Bronchiolitis
Conditions
Brief summary
This project aims to answer the essential questions about the management of acute, pediatric respiratory illness, accelerate recovery from these all-too-common diseases, curb unnecessary costs of care, and demonstrate UPMC Children's Hospital of Pittsburgh's capabilities as the premier, world-class leader in the arena of pediatric learning healthcare systems. REST EEC will focus on the question of whether clinical decision support (CDS) facilitates the standardization of the initiation and weaning of heated high flow nasal cannula (HHFNC) for bronchiolitis.REST EEC will focus on whether the application of CDS improves adherence to a standardized guideline and leads to improved patient-centered outcomes.
Interventions
Education to front line clinicians and staff on standardized implementation and weaning of HHFNC and standardized assessments of patient work of breathing. HHFNC implementation and weaning strategies will be based on age-specific practices recommended by the American Academy of Pediatrics. Education will be undertaken by dedicated clinical educators.
DEVICEHHFNC Weaning
Wean patient off oxygen and flow as oxygenation and work of breathing improves.
Sponsors
Christopher Horvat
The Greg Beckwith Foundation
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
We will be providing clinical decision support tools for children receiving HHFNC for bronchiolitis, testing the impact of decision support compared to usual care in a pragmatic randomized trial. All subjects will receive standard of care. Decisions regarding management will be at the discretion of the treating provider and will not be restricted or altered in any way.
Eligibility
Sex/Gender
ALL
Age
No minimum to 2 Years
Healthy volunteers
No
Inclusion criteria
* \<2 years of age Bronchiolitis WOB Score \>2
Exclusion criteria
* Immunocompromised * Immunosuppressed * Chronic lung disease * Congenital heart disease with baseline cardiorespiratory manifestations
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HFNC duration | Timeframe consists of a start time of either randomization or the last documentation of positive pressure ventilation (whichever is later) and the last documentation of HFNC in the electronic flowsheet, up to 30 days | Amount of time patient is on HFNC |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Respiratory support free days | From date the start of respiratory support until the first documented respiratory support free day, up to 30 days | Days alive and free of intensive care unit-based respiratory |
| Hospital length of stay | From date of admission until discharge or date of death from any cause, whichever came first, assessed up to 90 days. | Days admitted in hospital |
| Organ support free days | From date of admission until the first day of ICU-based respiratory or cardiovascular organ support or discharge or date of death from any case, whichever came first, assessed up to 30 days | Days alive and free of ICU-based respiratory or cardiovascular organ support |
| Time to oral intake | From date of ending HHFNC until first documented oral intake, assessed up to 30 days | Time from HHFNC and oral intake |
| Ostensible respiratory distress measured by a respiratory severity score | Through study completion, an average of 1 week | The product of mean airway pressure and the fraction of inspired oxygen |
| Cost of hospitalization | Days from admission to discharge from hospital or date of death, up to 90 days. Of note, an earlier outcome was listed for 90-day cost of care and the redundancy with this outcome was recognized, so the 90-day cost of care outcome was removed. | Totality of expenses incurred by a hospital in providing its services and care |
| Mortality | From date of admission until death from any cause, assessed up to 90 days | Patient Death |
| PICU length of stay | From data of admission to PICU to discharge from the PICU or death from any cause, whichever came first, assessed up to 90 days. | Days admitted in the PICU. This is added to reconcile the plan to evaluate this outcome and its noted absence from this website, as pointed out by a reviewer while working to publish the trial design. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORChristopher Horvat, MD
UPMC Children's Hospital of Pittsburgh
Outcome results
None listed