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Paediatric Intensive Care

Paediatric intensive care research is an exciting field spanning a number of diseases and conditions affecting critically ill children. The Paediatric Intensive Care team has a range of studies underway locally, nationally and internationally to improve the outcomes for children with life-threatening illnesses. Main research areas include cardiac disease, acquired brain injury, lung disease, sepsis, renal replacement therapy, and intensive care outcomes.

Research is carried out in the intensive care unit at The Royal Children's Hospital and the Murdoch Children's Research Institute laboratories.

Group Leaders: 
Group Members: 
Ms Anna Butlinski
Role: 
Senior Research Officer
Dr Ben Gilbert
Role: 
Honorary Research Fellow
Mrs Carmel Delzoppo
Role: 
Research Associate and Research Coordinator
Dr Siva Namachivayam
Role: 
Research Associate

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 provide a systematic snapshot of current practice in all patients in ICUs in Australia and New Zealand.

A prospective randomised clinical trial of sedation practices in PICU – standard Vs Dexmedetomidine
Almost every ventilated patient in paediatric intensive care needs sedative drugs for comfort and for the provision of life-saving treatment via a drip. Sedation practices between PICUs vary, and there is no superior evidence to support which sedatives to use and the best way to administer them. A recent study in Australia and New Zealand found that many children are very deeply sedated in PICU. The deeper the sedation, the longer those children spent on the ventilator and in the PICU. The Baby-SPICE Study will test a new approach called Early Goal-Directed Sedation and compare two sedatives, Midazolam and Dexmedetomidine, currently used in this PICU. The study will look at the level of sedation and aim for lighter sedation.The researchers will compare levels of sedation, time on the ventilator, time in PICU, incidences of delirium and evaluate the safety of the drugs used.

Approaches and decisions for paediatric Traumatic Brain Injury (TBI)
There is a large burden of disease related to Traumatic Brain Injury but despite this, advances in treatment have been limited. This study, once completed, will provide compelling evidence to change clinical practices, provide evidence for new recommendations for future guidelines and lead to improved research protocols that would limit variability in TBI treatments – helping children immediately through better clinical practices and ultimately through more effective investigation.

The consent process in PICU
This is a multi-centre, prospective, observational study of how written informed consent is sought from potential participant’s legal guardians for the Baby-SPICE pilot study. The Baby-SPICE study is an un-blinded randomised controlled trial of the sedation practices in Australian and New Zealand Paediatric Intensive Care Units.

Patient outcomes following PICU
Over the past few decades, there has been a substantial reduction in morbidity in the Paediatric Intensive Care Unit (PICU) as practices have changed, but the proportion of survivors with a moderate or severe disability has increased significantly. More than two thirds of children who stay in intensive care for 28 days or more have an unfavourable outcome. PICU’s should consider the quality of life, including the physical and psychological wellbeing, of all children survivors. In this study, each child’s level of function before admission to intensive care is routinely collected and entered into the PICU database. This will allow accurate identification of patient outcomes for quality control and to evaluate therapy.

Plasma transfusion point prevalence
Although plasma transfusions are frequently prescribed for critically ill patients, most clinical uses of plasma are not supported by evidence. Plasma transfusions do not seem to correct mild coagulation abnormalities, but seem to be independently associated with worse clinical outcomes, in moderately bleeding patients. This project aims to identify patient characteristics and clinical conditions leading to plasma transfusions in critically ill children, to assess the effect of plasma transfusions on coagulation tests, and to assess the outcome after plasma transfusions. This international study will involve PICUs in seven countries – Australia, Belgium, Canada, France, Great Britain, United States of America, and Switzerland. It will allow researchers to better characterise which critically ill children receive plasma transfusions and then address this issue in a randomised controlled trial on plasma transfusion strategies.

A prospective randomised trial of Dexamethasone and Adrenaline in Bronchiolitis
Children with bronchiolitis experience significant breathing difficulty and about 50 per cent need mechanical ventilation. The normal treatment is to support breathing, and to provide adequate nutrition and fluids. Previous research has shown that Dexamethasone and adrenaline nebules reduce the number of children admitted to hospital after presenting to the emergency department with bronchiolitis. The study is a randomised controlled trial in infants less than 18 months of age diagnosed with bronchiolitis who require admission to the PICU or Neonatal Intensive Care Unit (NICU).  A combined treatment of parenteral dexamethasone and nebulised adrenaline will be compared to standard treatment with length of positive pressure ventilation in the first 5 days of admission being the primary endpoint. Research will also be carried out at Princess Margaret Hospital for Children in Perth and the Starship Hospital and Middlemore Hospital in New Zealand. 

Long-term outcomes of children who have required prolonged intensive care after cardiac surgery
The number of children requiring prolonged stay in intensive care have increased in recent years. This project will look at the impact of long-stay on long-term outcomes after cardiac surgery. This information will be very useful both for clinicians managing these children and counselling families.

Extubation practice after stage one single ventricle operation
Single ventricle circulations (Hypoplastic left heart syndrome and other single ventricle circulations) are amongst the most complex of congenital heart lesions. These children undergo a series of 3 staged operations in the first few years of life, with the first operation performed in the first few days after birth and spend several days (sometimes weeks) receiving mechanical ventilation in intensive care unit. The reported incidence of extubation failure after this operation is high. This project will look at our extubation practice, incidence and outcomes related to extubation failure after stage 1 single ventricle operation.

One-year survival of infants after stage one single ventricle operation
Survival to 1-year after stage-1 single ventricle operation is a good indicator of long-term survival in infants with single ventricle circulations and several of these infants are supported with ECMO (Extracorporeal membrane oxygenation) after surgery. This project will be looking at the one-year survival, use of ECMO and its association with survival in these infants.

Role of high-flow nasal prong oxygen therapy or nasopharyngeal continuous positive airway pressure after cardiac surgery
The aim of this project is to study the use of high-flow nasal prong (HFNP) oxygen therapy and nasopharyngeal continuous positive airway pressure (NCPAP) in infants after cardiac surgery. In particular this study will target certain high-risk groups after surgery to study the following end-points of these therapies: overall effectiveness, incidence of extubation failure, related complications and outcomes in relation to these treatments.

Funding: 
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
  • Hospital for Sick Children, Ontario- (Biomarkers trial)
  • Geneva University Hospital, Geneva ( Plasma trial)
  • The Children’s Hospital Philadelphia (SPROUT)
  • PennSatae Hershey Children’s Hospital (SPROUT)
  • Pediatric Acute Lung Injury & Sepsis Investigators (PALISI) – (SPROUT & BMTx outcomes)
  • Starship Children’s Hospital, Auckland (Hearts & Minds)
  • UVA Children’s Hospital, Professor Doug Wilson (Calfactant trial)
  • Canadian Critical Care Research Network, Professor David Adelson
  • Pediatric Traumatic Brain Injury consortium: Hypothermia ( Cool Kids)
  • Prevalence of Acute critical Neurologic disease in children: a Global Epidemiological Assessment (PANGEA) Children’s Hospital Pittsburgh
  • PROphylaxis against ThRombosis prACTice (PROTRACT) Survey PROTRACT Study Group