The Effect of Intensive Care unit therapies on long-term outcome for children with Pediatric ARDS
Robinder Khemani, MD
BACKGROUND: Pediatric acute respiratory distress (PARDS) results in severe inflammation in the lung, mandating life-saving treatment with ventilators in the intensive care unit (ICU); but children who survive PARDS are sometimes left with lifelong morbidity. Comprehensive follow-up data on these children are lacking and there have been no studies which have tried to link management strategies in the ICU during the PARDS illness with post-ICU morbidity. GAP: Through this study, we seek to understand how ICU management strategies during the acute PARDS illness impact post-ICU pulmonary function and quality of life, and whether this post-ICU morbidity can be reduced by a ventilator strategy (called REDvent) targeting preventing Ventilator Induced Lung Injury (VILI) and Ventilator Induced Diaphragm Dysfunction (VIDD). HYPOTHESIS: We hypothesize that impairments in all domains will be common and persistent amongst PARDS survivors, that the REDvent strategy will prevent some of these impairments, and that we can identify potentially modifiable ICU treatment approaches which are associated with these impairments. METHODS: We will be conducting a prospective, observational study of PARDS patients enrolled in the parent REDvent randomized controlled trial. On all PARDS survivors, we will obtain serial, longitudinal follow up for the 2 years after ICU discharge related to pulmonary function and health related quality of life. RESULTS: Pending. IMPACT: This study will have an immediate impact on patients why survive ARDS by alerting practitioners to make appropriate referrals for rehabilitation services. Furthermore, if REDvent is effective at preventing morbidity, it will promote wide scale adoption of ICU strategies to prevent VIDD, VILI and shorten time on mechanical ventilation.