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World’s largest paediatric intensive care trial is improving care for critically ill children

child feeling unwell

A major UK clinical trial, funded by National Institute of Health Research (NIHR) has shown how a new approach to reduce the use of mechanical ventilation can greatly improve outcomes for critically ill infants and children.  

Annually, in the UK, approximately 20,000 infants and children are treated in a paediatric intensive care unit (ICU) and, of these, around 12,000 receive mechanical ventilation. 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. 

The study, running at Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) found that a greater involvement of nurses, minimising sedation use and increasing daily testing to assess the child’s readiness to come off the ventilator, significantly reduced the time on mechanical ventilation. 

Depending on the time children were expected to be on a ventilator, compared to standard care, the intervention reduced the time on the mechanical ventilator by an average of six to seven hours. Overall, the chances of children having their breathing tube removed successfully was also greater.  

The Sedation AND Weaning In CHildren (SANDWICH) trial is led by Queen’s University Belfast and is the world’s largest trial recruiting infants and children in paediatric ICUs. The study involved more than 10,000 admissions to 18 ICUs, that accounts for two-thirds of the UK’s paediatric ICUs. GOSH played a crucial role both as the largest recruiter of patients and as lead contributors to the research. 

Professor Mark Peters, Consultant in Intensive Care at GOSH and Professor of Paediatric Intensive Care at UCL GOS ICH, a major partner in the research, said;

“This is the largest randomised control trial ever undertaken in paediatric intensive care with more than 8,800 critically ill children taking part – almost 2,000 children at GOSH alone.  

 “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.” 

The trial involved training more than 2,000 doctors and nurses in the new SANDWICH intervention. This resulted in a change in practice for two-thirds of the UK paediatric ICUs for the benefit of infants and children. The success of this quality improvement intervention in changing medical and nursing practice is far reaching for other paediatric ICUs world-wide. Results are expected to improve outcomes and reduce costs.

The results have been published in the Journal of American Medical Association.