged in age from 27 to 75, which necessitated a change in some bedside habits.

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

What didn’t change at The Children’s, however, was the level of medical care adult patients received.

“When we started the project, some of us went here to kind of give them (paediatrics specialists) briefings on what to expect and what to look out for” , Melanson said.

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

Both teams established open lines of communication, including with sub-specialists, and spoke daily to review any concerns.

“I’ve seen in their world and learned a lot,” Razack said, and “there’s room for a lot more collaboration.”

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

“The bridges we’ve built allow for better communication and hopefully a better transition,” Melanson said.

Towards the end of the fourth wave, the adult intensive care team was able to reciprocate when respiratory syncytial virus (RSV) returned and infected more children than expected.

RVH cared for two teenage patients for about two months.

“In many ways, it feels like we’ve been through a war together,” Razack said.

They all came out of it “strengthened,” Melanson said.

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