The outcomes for critically ill children on ventilators are improved with nurse-led care, minimising sedation and increased daily testing, a major new UK study has found.
The findings from the Sedation AND Weaning In Children (SANDWICH) trial – the largest study of its kind – have already led to changes in practice for two-thirds of the UK paediatric ICUs.
The study involved more than 10,000 admissions to 18 ICUs, accounting for two-thirds of the UK’s paediatric ICUs, and also involved training more than 2,000 doctors and nurses in the new SANDWICH intervention.
Compared to the current standard care, the study, published in the Journal of American Medical Association, 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.
In children who were expected to be on a ventilator for more than 24 hours, the intervention reduced the time on the mechanical ventilator by an average of six hours.
It also found that the interventions reduced ventilation time by an average of seven hours regardless of whether they were expected to be on a ventilator for more or less than 24 hours. The study added that the chances of children having their breathing tube removed successfully were greater.
Clinical trial lead Professor Bronagh Blackwood, professor of critical care from The Wellcome-Wolfson Institute for Experimental Medicine at Queen’s University Belfast, said: “To minimise the risks associated with mechanical ventilation, the sooner children are weaned off the ventilator, the better their outcomes.
Largest trial
“We have shown that nurse-led care, with daily screening to test for readiness to come off the ventilator and reduced sedation, is safe and greatly improved their chances of getting off the ventilator earlier than before.”
Professor Mark Peters, consultant in intensive care at Great Ormond Street Hospital and professor of paediatric intensive care at UCL Great Ormond Street Institute of Child Health, added: “This is the largest randomised control trial ever undertaken in paediatric intensive care with more than 10,000 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.
“This trial redefines what is feasible in children’s intensive care research."
Blackwood B, Tume LV, Morris KP et al. Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units. A Randomized Clinical Trial. JAMA 3 August 2021
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