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Clinical Decision Support Tool in PARDS Pilot Study

ARDS | Ventilator-Induced Lung Injury | Ventilation Therapy; Complications

Previous clinical trials in adults with acute respiratory distress syndrome (ARDS) have demonstrated that ventilator management choices can improve Intensive Care Unit (ICU) mortality and shorten time on mechanical ventilation. This study seeks to scale an established Clinical Decision Support (CDS) tool to facilitate dissemination and implementation of evidence-based research in mechanical ventilation of infants and children with pediatric ARDS (PARDS).

This will be accomplished by using CDS tools developed and deployed in Children's Hospital Los Angeles (CHLA) which are based on the best available pediatric evidence, and are currently being used in an NHLBI funded single center randomized controlled trial (NCT03266016, PI: Khemani). Without CDS, there is significant variability in ventilator management of PARDS patients both between and within Pediatric ICUs (PICUs), but clinicians are willing to accept CDS recommendations. The CDS tool will be deployed in multiple PICUs, targeting enrollment of up to 180 children with PARDS. Study hypotheses:

1. The CDS tool in will be implementable in nearly all participating sites
2. There will be \> 80% compliance with CDS recommendations and
3. The investigators can implement automatic data capture and entry in many of the ICUs

Once feasibility of this CDS tool is demonstrated, a multi-center validation study will be designed, which seeks to determine whether the CDS can result in a significant reduction in length of mechanical ventilation (LMV).

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Participation Requirements

  • Sex:

    ALL

  • Eligible Ages:

    1 to 18

Participation Criteria

Inclusion Criteria:

* Children \> 1 month of age and \>44 weeks gestation and ≤ 18 years of age AND
* Supported on mechanical ventilation with pulmonary parenchymal disease (i.e. Pediatric Acute Respiratory Distress Syndrome (PARDS)) with Oxygen Saturation Index (OSI) ≥ 5) or Oxygenation Index (OI) ≥ 4 AND
* Who are within 72 hours of initiation of invasive mechanical ventilation AND
* Who are anticipated to require \>72 hours mechanical ventilation.

Exclusion Criteria:

* Conditions on enrollment that preclude conventional methods of weaning (i.e., status asthmaticus, severe lower airway obstruction, bronchiolitis, critical airway, Extra Corporeal Life Support (ECLS), intubation for Upper Airway Obstruction, Do Not Resuscitate orders, severe chronic respiratory failure, spinal cord injury above lumbar region, cyanotic heart disease (unrepaired or palliated)) OR
* Conditions precluding the use of permissive hypercapnia or hypoxemia (i.e. intracranial hypertension, severe pulmonary hypertension)
* Primary Attending physician refuses to enroll the patient

Study Location

CHU Sainte-Justine
CHU Sainte-Justine
Montréal, Quebec
Canada

Contact Study Team

Primary Contact

Philippe Jouvet

Study Sponsored By
Children's Hospital Los Angeles
Participants Required
More Information
Study ID: NCT04068012