Table 1 Recommendations for considering admission to the pediatric intensive care unit (PICU) in the Emilia-Romagna Region, Italy

When is it recommended to admit a pediatric patient to the PICU?

In case of the need for CPAP in the COVID-positive patient in acute respiratory failure, hospitalization in a referral center equipped with a PICU is recommended.

Hospitalization in the PICU is recommended in case of the following:

 •Tachypnea associated with at least one of the following signs or symptoms: dyspnea, elevated work of breathing, cyanosis, hypoxia and/or desaturation, inability to eat and drink, lethargy, unconsciousness or convulsions;

 •Acute respiratory distress syndrome (PaO2/FiO2 ≤ 300 in bilevel or CPAP ≥5 cm/H₂O);

 •Need for inotropic support and/or hemodynamic monitoring;

 •Instability, cardiocirculatory insufficiency or any condition of shock;

 •Multiorgan failure;

 •Severe sepsis;

 •Coma.

What are the risk factors for admission to the PICU?

 •Presence of new onset left ventricular dysfunction, coronary abnormalities or pericardial effusion on echocardiography;

 •Deterioration of laboratory tests (C reactive protein, procalcitonin, interleukin-6, ferritin, D-dimer, troponin, liver indices, and lactate dehydrogenase);

 •Progressive respiratory failure: failure to reduce heart rate, respiratory rate and work of breathing and failure to improve O₂ saturation, 30 min and 2 h from the start of high flow therapy are highly predictive of noninvasive ventilation failure, as well as elevated PRISM values basal, CO₂ and FiO₂.