Clinical Effectiveness of the "PICU Up!" Multifaceted Early Mobility Intervention for Critically Ill Children (PICU Up!)

March 16, 2026 updated by: Johns Hopkins University

Clinical Effectiveness of the "PICU Up!" Multifaceted Early Mobility Intervention for Critically Ill Children: A Pragmatic, Stepped-wedge Trial

While mortality in U.S. pediatric intensive care units (PICUs) is improving, surviving children frequently develop persistent physical, cognitive, and psychological impairments. Over half of critically ill children experience potentially preventable PICU-acquired morbidities, with mechanically ventilated children being at greatest risk. In critically ill adults, randomized trials have shown that progressive mobility, started early (within 3 days of initiating mechanical ventilation), decreases muscle weakness and the duration of mechanical ventilation. However, similar randomized studies have not been conducted in the PICU. The investigator's prior studies revealed that less than 10 percent of critically ill children at the highest risk of functional decline are evaluated by a physical or occupational therapist within 3 days of PICU admission. Given the interplay of sedation, delirium, sleep, and immobility in the PICU, single-component interventions, such as sedation protocolization, have not consistently shown benefit for decreasing mechanical ventilation duration. Thus, the investigators developed the first pediatric-specific, interprofessional intervention (PICU Up!) to integrate goal-directed sedation, delirium prevention, sleep promotion, and family engagement into daily PICU care in order to facilitate early and progressive mobility. The investigators have demonstrated the safety and feasibility of this pragmatic, multifaceted strategy in both single-site and multicenter pilot studies. Hence, the next phase of the investigators research is to evaluate the clinical effectiveness and delivery of the PICU Up! intervention across a range of PICU patients and health systems. The investigators propose a pragmatic, stepped-wedge, cluster randomized controlled trial that will include 10 academic and community hospitals in the United States, with the following Aims: 1) Evaluate if the PICU Up! intervention, delivered under real-world conditions, decreases mechanical ventilation duration (primary outcome) and improves delirium and functional status compared to usual care in critically ill children; and 2) Conduct a multi-stakeholder, mixed-methods process evaluation to identify key contextual factors associated with delivery of PICU Up!. If proven effective, the PICU Up! intervention has potential to profoundly change medical care in the PICU and substantially impact public health by improving outcomes for the growing number of pediatric survivors of critical illness.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

1440

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: Sapna R Kudchadkar, MD, PhD
  • Phone Number: 410-955-6412
  • Email: sapna@jhmi.edu

Study Contact Backup

Study Locations

  • United States
    • California
      • Madera, California, United States, 93636
        • Recruiting
        • Valley Children's Hospital
        • Contact:
          • Molly Dorfman, MD
        • Principal Investigator:
          • Molly Dorfman, MD
    • Florida
      • Orlando, Florida, United States, 32827
        • Recruiting
        • Nemours Children's Hospital of the Nemours Foundation
        • Contact:
          • Mashael Alqahtani, MBBS, MS
        • Principal Investigator:
          • Mashael Alqahtani, MBBS, MS
    • Kentucky
      • Louisville, Kentucky, United States, 40202
        • Recruiting
        • Norton Children's Hospital: University of Louisville
        • Principal Investigator:
          • John Berkenbosch, MD
        • Sub-Investigator:
          • Melissa Porter, MD
        • Contact:
          • John Berkenbosch, MD
    • Maryland
      • Baltimore, Maryland, United States, 21287
        • Active, not recruiting
        • Johns Hopkins Hospital
    • Minnesota
      • Minneapolis, Minnesota, United States, 55415
        • Recruiting
        • Hennepin Healthcare: University of Minnesota
        • Contact:
          • Andrew Kiragu, MD
        • Sub-Investigator:
          • Andrew Kiragu, MD
        • Principal Investigator:
          • Ashley Bjorklund, MD
    • New Hampshire
      • Lebanon, New Hampshire, United States, 03756
        • Recruiting
        • Children's Hospital at Dartmouth: Geisel School of Medicine
        • Contact:
          • Kelly Corbett, MD
        • Principal Investigator:
          • Kelly Corbett, MD
    • North Carolina
      • Chapel Hill, North Carolina, United States, 27514
        • Recruiting
        • UNC Children's: University of North Carolina
        • Contact:
          • Tracie Walker, MD
        • Principal Investigator:
          • Tracie Walker, MD
    • Pennsylvania
      • Danville, Pennsylvania, United States, 17822
        • Recruiting
        • Janet Weis Children's Hospital: Geisinger Commonwealth School of Medicine
        • Contact:
          • Justin Azar, MD
        • Principal Investigator:
          • Justin Azar, MD
    • Texas
      • Houston, Texas, United States, 77030
        • Recruiting
        • Texas Children's Hospital: Baylor College of Medicine
        • Contact:
          • Matthew Musick, MD
        • Principal Investigator:
          • Matthew Musick, MD
    • West Virginia
      • Morgantown, West Virginia, United States, 26506
        • Recruiting
        • West Virginia University Medicine Children's: West Virginia University
        • Contact:
          • Mel Wright, DO
        • Principal Investigator:
          • Mel Wright, DO
    • Wisconsin
      • Milwaukee, Wisconsin, United States, 53226
        • Recruiting
        • Children's Hospital of Wisconsin: Medical College of Wisconsin
        • Contact:
          • Charles Rothschild, MD
        • Principal Investigator:
          • Charles Rothschild, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

No older than 18 years (Child, Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Invasive mechanical ventilation via oral or nasal endotracheal tube ≥ 48 hours at 7 a.m. on PICU Day 3

Exclusion Criteria:

  • Active or anticipated withdrawal of life support within 48 hours
  • Open chest or open abdomen
  • Current use of Extracorporeal Membrane Oxygenation (ECMO)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Sequential Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Baseline/Pre-implementation
Usual PICU care
Active Comparator: Intervention/Post-implementation
PICU Up! is a multifaceted, inter-professional pathway that is integrated into routine PICU practice to safely optimize early and progressive patient mobility.
Other: PICU Up!
PICU Up! incorporates the screening process for determining a patient's appropriate activity level into the daily rounding workflow for all PICU patients, with a tiered activity plan based on clinical parameters to individualize goals based on each child's unique needs. While the patient's PICU Up! level is based on objective criteria, the interprofessional team collectively determines the daily activity goal(s) through shared decision-making which is documented in the medical record on morning rounds. The intervention facilitates daily discussion of 1) analgesia; 2) extubation readiness testing; 3) sedation level and goal; 4) delirium screening and management; 5) mobility goal including physical and occupational therapy consultation by PICU Day 3; 6) sleep promotion; and 7) family engagement in mobility.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Duration of Mechanical Ventilation
Time Frame: Through Day 21
In computing duration of mechanical ventilation, the investigators will consider Time 0 as the time of endotracheal intubation or PICU admission for patients intubated at an outside hospital, and continuing until the first time the endotracheal tube was continuously absent for at least 24 hours. Patients will be assigned 21 days for ventilation duration if they remain intubated and mechanically ventilated, are transferred to another facility while ventilated or die prior to day 21 without ever remaining off mechanical ventilation ventilation (via endotracheal tube) for more than 24 continuous hours. If a patient is transitioned to mechanical ventilation via a new tracheostomy those days will be counted as mechanical ventilation days.
Through Day 21

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Proportion of Days with Delirium
Time Frame: Through Day 21
Defined as the number of days with delirium divided by the total number of days that the child is at risk for delirium (i.e. the number of days that the patient is in the PICU and free of coma and therefore assessable for delirium).
Through Day 21
Change in Functional Status as assessed by the Pediatric Cerebral Performance Category (PCPC) scale
Time Frame: Through Day 21
The Pediatric Cerebral Performance Category is a global scale based on observer impressions. It's is a six point graded scale of increasing disability from 1 normal function, to 6 death. Scores include 1 for good, 2 for mild disability, 3 for moderate disability, 4 for severe disability, and 5 for vegetative state or coma. Higher scores indicating worse performance or functional morbidity.
Through Day 21
Change in Functional Status as assessed by the Pediatric Overall Performance Category (POPC) scale
Time Frame: Through Day 21
The Pediatric Overall Performance Category (POPC) is a global scale based on observer impressions. It's is a six point graded scale of increasing disability from 1 normal function, to 6 death. Scores include 1 for good, 2 for mild disability, 3 for moderate disability, 4 for severe disability, and 5 for vegetative state or coma. Higher scores indicating worse performance or functional morbidity.
Through Day 21

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
PICU length of stay
Time Frame: Through Day 21
PICU length of stay days
Through Day 21
Percentage of patients PICU mortality
Time Frame: Through Day 21
PICU mortality
Through Day 21
Number of patients discharged to home
Time Frame: Through Day 21
Number of patients discharged to home
Through Day 21
Number of patients discharged to inpatient floor
Time Frame: Through Day 21
Number of patients discharged to inpatient floor
Through Day 21
Number of patients discharged to inpatient rehabilitation
Time Frame: Through Day 21
Number of patients discharged to inpatient rehabilitation
Through Day 21
Number of patients discharged to other hospital
Time Frame: Through Day 21
Number of patients discharged to other hospital
Through Day 21
Percentage of patients with new pressure injuries
Time Frame: Through Day 21
Percentage of patients with new pressure injuries
Through Day 21
Percentage of patients with physical therapy consultation
Time Frame: Day 3
Physical therapy consultation by PICU
Day 3
Percentage of patients with occupational therapy consultation
Time Frame: Day 3
Occupational therapy consultation by PICU
Day 3
Mean daily Opioid exposure
Time Frame: Through Day 21
Opioid exposure: mean daily morphine and equivalents (mg/kg/day) via chart review
Through Day 21
Mean daily Benzodiazepine exposure
Time Frame: Through Day 21
Benzodiazepine exposure: mean daily benzodiazepine equivalents (mg/kg/day) via chart review
Through Day 21

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Johns Hopkins University

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Investigators

  • Principal Investigator: Sapna Kudchadkar, MD, PhD, Johns Hopkins University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 8, 2022

Primary Completion (Actual)

August 11, 2025

Study Completion (Estimated)

September 30, 2026

Study Registration Dates

First Submitted

July 26, 2021

First Submitted That Met QC Criteria

July 26, 2021

First Posted (Actual)

August 4, 2021

Study Record Updates

Last Update Posted (Actual)

March 18, 2026

Last Update Submitted That Met QC Criteria

March 16, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IRB00297110
  • R01HD103811 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

Data generated in this grant will be presented in a timely fashion at national and international meetings and in publications. All final peer-reviewed manuscripts that arise from this proposal will be submitted to the digital archive PubMed Central. The investigators plan to share data from this research with other researchers who have interests in improving outcomes in critically ill children through early and progressive mobility interventions. Written proposals for data sharing requests will be accepted and reviewed by an independent review committee to ensure the proposal is scientifically and methodologically sound and not duplicative with other analyses. If approved, data sharing would occur after establishing a data use agreement with institutional signing authorities of each institution. Medical record and outcomes data will then be made available in the form of deidentified datasets with no identifiers in keeping with NIH Data Sharing Policy and Implementation Guidance.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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