Table 1. Physiological basic and complex domain.
Domain | Class | Intervention | Summary of Intervention |
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(1) Physiological: Basic | Nutrition Support | Nutrition Management | • Ensure adequate fluid, and nutrient intake [14, 49, 50]. Fulfil energy supply of 25–30 kcal /kg/day [51] and pay attention to the nutrition strategy for PICU critical children [52], post-critical recovery, and the acute phase [52–54]. NEONATES • Rooming-in, and direct breastfeeding or expressing breast milk (if the baby is sick and not admitted to rooming-in) is recommended for babies of mothers who have no symptoms / mild symptoms of COVID-19 and mothers can care for LBW independently by controlling the spread of infection [49, 55–64]• Caregivers who are not infected can assist in giving breast milk to the baby [61, 65] using a special bottle [62].• Give the mother support to breastfeeding the baby [56] and make decisions about breastfeeding [63, 66] by discussing the risks, and benefits of breastfeeding the baby in the covid-19 positive mother [67].• Assess the possibility of breastfeeding with re-lactation, wet nursing (another woman breastfeeding the baby), or donor breast milk according to culture and patient acceptance [66]. • Use pasteurized donor breast milk, and breastfeeding donors have performed a blood test if expressed breast milk is not available [62, 68]. Another suggestion states that dairy milk should not be pasteurized because it is believed that it is not a carrier of infection and pasteurization can reduce the biological and immunological levels of breast milk [59]. • Stop breastfeeding donations for two weeks if the mother is suspected of COVID-19 until she gets two negative swabs [62]. |
Immobility Management | Transfer | • Use special vehicles to transfer infected patients, strict protection for transportation staff, vehicle disinfection [49, 69, 70], and pay attention to patient transfer procedures [71]. • Pay attention to the transport of the intubated patient. patient using ventilator needs to be supplemented with viral filters and consideration of additional sedation [72]. NEONATES • Transportation of neonates with suspected/confirmed COVID-19 must be equipped with PPE, disinfectant, ventilator, vital sign monitor, first aid drugs, and a closed incubator for transfer equipment [73–75]. • It is recommended to use a NETS ambulance as COVID-19 NETS to transport newborns [76]. |
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Positioning | • Position the patient in an early prone position or prolonged moderate to severe PARDS (i.e. PaO2 / FiO2 <150; OI ≥ 12; OSI ≥ 10 for 12–18 hours per day (avoid disconnection) [42, 65, 77–81] and discontinue if PaO2 / FiO2 ≥ 150; OI <12; OSI <10 [66, 82] or change the position to supine during a heart attack [80]. If the patient is intubated, cardiopulmonary resuscitation (CPR) can remain prone [80]. • If the long duration of prone position is not achievable, try to position the patient 1–2 hours 3–4 times/day [77, 83]. |
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Physical Comfort Promotion | Pain Management: Acute | • Treatments in pain management include physical therapy, psychology, medical providers, and complementary services such as massage, and acupuncture [84]. • Perform non-pharmacological techniques according to the location of the pain. Provide psychotherapy, such as distraction, spending time with family, playing games with others, laughter. Provide physical therapy such as acute pain, preferably rest but chronic pain, need regular movement every day so that much pain is reduced, for example; take a walk around the neighbourhood with the family, do fun online dance or yoga classes, ride a bike. Relaxation skills: diaphragmatic breathing, progressive muscle relaxation, guided imagery [84]. NENEONATES • Give D10% as a non-pharmacological action to reduce pain due to invasive action in neonates [85]. |
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(2) Physiological: Complex |
Respiratory Management | Mechanical Ventilation Management: Invasive | • Use cuffed endotracheal tubes [67, 79], and monitor the ETT cuff pressure every 6–12 hours to ensure there is no leak, and the pressure is at the safe limit of <20cm H2O [42]. • Use a disposable ventilator circuit for each new patient [86], attach a viral filter (HEPA) to the expiration circuit [56, 86] or a hydrophobic mechanical filter attached to the inspirational and expiratory section [87]. Heat and moisture exchanger (HME) must be replaced every 48 hours or when dirty [86]. |
Airway Suctioning | • Closed suction is recommended [86, 88] if there is airway obstruction [89] or only if needed [57] and there are indications [56, 86]. | ||
Oxygen Therapy | • Maintain SpO2> 92% [90], pay attention to the oxygen saturation value that is safe for patients [83]. • Early intubation is recommended for children with severe/critical symptoms of COVID-19 rather than non-invasive ventilation or high flow nasal cannula because it can produce aerosols [86] which should be minimized [91]. • Provide adequate humidity, and heating when giving oxygen, especially at concentrations> 3–4 L / minute [83]. • Avoid using high flow nasal cannulas [67], and NIV considering the potential for aerosol formation [86]. |
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Thermoregulation | Hyperthermia Treatment | • Observe body temperature regularly. It needs serious attention related to temperature increase, even though the increase is not too high [92]. • Pediatric patients with high fever exceeding 38.5°C and seem uncomfortable, it is recommended to physically cool down with warms baths, use antipyretic patches or fever-reducing drugs [51, 86, 93] and maintain good hydration when the child has a fever [94]. |
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Hypothermia Treatment |
NEONATES • After delivery, babies with COVID-19 are kept dry, given stimulation, warmed by the mother and breastfed immediately [57]. However, bathing is not recommended to prevent hypothermia and the spread of nosocomial infections [56]. |
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Tissue Perfusion | Fluid Management | • Adjust the patient’s fluid volume according to hemodynamic conditions. The amount of fluid restriction is adjusted according to the Holliday-Fresh formula [78], then record the hourly fluid intake, and output [25]. • Provide supportive care by providing, and maintaining a balanced body fluid intake, and adequate calories [14, 80, 89, 95] • Assess fluid status, and heart function before starting MISC (multisystem inflammatory syndrome-Children) treatment in children with COVID-19 [96]. |
COVID-19: Coronavirus Disease-2019, ETT: Endotracheal Tube, FiO2: Fraction of Inspired Oxygen, H2O: Dihydrogen Monoxide, HEPA: High-Efficiency Particulate Air, LBW: Low Birth Weight, NETS: Newborn Emergency Transport Service, NIV: Non-invasive Ventilation, OI: Oxygenation Index, OSI: Oxygen Saturation Index, PARDS: Pediatric Acute Respiratory Syndrome, PaO2: Partial Pressure of Oxygen, PICU: Pediatric Intensive Care Unit, PPE: Personal Protective Equipment, SpO2: Peripheral Capillary Oxygen Saturation.
The number in the point of intervention column corresponds to the order of the articles in S3 Table.