Critical care

Pediatric Critical Care is committed to cutting-edge research to improve the care of our patients. Our unit participates in multi-center, National of Institutes of Health (NIH) funded projects and have original research to investigate novel approaches to care.

Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE)
Site Principal Investigator: Marc D. Berg, MD
Co-Investigators: Brent Hall, PharmD, Michele Munkwitz, MD, Claire Wells, CNP

RESTORE is an NIH sponsored study at 31 pediatric intensive care units across the United States. The purpose of the study 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.

Ensuring the safety and comfort of critically ill infants and children supported on mechanical ventilation is integral to the practice of pediatric critical care. Yet, the medications required to keep patients comfortable and safe can cause other complications. Over time, children can develop a tolerance to the sedation medications and may experience undesired side effects requiring them to remain on the ventilator longer.

This study is being done to learn more about the best ways to keep children comfortable and safe during mechanical ventilation, while limiting undesired short-term and long-term risks.  Using a protocol or guideline to manage sedation may allow some pediatric patients to come off the ventilator faster with fewer side effects because less medication is used. 

Associated ancillary projects with RESTORE are:
Genetic Variations and Biomarkers in Acute Lung Injury (BALI)
The purpose of this study is to examine plasma biomarkers and genetic variations in several loci that may influence the development of acute lung injury and acute respiratory distress.  By learning about biomarkers, in the future we can better identify those children who are potentially at a greatest risk for acute lung injury.

Pharmacologic Impact on Sedation Assessments (PISA)
This project uses sophisticated modeling and simulation techniques to evaluate the impact of genetics and other variables such as degree of illness, age, weight and organ dysfunction on the use of morphine and midazolam in children who are mechanically ventilated for respiratory failure.  Information learned through this project will allow the design of a pharmacologic model that can be used to individualize therapy in children requiring mechanical ventilation with the goal of optimizing sedation while minimizing the duration of mechanical ventilation.

Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA)
Site Principal Investigator: Andreas A. Theodorou, MD
Co-Investigator: Katri V. Typpo, MD, MPH

THAPCA is an NIH sponsored study with 38 participating pediatric intensive care units in the United States and Canada.  Therapeutic hypothermia (lowering the body temperature) has been successfully used in adults after cardiac arrest to improve survival and outcome.  Hypothermia has also been studied in newborn infants, but it has not been studied in infants or children who have had cardiac arrest.

When a person has a cardiac arrest, cells throughout body undergo severe stress which may result in cell injury or death.   Brain cells are especially susceptible to lack of oxygen and blood supply that occur during a cardiac arrest.  Fever commonly occurs after cardiac arrest and is associated with worse outcome.  It is not known whether preventing elevated body temperature, by keeping it in a normal range (Normothermia) or a below normal range (Hypothermia), results in less brain injury and greater survival. 

Associated ancillary projects with THAPCA:
Hypothermia’s Impact on Pharmacology (HIP)
Very little is known about the impact of hypothermia on a child’s ability to metabolize medications.  The THAPCA trial provides an extraordinary opportunity to research if there is any impact on drug metabolism in children when temperature is rigorously controlled.  By including children from both the hypothermia and normothermia strategies, differences in drug metabolism can be identified.   This study specifically looks at morphine and midazolam, since these two drugs both undergo substantial metabolism before they are eliminated from the body. The information gathered from this research will help to guide future dosing of these and other medications, to optimize their effect and reduce possible side effects.

Eliminating Catheter-Associated Bloodstream Infections in Pediatric ICUs (NACHRI-CLABSI)
Site Principal Investigator: Robyn J. Meyer, MD

The NACHRI-CLABSI project is a national collaborative effort of pediatric intensive care units that are members of The National Association of Children’s Hospital and Related Institutions. A quality improvement project focused on eliminating central line-associated blood stream infections (CLABSI), the project improves clinical care and maintains rigorous standards for central-line management. CLABSIs can prolong hospitalization and complicate the course of care. While some previous work has produced results in PICUs to reduce infections associated with central-line insertion, data from a number of children’s hospitals suggest that even after reliable implementation of sterile insertion practices, PICU patients may continue to experience infection. Despite these experiences, there are no pediatric specific evidence-based strategies related to catheter maintenance practices which focus upon reducing CLABSI.

Epithelial Permeability in Children after Cardiopulmonary Bypass (EPIC-Cardiac)
Principal Investigator: Katri V. Typpo, MD, MPH

The EPIC-Cardiac project is original research started here at the University of Arizona.  In children who undergo cardiac bypass for repair of their congenital heart disease, the lungs and intestines may be injured from the surgery and predispose the patient to necrotizing enterocolitis (NEC).  NEC is a serious intestinal infection and can prolong hospitalization and delay the post operative healing process.  If we have a better understanding of mucosal injury after bypass, we may be able to find medications or therapies to prevent or protect patients from these types of complications before they go onto bypass and reduce their likelihood of developing NEC.  This study measures intestinal and lung permeability, as well as other markers for mucosal injury, with the ultimate goal of improving post operative care in our cardiac bypass patients.

Other projects and research interests:

• Clinical nutrition
• CPR performance and ventricular fibrillation
• Medication safety and error reduction
• Patient safety and quality of patient care
• Traumatic brain injury
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If you have any questions about any of our research projects, please contact our Program Coordinator.