Biggest ever study on child ICU patients reveals major improvements with nurse centred care

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THE biggest ever study into critically ill children in hospital intensive care units has shown major improvements in outcomes with a new approach to ventilation and care. Led by Queen's University Belfast, the clinical trial involved more than 10,000 infant and child patient admissions to 18 paediatric units across the NHS. Researchers discovered that a greater involvement of nurses, minimising sedation use and increasing daily testing to assess the child’s readiness to come off a ventilator significantly reduced the time on mechanical ventilation. More than 2,000 doctors and nurses also took part in the Sedation AND Weaning In Children (SANDWICH) trial. The groundbreaking results have already led to changes in practice for two-thirds of the paediatric ICUs. Compared to the current standard care, the study reported that in children who were expected to be on a ventilator for more than 24 hours, the intervention reduced the time on the mechanical ventilator by an average of six hours. Overall, the chances of young patients having their breathing tube removed successfully was greater.
Trial lead Bronagh Blackwood, Professor of Critical Care from The Wellcome-Wolfson Institute for Experimental Medicine at QUB, said: "To minimize the risks associated with mechanical ventilation, the sooner children are weaned off the ventilator, the better their outcomes. "We have shown that nurse-led care, with daily screening to test for readiness to come off the ventilator and reduced sedation, is safe and greatly improved their chances of getting off the ventilator earlier than before." Each year approximately 20,000 babies and children are treated in a paediatric ICU across the NHS. Of this total, around 12,000 are placed on ventilators. Mechanical ventilation is a lifesaving therapy but may involve related risk caused by the breathing tube in the mouth and throat, the sedative drugs needed to reduce anxiety, and remaining confined to bed.
Professor Mark Peters, Consultant in Intensive Care at Great Ormond Street Hospital (GOSH) in London, said the trial's results were far reaching for other paediatric units around the world. "This is the largest randomised control trial ever undertaken in paediatric intensive care with more than 10,000 critically ill children taking part – almost 2,000 children at GOSH alone," he said. "To improve the care of the very sickest children in our hospitals, paediatric intensive care teams from across the UK have come together to put bedside nursing at the heart of decision making and introducing a more structured approach to reducing sedatives and ventilation.  "This trial redefines what is feasible in children’s intensive care research."