RSV bronchiolitis versus COVID-19: could pediatric intensive care units have done more during the pandemic?

The COronaVirus Disease 2019 (COVID-19) pandemic disproportionately overwhelmed adult critical care resources. It also led to a reduction of pediatric intensive care unit (PICU) admissions due to the significant attenuation of respiratory syncytial virus (RSV) epidemics. We compared RSV bronchiolitis with pediatric COVID-19 admissions in the context of accepting adult ICU patients to our PICU during the pandemic. This retrospective study compared pediatric patients admitted to the PICU with bronchiolitis and a COVID-19 infection between November 2019 to March 2023 inclusive. These two cohorts were considered with allcomers and adult patients admitted to the PICU between June 2020 and December 2021. One hundred and twenty-six patients with RSV bronchiolitis were compared with 35 pediatric patients with COVID-19. There were zero and 14 RSV admissions during the winters of 2020-21 and 2021-22, respectively. The COVID-19 cohort had higher acuity, C- reactive protein, conventional mechanical ventilation requirements and mortality. The PICU averaged 47.9 PICU admissions per month during the pandemic. There were no differences in monthly PICU admissions when adults were or were not admitted (mean 44.0 versus 49.4; p = 0.16). While COVID-19 disproportionately burdened adult ICU resources, the RSV epidemic was disrupted for two winters. Consequently, our vacant PICU beds were used to support adult ICU surges while maintaining below baseline admission rates. This suggests that our PICU may have had the capacity to absorb more ICU patients.