- ICH GCP
- 미국 임상 시험 레지스트리
- 임상시험 NCT00814099
Sedation Management in Pediatric Patients With Acute Respiratory Failure (The RESTORE Study) (RESTORE)
Sedation Management in Pediatric Patients With Acute Respiratory Failure
연구 개요
상태
상세 설명
People who are hospitalized for acute respiratory failure are typically supported on mechanical ventilation, which delivers oxygen and a continuous level of pressure to the damaged lungs. Over 90% of infants and children supported on mechanical ventilation receive some form of sedation medication, which helps keep them safe, calm, and comfortable. Unfortunately, the use of sedation medications may prolong the duration of mechanical ventilation, which can lead to an increased risk for pneumonia and other complications.
Recent studies among adults in intensive care units (ICUs) have shown that when doctors and nurses work together as a team to manage the use of sedation medication, patients are taken off mechanical ventilation sooner and with fewer side effects. This team strategy includes the following:
- Training and discussion between doctors and nurses regarding which sedative medications should be used
- Having doctors and nurses jointly identify the patient's progress and a daily sedation medication goal for the patient
- Having nurses use a decision-making tool to help guide changes in a patient's sedative medication dose
- Keeping track of patient care, which allows doctors and nurses to evaluate the effectiveness of how they manage each patient's sedative medication use
This study will examine the use of the sedation management strategy for infants and children in pediatric ICUs who have acute respiratory failure and require mechanical ventilation. The purpose of the study is to evaluate whether this team approach to sedation medication management is more effective than the usual approach at reducing the amount of time children remain on mechanical ventilators. Study researchers will also examine the cost-effectiveness of this approach and associated quality of life factors.
All participants will be enrolled within 24 hours of starting mechanical ventilation and will be monitored until they receive their last dose of sedative medication, hospital discharge, or Day 28 (whichever comes first). During a 3-month baseline period, all participating pediatric ICUs will provide their usual sedation management, and study researchers will review participants' medical records on a daily basis. Each pediatric ICU will then be randomly assigned to either the control group or the team approach group. Pediatric ICUs in the control group will continue to provide usual care for sedation management. Pediatric ICUs in the team approach group will implement the team approach sedation management guidelines. For both groups, pain and sedation levels will be monitored daily, and study researchers will review participants' medical records on a daily basis, too. Six months after hospital discharge, half of the participants and their parents will complete a follow-up survey and take part in a telephone interview to assess quality of life, psychological factors, and health-related resource use.
연구 유형
등록 (실제)
단계
- 3단계
연락처 및 위치
연구 장소
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Alabama
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Birmingham, Alabama, 미국, 35233
- Children's Hospital of Alabama
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Arizona
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Tucson, Arizona, 미국, 85724
- University Medical Center, The University of Arizona
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California
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Oakland, California, 미국, 94609-1809
- Children's Hospital and Research Center at Oakland
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Orange, California, 미국, 92868
- Children's Hospital of Orange County
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Palo Alto, California, 미국, 94304-0126
- Lucile Salter Packard Children's Hospital at Stanford
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Sacramento, California, 미국, 95817
- University of California Davis Medical Center
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San Francisco, California, 미국, 94143
- Children's Hospital at University of California San Francisco Medical Center
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Connecticut
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Hartford, Connecticut, 미국, 06106
- Connecticut Children's Medical Center
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New Haven, Connecticut, 미국, 06520-8064
- Yale-New Haven Children's Hospital
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Delaware
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Wilmington, Delaware, 미국, 19803
- Nemours/Alfred I. DuPont Hospital for Children
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Florida
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Miami, Florida, 미국, 33136
- Holtz Children's Hospital
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Orlando, Florida, 미국, 32803
- Florida Hospital for Children
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Illinois
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Chicago, Illinois, 미국, 60614-3363
- Children's Memorial Hospital, Chicago
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Oak Lawn, Illinois, 미국, 60453
- Advocate Hope Children's Hospital
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Maryland
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Baltimore, Maryland, 미국, 21287
- Johns Hopkins Children's Center
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Baltimore, Maryland, 미국, 21201-1595
- University of Maryland Hospital for Children
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Massachusetts
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Worcester, Massachusetts, 미국, 01655
- University of Massachusetts Memorial Children's Medical Center
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Michigan
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Ann Arbor, Michigan, 미국, 48109-0243
- C. S. Mott Children's Hospital of the University of Michigan
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Missouri
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Kansas City, Missouri, 미국, 84108
- Children's Mercy Hospital, Kansas City
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St. Louis, Missouri, 미국, 63110
- St. Louis Children's Hospital
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Nebraska
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Omaha, Nebraska, 미국, 68114
- University of Nebraska Medical Center
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New Hampshire
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Lebanon, New Hampshire, 미국, 03756-0001
- Dartmouth-Hitchcock Medical Center
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New York
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Bronx, New York, 미국, 10467
- The Children's Hospital at Montefiore
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New Hyde Park, New York, 미국, 11040
- Cohen Children's Medical Center of New York
