Pediatric Acute Respiratory Distress Syndrome Ventilation Bundle
Study Details
Study Description
Brief Summary
Mortality rates in children with pediatric acute respiratory distress syndrome (PARDS) are higher in Asia compared to other regions. In adults with acute respiratory distress syndrome, the only therapy that improves mortality rates is a lung protective ventilation strategy. The pediatric ventilation recommendations by the Pediatric Acute Lung Injury Consensus Conference (PALICC) are extrapolated from evidence in adults, including ventilation with low tidal volume, low peak/plateau pressures and high end expiratory pressure. A recent retrospective study of ventilation practices in Asia including Singapore showed that a majority of patients with PARDS were being ventilated with high tidal volume, high peak pressure and low end expiratory pressure, not in compliance with PALICC recommendations. We postulate that currently used ventilation strategies could have contributed to the high PARDS mortality rates in Asia. We aim to determine if implementing a ventilation bundle comprising PALICC recommendations lowers PARDS and pediatric intensive care unit (PICU) mortality rates.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Detailed Description
We implement a PARDS ventilation bundle compliant with PALICC recommendations. The bundle contains a daily checklist for ventilation targets and reference tables listing targeted tidal volumes and end expiratory pressure-fraction of inspired oxygen titration. We will recruit mechanically ventilated patients who meet PARDS criteria. After a one-month implementation period, we will collect patient data over the subsequent 18 months, and compare them with the corresponding data in the 24 months prior to the implementation. The primary outcome is PARDS mortality, defined as number of deaths out of PARDS cases. Secondary outcomes are feasibility of ventilation bundle implementation, ventilator (VFD) and intensive care unit (IFD) free days and PICU mortality (number of deaths out of PICU admissions).
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Intervention Patients will be ventilated according to the bundle; including ventilation targets, tidal volume, end expiratory pressure-fraction of inspired oxygen titration. |
Other: Ventilation bundle
ventilation targets (pH, spO2, pCO2) tidal volume 3-6ml/kg peak pressures <28-32cmH2O PEEP-FiO2 titration tables
|
| Control Standard of care prior to implementation of the ventilation bundle |
Outcome Measures
Primary Outcome Measures
- mortality [up to 60 days]
death during PICU stay
Secondary Outcome Measures
- ventilator free days [up to 28 days]
days alive and free from mechanical ventilation
- PICU free days [up to 28 days]
days alive and discharged from PICU
Eligibility Criteria
Criteria
Inclusion Criteria:
-
fulfill criteria for PARDS
-
mechanically ventilated
Exclusion Criteria:
- perinatal lung disease
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | KK Women's and Children's Hospital | Singapore | Singapore | 229899 |
Sponsors and Collaborators
- KK Women's and Children's Hospital
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2017/3076