ICS and PCCS joint position statement on paediatric RSV surge

Public Health England anticipate an unseasonal surge in Respiratory Syncytial Virus (RSV) infections in children this autumn. Some modelled scenarios suggest that paediatric services may come under intense pressure: primary care, emergency departments, and level 1, 2 and 3 paediatric critical care services in both local District General Hospitals and tertiary children’s hospitals.

NHS England is leading on system-wide preparedness and Operational Delivery Networks are tasked with undertaking stock-takes of equipment and establishing operational policies around patient pathways. However, it is clear there may be significant consequences on colleagues working in paediatric and adult critical care. 

Adult Critical Care:

• Pressure on adult critical care services to assist their paediatric colleagues in the intubation, ventilation, and stabilisation of critically ill children with acute respiratory failure
• Potential impact on adult ICU bed capacity if pressure on national paediatric ‘surge’ ICU bed capacity becomes unsustainable
• Staffing: nurse to patient ratios, well-being, fatigue

Paediatric Critical Care:

• Pressure on national paediatric critical care bed capacity with potentially large numbers of infants and young children managed on high-flow nasal oxygen in level 1 and level 2 PCCUs in local hospitals
• Adverse impact on elective surgical work
• Staffing: nurses to patient ratios, well-being, fatigue
• Ensuring sufficient resources: oxygen, monitors, ventilators, cots

Position statement

This position statement has been written by the Intensive Care Society and  Paediatric Critical Care Society (PCCS) to provide preliminary guidance to their members in the event of a significant RSV surge.

1. The primary responsibility for the management of critically ill children remains with the paediatric critical care team, regional transport service and paediatric Operational Delivery Network.
2. However, should the demand for level 3 paediatric critical care beds become unsustainable then the Society recognises that some older children may be suitable for admission to adult intensive care. For example, adult ICUs may admit children over 12 years of age and over 50kg with pathology that is familiar to adult intensive care colleagues.
3. The Society and PCCS emphasise that decisions about admitting children to adult ICU beds should be taken at a regional level based on adult ICU capacity and expected demand for adult ICU beds, as well as availability of appropriately trained staff and equipment. Appropriate clinical care procedures should be available. These decisions should involve the medical and nursing clinical leads of both adult ICU and paediatric ICU as well as the hospital executive teams.
4. Adult critical care teams may be called more frequently to assist paediatric colleagues in local hospitals in the stabilisation of critically ill infants and children with acute respiratory failure prior to the arrival of a paediatric transport team. Adult critical care services should ensure that skilled personnel competent in paediatric airway management skills are available 24/7. Local policies and procedures should be followed with an emphasis on shared responsibilities.
5. Adult and paediatric Operational Delivery Networks should work together to ensure that regional escalation pathways for older ventilated children are well designed and understood by all stakeholders.
6. PCCS and Health Education England have written educational material relating to bronchiolitis, recognition of the sick child and high-flow nasal oxygen (insert hyperlink). PCCS and the Society will continue to work together to produce further relevant guidance for its members.
7. Local policies and procedures should be followed with an emphasis on shared responsibilities. This may include other specialist services (eg anaesthetics) to assist in the stabilisation and airway management of any infants or children, particularly at times where adult critical care may be stretched with other surge demands (eg further pandemic waves).

Both Societies would like to thank everyone in advance for their help in this difficult situation.