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North Carolina
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Durham, North Carolina, 미국, 27710
- Duke Children's Hospital and Health Center
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Oregon
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Portland, Oregon, 미국, 97239
- Doernbecher Children's Hospital
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Pennsylvania
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Philadelphia, Pennsylvania, 미국, 19104
- Children's Hospital of Philadelphia
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Tennessee
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Nashville, Tennessee, 미국, 37232-9075
- Monroe Carell, Jr. Children's Hospital at Vanderbilt
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Texas
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Dallas, Texas, 미국, 75235
- Children's Medical Center Dallas
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Dallas, Texas, 미국, 75230
- Medical City Children's Hospital
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Utah
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Salt Lake City, Utah, 미국, 84113
- Primary Children's Medical Center
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참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
Inclusion Criteria:
- At least 2 weeks of age (and at least 42 weeks post-menstrual age) and less than 18 years of age
- Intubated and mechanically ventilated for acute lung disease
Exclusion Criteria:
- Cyanotic heart disease with unrepaired or palliated right to left intracardiac shunt
- History of single ventricle at any stage of repair
- Congenital diaphragmatic hernia or paralysis
- Primary pulmonary hypertension
- Critical airway or anatomical obstruction of the lower airway
- Ventilator dependent upon pediatric ICU admission
- Neuromuscular respiratory failure
- Spinal cord injury above the lumbar region
- Pain managed by patient-controlled analgesia or epidural catheter
- Patient transferred from an outside ICU where sedatives had already been administered for more than 24 hours
- Family or medical team has decided not to provide full support
- Enrolled in any other critical care interventional clinical trial concurrently or in the 30 days before study entry
- Known allergy to any of the study medications
- Pregnancy
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
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활성 비교기: 1
Participants will receive care at a pediatric ICU that is continuing the usual approach to sedation management.
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The pediatric ICU will continue its usual approach to sedation management.
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실험적: 2
Participants will receive care at a pediatric ICU that is implementing the team approach to sedation management.
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The team approach to sedation management includes the following:
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
기간 |
---|---|
Duration of mechanical ventilation
기간: Measured from the time of endotracheal intubation to the end of scheduled sedation therapy, hospital discharge, or Day 28 (whichever comes first)
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Measured from the time of endotracheal intubation to the end of scheduled sedation therapy, hospital discharge, or Day 28 (whichever comes first)
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2차 결과 측정
결과 측정 |
기간 |
---|---|
Time to recovery of acute respiratory failure
기간: Measured from the time of endotracheal intubation to when participants first meet the criteria to be tested for extubation readiness
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Measured from the time of endotracheal intubation to when participants first meet the criteria to be tested for extubation readiness
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Duration of weaning from mechanical ventilation
기간: Measured from the time participants meet the criteria to be tested for extubation readiness until the time of the first successful extubation (defined as extubation for more than 24 hours)
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Measured from the time participants meet the criteria to be tested for extubation readiness until the time of the first successful extubation (defined as extubation for more than 24 hours)
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Occurrence of adverse events
기간: Measured for the duration of the study
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Measured for the duration of the study
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Detection of life-threatening neurological events
기간: Measured for the duration of the study
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Measured for the duration of the study
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Total sedative exposure
기간: Measured for the duration of the study
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Measured for the duration of the study
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Occurrence of iatrogenic withdrawal symptoms
기간: Measured for the duration of the study
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Measured for the duration of the study
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Pediatric ICU and hospital length of stay
기간: Measured for the duration of the study
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Measured for the duration of the study
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Hospital costs
기간: Measured for the duration of the study
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Measured for the duration of the study
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Study implementation costs and cost-effectiveness
기간: Measured for the duration of the study
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Measured for the duration of the study
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In-hospital mortality
기간: Measured for the duration of the study
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Measured for the duration of the study
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Post-discharge quality of life and emotional health
기간: Measured 6 months after pediatric ICU discharge
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Measured 6 months after pediatric ICU discharge
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공동 작업자 및 조사자
수사관
- 수석 연구원: Martha A.Q. Curley, RN, PhD, University of Pennsylvania
- 연구 책임자: David Wypij, PhD, Director, Statistics and Data Coordinating Center; Children's Hospital Boston
간행물 및 유용한 링크
일반 간행물
- Monteiro ACC, Flori H, Dahmer MK, Sim MS, Quasney MW, Curley MAQ, Matthay MA, Sapru A; BALI Study Investigators of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Thrombomodulin is associated with increased mortality and organ failure in mechanically ventilated children with acute respiratory failure: biomarker analysis from a multicenter randomized controlled trial. Crit Care. 2021 Aug 3;25(1):271. doi: 10.1186/s13054-021-03626-1.
