Alexandra Schaller, DO
University of Tennessee Le Bonheur Children's Hospital
Memphis
Disclosure information not submitted.
Samir Shah, MBA, MD, FRCPC
MD, Professor, FAAP
Methodist Le Bonheur Childrens Hospital, United States
Disclosure information not submitted.
Rebekah Shappley, MD, FAAP
MD, Assistant Professor
University of Tennessee Health Science Center LeBonheur Children's Medical Center, United States
Disclosure information not submitted.
Nicholas Hysmith, MD
MD, Associate Professor, FAAP
University of Tennessee Health Science Center, United States
Disclosure information not submitted.
Alisha Clark, CPNP, CPNP-AC
CPNP, CPNP-AC
University of Tennessee Health Science Center, United States
Disclosure information not submitted.
Becky Landman, BS
DPh
Methodist Le Bonheur Childrens Hospital, United States
Disclosure information not submitted.
Title: Successful Management of Nosocomial Outbreak of SARS-CoV-2 among Chronically Ventilated Children
Introduction: Children with tracheostomies and long-term mechanical ventilation present unique challenges. We report a review of five children with tracheostomy and long-term mechanical ventilation admitted to an intermediate care facility who contracted SARS-CoV-2 virus during hospitalization. Our goal is to raise awareness about the risk factors and disease course in this patient population and help discern strategies for initiating therapy by describing our institution’s effective response to treat and contain the spread of the SARS-CoV-2 virus.
Methods: Retrospective Case Cohort Review
Results: Five patients with chronic mechanical ventilation admitted to an intermediate care unit developed COVID-19. Patients were identified based on clinical suspicion, appropriate isolation measures were instituted, respiratory support optimized, and early treatment was initiated with dexamethasone and remdesivir. All patients required transient escalation of ventilatory support, and 4/5 patients (80%) demonstrated gastrointestinal symptoms. Systematic approach addressing the outbreak at an individual, unit, and hospital level were instituted allowing strategies for case containment, recognition, and treatment of similar cases.
Conclusion: A systematic, team-based approach to a nosocomial outbreak of SARS-CoV-2 among children with chronic mechanical ventilation prevented the spread of COVID-19 in this vulnerable population preventing high morbidity and mortality. Early diagnosis based on clinical suspicion, rapid treatment, and a structured approach for containment were key to successful outcomes. This approach could further be extrapolated for use at other institutions for similar viral outbreaks among chronically mechanically ventilated children.