Pediatric Critical Care

In 2010, the Pediatric Critical Care Research Center was launched with the support of Connecticut Children’s Medical Center and in concert with the strategic plan. This center seeks to improve the care of critically ill children through clinical and translational research and to foster a vibrant academic environment within the division of critical care and within the hospital. Dr. Christopher Carroll serves as the Director of the Pediatric Critical Care Research Center, which is staffed by three full-time staff members: two experienced research associates and a data and quality manager. In 2010, the Pediatric Critical Care Research Center was very productive, publishing over 10 original manuscripts, and presenting over 20 abstracts at international meetings.

Asthma and Genetics
Severe asthma exacerbations are one of the most common causes of critical illness in children, accounting for approximately 10,000 pediatric intensive care unit (PICU) admissions per year in the United States. Even children with mild baseline asthma are at risk for developing near fatal exacerbations. Despite a large number of studies evaluating outpatient populations, the risk factors for the development of near fatal asthma exacerbations in children are unclear. Research is beginning to show that a person’s genes may help to determine how well he or she responds to treatment for asthma and Dr. Carroll has conducted several studies looking at particular genes and their association with asthma. From these preliminary studies, he has found that specific genes are related to response to asthma therapy. Further knowledge of these genetic associations could allow for personalized therapy in children with severe asthma. These studies have won several awards for research at international meetings and two were selected by the journal Pediatrics for the 2009 list of the Best Articles Relevant to Pediatric Allergy.

Bronchiolitis and Genetics
Bronchiolitis is a potentially life-threatening respiratory condition that affects babies. It is the cause of approximately 125,000 hospitalizations every year in the United States. As with asthma, little is known about what causes children to be susceptible to bronchiolitis, but genetics may play a role. Dr. Carroll has also conducted research exploring genes that are associated with bronchiolitis and has found that certain genetic factors are related to poor outcome in children with bronchiolitis.

Improving Quality of Care
In April 2008, Connecticut Children’s changed to a clinical care model where PICU attendings remain in the hospital 24 hours/day, 7 days/week. Before this, attendings were on-call during off hours (weekdays 5 p.m. to 7 a.m., and weekends). This change in coverage provided a “natural experiment” to examine whether the new model improved the quality of care of patients in the PICU. Dr. Carroll has taken this opportunity to examine several outcomes, including complications during endotracheal intubations, the incidence and outcome of code blue events, and outcomes of unplanned endotracheal extubations. These studies have garnered national attention in the media and from the Society of Critical Care Medicine.

Virtual PICU Database
The Virtual PICU is a multi-institutional database designed to improve the quality of critical care for children worldwide, with daily data provided from 87 PICUs. This system is dedicated to standardized data sharing and benchmarking among PICUs with the goal of quality improvement and outcomes research. Connecticut Children’s is using this system to benchmark our outcomes and to look for methods to improve the quality of care provided to critically ill children.

RESTORE
The Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial is a multicenter study examining how best to provide sedation and pain control to critically ill children. Connecticut Children’s is one of 31 sites that participates in this NIH-funded study whose purpose is to evaluate if sedatives used in children with acute respiratory failure affects how long they need to be mechanically ventilated, how much it costs, and their quality of life and emotional health after hospital discharge. Dr. Allison Cowl is the site PI for this study.

PediBIRN
The Pediatric Brain Injury Research Network (PediBIRN) is a national group of pediatric intensivists and child abuse pediatricians who are working together to derive and validate an effective “clinical prediction rule” that will facilitate the calculation of an evidence-based estimate of the probability of abuse for any hospitalized, acutely head-injured child less than three years of age.

Influenza Vaccine Effectiveness in High-Risk Children
Influenza is an important and often poorly controlled cause of morbidity, mortality, and healthcare burden among children. Although the general population benefits of influenza vaccination for healthy children are clear, the effectiveness of influenza vaccine in preventing serious illness among children at high risk for complications from influenza is not well understood. The primary objective of this multi-center study is to evaluate the effectiveness of influenza vaccination during the 2010-2011 influenza season in preventing laboratory-confirmed influenza infection associated with admission to an ICU among children.

Genetic Epidemiology and Immune Response of Life-Threatening Influenza Infection in Children and Young Adults
This study of life-threatening influenza lower respiratory tract infection (LRTI) in children evaluates how the host innate immune response is associated with disease susceptibility, severity and outcome. The main goal of this multi-center study is to identify risk factors present on admission associated with having a fatal or near fatal outcome. To achieve the aims of the study, we are working with Hartford Hospital’s Transplant Immunology Lab, under the direction of Dr. Laurine Bow, Vice President for Research, to perform sensitive multiplex viral PCR testing to identify co-infection and subtype the influenza strain.

Collaboration with Critical Care Nurses

We are fortunate to collaborate with several enthusiastic nurses on clinical projects in the PICU. These include:

DVT Study
Petronella Stoltz, A.P.R.N., is the site PI for this multicenter quality improvement study examining the incidence and factors related to the development of thrombi with central venous catheters.

Continuous Feeding Advancement Protocol Study
Amanda Watkins, R.N., is the PI for this protocol and research project whose goal is to shorten time to goal feedings in critically ill children receiving continuous enteral feeds. Our hypothesis is that a nursing-driven protocol will facilitate feeding and allow us to identify factors associated with feeding intolerance.

Influenza Vaccine Study
Edie Black, R.N., is the PI for this study which examined whether relaxation techniques could reduce pain and improve satisfaction with a staff immunization program.