Paediatric Intensive Care (PICU)
Our team aims to improve the short- and long-term outcome of children after admission to Paediatric Intensive Care Unit (PICU).
Paediatric Intensive Care Research group is a field spanning several diseases and conditions affecting critically ill children, at a local national, and international level.
Our research team is led by Professor Warwick Butt and PICU director A/Prof Tom Rozen and we have consultants engaged in research projects with their clinical appointments, as well as a dedicated team of research nurses, many with further degrees. We have additional research support through our PICU MDT (multidisciplinary team) including clinical technology and pharmacy and many of our clinical staff are completing research and quality projects with their clinical appointments.
We support international visiting researchers and students conducting projects in PICU. Previously, we have supported students’ to complete projects as part of masters of science, biomedical science, PhDs, and degree electives. All staff from the medical, nursing, and technology departments within the intensive care unit are encouraged to undertake research.
Our team has a range of studies underway locally, nationally, and internationally to improve the outcomes for children with life-threatening illnesses. The PICU at the Royal Children's Hospital research group is a member of ANZICS PSG (Australian and New Zealand Intensive Care Society, Paediatric Study Group).
Our main research areas
- Cardiac disease
- Acquired brain injury
- Lung disease
- Sepsis
- Renal replacement therapy
- Intensive care outcomes
- The role of extracorporeal membrane oxygenation (ECMO) in both cardiac and general PICU.
Group Leaders
Group Members
Our projects
Early prophylactic peritoneal dialysis in infants postcardiac surgery (EPICS)
This study is a randomised, open, two group trial. It aims to test the hypothesis that early peritoneal dialysis (PD) initiated soon after admission to intensive care following cardiac surgery would result in a lower rate of (a) major adverse events such as cardiac arrest, emergency chest reopening, the requirement for extracorporeal membrane oxygenation and death and (b) shorter duration of mechanical ventilation and intensive care stays. Study participants will also have long-term follow-up and we also plan to estimate health care costs.
Oedema study
Fluid accumulation and oedema can be a problem in the day-to-day management of critically ill children. It can cause a significant impact on patient outcomes such as length of mechanical ventilation and intensive care stay. This study aims to use new techniques and assessments to measure what has not been previously done in critically ill children. We have developed a new but exploratory method for measuring oedema using 3D photography. This study may be able to improve our clinical understanding of these commonly encountered problems in critically ill children.
Nitric Oxide during Cardiopulmonary Bypass: A blinded randomised controlled trial
The NITRIC trial is a randomised control trial to be conducted in six paediatric cardiac surgical centres. 1320 infants under two years of age undergoing cardiac surgery with Cardiopulmonary Bypass. Participants will be randomised into one of two treatment arms:
- The intervention arm will receive nitric oxide 20 ppm into the Cardio-Pulmonary Bypass (CPB) circuit.
- The control arm will not receive nitric oxide.
The primary outcome will be how long the patients are ventilated in the first 28 days. Secondary outcomes include the length of stay in intensive care and in hospital and healthcare costs.
NASO: A randomised controlled trial of nitric oxide administration during cardiopulmonary bypass in infants undergoing Arterial Switch Operation for repair of transposition of the great arteries.
This study aims to explore the impact of exposure to nitric oxide on bypass in infants who are undergoing an arterial switch (ASO) for correction of Transposition of the Great Arteries (TGA). This is a multi-centre randomised controlled trial. Participants will be randomised (into one of two treatment arms:
- The intervention arm will receive nitric oxide 20 ppm into the Cardio-Pulmonary Bypass (CPB) circuit.
- The control arm will not receive nitric oxide.
At the end of the surgery, the patient will return to the Intensive Care Unit where normal care will continue. Approximately 20-30 centres across four continents are expected to participate.
Gene Expression to Predict Long-Term Outcome in Infants After Heart Surgery – A multicentre prospective trial: The NITRIC Follow-up Study
This study will expand upon our current National Health and Medical Research Council (NHMRC) funding a multicentre randomised controlled trial in infants with coronary heart disease (CHD) undergoing Cardiopulmonary bypass (CPB) surgery. This worldwide unique study of 1,320 patients will aim to use the established biobank to study host response to CPB, including transcriptomics. This study aims to develop novel diagnostic approaches to identify early children at high risk of poor short- and long-term outcomes after CPB. The project outcomes will improve our understanding of the molecular mechanisms underlying the deleterious response to CPB.
Intensive care point prevalence studies looking at PICU practice
This is a joint research initiative of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) and the George Institute for International health. The program includes adult, paediatric, and mixed studies and provides a systematic snapshot of current practice in all patients in ICUs in Australia and New Zealand.
Life after Paediatric Critical Illness (LPCI): an Integrated Multi-stage Evaluation of Functional Outcome, Quality of Life Trajectories & their Determinants in Children
Over the past few decades, there has been a substantial reduction in morbidity in the PICU but there are more children surviving with moderate or severe disability. Awareness of baseline status & quality of life, hospitalisation data, and follow-up outcomes help us learn more about how children function after PICU. A comprehensive understanding of these factors for children surviving critical illness in Victoria will help us to better understand disease and treatment-related factors associated with changes in long-term outcomes.
Other studies
- Chronic PICU patient: Profile, burden, health care challenges and long-term outcomes: In a series of studies we are investigating the changing profile of children requiring prolonged ICU, an assessment of burden and major challenges faced by health care providers, children’s outcomes, and also provide recommendations for improving quality of care both in ICU and post-discharge
- Studies to improve outcomes for neonates undergoing surgery for congenital heart disease: We are conducting a series of studies in this high-risk population aimed at improving their hospital and long-term outcomes – studies particularly relate to maturational effects on outcomes and organ systems, intensive care interventions and practices and their relation to outcomes
- International collaborations: We are participating in several international studies exploring clinical care including ASCEND, PROSPECT, ADAPT, THRIVE and RESPOND.
- Quality assurance projects include exploring adverse events in PICU.
Funding
- ANZICS Foundation
- National Heart Foundation of Australia
- Medical Research Future Fund (MRFF)
- Royal Children's Hospital Foundation
Collaborations
- Australian & New Zealand Intensive Care Society (ANZICS)
- ANZICS Paediatric Study Group (PSG)
- ANZICS Clinical Trials Group (CTG)
- Australian & New Zealand Paediatric Intensive Care Registry
- ANZICS CORE
- Queensland Children's Hospital
- Gold Coast University Hospital:
- Monash Children’s Hospital Melbourne:
- Perth Children's Hospital, Perth:
- Women's and Children's Hospital, Adelaide
- Sydney Children's Hospital, Sydney:
- The Children’s Hospital at Westmead, Sydney
- Starship Children's Hospital, Auckland, NZ
- University Children's Hospital Zurich, Zurich, Switzerland.
- Texas Children's Hospital
- Boston Children’s Hospital
- University of Melbourne
- University of Queensland
Featured publications
- Trends in rates and inequalities in paediatric admissions for Ambulatory Care Sensitive Conditions in Victoria, Australia (2003 to 2013). 2021
- Characterisation of serum total tau following paediatric traumatic brain injury: a case-control study. 2019
- Emergent Prophylactic, Reparative and Restorative Brain Interventions for Infants Born Preterm With Cerebral Palsy. 2019
- Special issues in pediatric deceased organ donation. 2019
- Transnasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergent intubation (Kids THRIVE): a protocol for a randomised controlled trial. 2019
- Use of magnetic resonance imaging in severe pediatric traumatic brain injury: assessment of current practice. 2019