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Abstract Body

Background and aims

Within our prospective multidisciplinary follow-up program for children with congenital foregut-anomalies, the pediatric physical therapist evaluates exercise capacity at ages 5, 8, 12 and 17 years. We previously described decreased exercise capacity in school-aged congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) patients, which deteriorated over time. We aimed to evaluate their exercise capacity at adolescent age.

Methods

Maximal exercise capacity at 17 years was evaluated with a bicycle ergometer test using a standardized and validated protocol (ten Harkel, 2011). Peak workload was the primary outcome variable, defined as the mean highest workload during the last 60s. SD-scores were calculated corrected for age and height.

Results

We included 61 participants (CDH n=41 and EA n=20). Thirty-one (50.8 %) participated in organized sports activities. Mean(SD) peak workload was 225.5 (35.6) and 153.0 (24.9) Watt for boys and girls, respectively. Mean(SD) SDS peak workload corrected for gender and age was -1.5 (1.4), and corrected for gender and height -0.7 (1.3); both significantly less than that of the norm population (p < 0.001). See figures for SDS workload per diagnosis. Mean(SD) SDS height was below the reference norm: -0.5 (1.1), p< 0.001. SDS peak workload correlated positively with sports participation (Rho = 0.37; p = 0.003).

Conclusions

Especially age-corrected maximal exercise capacity was reduced in adolescents with CDH and EA, suggesting that adolescents with CDH and EA may experience more difficulties with sports participation than healthy peers. Early guidance regarding physical activities and sports is needed to improve this.

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Background/Aims:

In line with UK guidance, staff working on our Paediatric Intensive Care Unit (PICU) wear PPE including filtering face-piece masks (FFP) for 9-10 hours per shift. We explored how this impacts wellbeing and performance, and whether symptoms experienced could relate to increased pCO₂ whilst wearing FFP masks. We compared valved and non-valved masks.

Methods:

We used a questionnaire to explore symptoms experienced.

We measured pCO₂ at various time-points using capillary blood gases (while donned and 30 minutes post-doffing) and transcutaneous forehead measurements (pre-donning, one/two hours post-donning, and 30 minutes post-doffing).

Results:

We received 48 survey responses reporting headaches (87.5%), tiredness (81%), feeling flushed/overheated (60%), dizziness (50%), and anxiety (31%).

89% experienced symptoms “every day” or “most days”. Symptoms often persisted for hours (35%), or into the following day (27%).

65% reported drinking “much less” water and feared wasting PPE by doffing for breaks. To improve comfort, respondents suggested more breaks, improved access to water and reduced ambient unit temperature.

Mean donned capillary pCO₂ was 4.988 (n=16). This reduced to 4.675 post-doffing (p=0.034).

Mean transcutaneous pCO₂ measurements (n=28) increased from 5.14 pre-donning to 5.18 and 5.25 at one and two hours donned, returning to 5.18 after a 30-minute break. This was not statistically significant.

We found no significant differences between mask types.

Conclusions:

Staff wearing PPE experience adverse symptoms. Although we recorded modest increases in pCO₂, these symptoms likely result from a combination of factors. Modifying working conditions may mitigate the effects of PPE and enhance staff comfort and performance.

Abstract Body

Background and Aims

Exceeding critical care capacity was identified early during the pandemic as a potential cause for concern. One solution was repurposing other clinical areas to accept adult COVID-19 patients requiring critical care, including PICU. We aimed to evaluate the care provided to establish whether this strategy could be safely repeated if required again.

Methods

Electronic patient data were collected for adults admitted for intensive care at St. Mary’s Hospital, London, with COVID-19 between 1^st March and 1^st June, 2020. Patients were categorised by the location of the majority of their admission: PICU, Adult ICU (AICU) and Theatre Recovery ICU (RICU). Patient characteristics, type and duration of organ support and outcomes including survival and ventilator-free days were analysed. Survival was compared using a Cox proportional hazards model, adjusting for risk factors for mortality and severity of illness on admission based on the Acute Physiology And Chronic Health Evaluation II (APACHE II) score.

Results

88 patients were included for analysis; 15 spent the majority of their admission in PICU, 57 in AICU and 16 in RICU. Patient characteristics, including age, BMI and comorbidities were similar across locations, as were APACHE II scores. Overall survival to hospital discharge was 51%, with 10 (66.7%), 25 (45.5%) and 9 (56.3%) patients surviving from PICU, AICU and RICU respectively. There was no significant difference in survival once adjusted for patient characteristics and APACHE II score.

Conclusions

Managing adult patients on PICU is a safe strategy to be reconsidered in future surges of COVID-19 patients.