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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
362
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.
Wean patient off oxygen and flow as oxygenation and work of breathing improves.
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States
HFNC duration
Amount of time patient is on HFNC
Time frame: 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
Respiratory support free days
Days alive and free of intensive care unit-based respiratory
Time frame: From date the start of respiratory support until the first documented respiratory support free day, up to 30 days
Hospital length of stay
Days admitted in hospital
Time frame: From date of admission until discharge or date of death from any cause, whichever came first, assessed up to 90 days.
Organ support free days
Days alive and free of ICU-based respiratory or cardiovascular organ support
Time frame: 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
Time to oral intake
Time from HHFNC and oral intake
Time frame: From date of ending HHFNC until first documented oral intake, assessed up to 30 days
Ostensible respiratory distress measured by a respiratory severity score
The product of mean airway pressure and the fraction of inspired oxygen
Time frame: Through study completion, an average of 1 week
Cost of hospitalization
Totality of expenses incurred by a hospital in providing its services and care
Time frame: 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.
Mortality
Patient Death
Time frame: From date of admission until death from any cause, assessed up to 90 days
PICU length of stay
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.
Time frame: From data of admission to PICU to discharge from the PICU or death from any cause, whichever came first, assessed up to 90 days.
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