- Kopp W, Gedeit RG, Asaro LA, McLaughlin GE, Wypij D, Curley MAQ; Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators. The Impact of Preintubation Noninvasive Ventilation on Outcomes in Pediatric Acute Respiratory Distress Syndrome. Crit Care Med. 2021 May 1;49(5):816-827. doi: 10.1097/CCM.0000000000004819.
- Natale JE, Asaro LA, Joseph JG, Ulysse C, Ascenzi J, Bowens C, Wypij D, Curley MAQ; RESTORE Study Investigators. Association of Race and Ethnicity with Sedation Management in Pediatric Intensive Care. Ann Am Thorac Soc. 2021 Jan;18(1):93-102. doi: 10.1513/AnnalsATS.201912-872OC.
- Curley MAQ, Gedeit RG, Dodson BL, Amling JK, Soetenga DJ, Corriveau CO, Asario LA, Wypij D; RESTORE Investigative Team. Methods in the design and implementation of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) clinical trial. Trials. 2018 Dec 17;19(1):687. doi: 10.1186/s13063-018-3075-8. Erratum In: Trials. 2019 Jan 7;20(1):17. Asaro, Lisa A [corrected to Asario, Lisa A].
- Watson RS, Asaro LA, Hertzog JH, Sorce LR, Kachmar AG, Dervan LA, Angus DC, Wypij D, Curley MAQ; RESTORE Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Long-Term Outcomes after Protocolized Sedation versus Usual Care in Ventilated Pediatric Patients. Am J Respir Crit Care Med. 2018 Jun 1;197(11):1457-1467. doi: 10.1164/rccm.201708-1768OC.
- Lebet R, Hayakawa J, Chamblee TB, Tala JA, Singh N, Wypij D, Curley MAQ. Maintaining Interrater Agreement of Core Assessment Instruments in a Multisite Randomized Controlled Clinical Trial: The Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Trial. Nurs Res. 2017 Jul/Aug;66(4):323-329. doi: 10.1097/NNR.0000000000000224.
- Natale JE, Lebet R, Joseph JG, Ulysse C, Ascenzi J, Wypij D, Curley MAQ; Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators. Racial and Ethnic Disparities in Parental Refusal of Consent in a Large, Multisite Pediatric Critical Care Clinical Trial. J Pediatr. 2017 May;184:204-208.e1. doi: 10.1016/j.jpeds.2017.02.006. Epub 2017 Mar 2.
- Curley MA, Wypij D, Watson RS, Grant MJ, Asaro LA, Cheifetz IM, Dodson BL, Franck LS, Gedeit RG, Angus DC, Matthay MA; RESTORE Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators Network. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial. JAMA. 2015 Jan 27;313(4):379-89. doi: 10.1001/jama.2014.18399.
연구 기록 날짜
연구 주요 날짜
연구 시작
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (추정)
연구 기록 업데이트
마지막 업데이트 게시됨 (추정)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
기타 연구 ID 번호
- 611
- U01HL086622 (미국 NIH 보조금/계약)
- U01HL086649 (미국 NIH 보조금/계약)
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