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Penn Nursing’s $10 Million Grant from NIH to Improve Sedation Management of Critically-Ill Children
April 22, 2008, Volume 54, No. 30

The National Institutes of Health has awarded the University of Pennsylvania School of Nursing a $10 million grant to investigate better ways of managing sedation for children on life-saving ventilators. The grant, the largest in the school’s history, will be devoted to conducting one of the most comprehensive studies ever undertaken in pediatric critical care.

The children, who range in age from infant to 18 years, are typically the victims of trauma, pneumonia, bronchiolitis, asthma and other conditions, and are often critically ill, requiring the insertion of ventilation tubes into the throat to assist breathing. The study will involve more than 2,750 patients in 18 of some of the most prestigious pediatric hospitals in the United States and Canada.

“This research asks an important question that will directly inform doctors how to care for critically ill pediatric patients,” said Dr. Andrea Harabin, program director for Acute Lung Injury and Critical Care Medicine, of the National Heart, Lung, and Blood Institute (NHLBI), which co-funded the grant.

“The truly collaborative, interdisciplinary approach used in this study is very exciting,” added Dr. Patricia A. Grady, director of the National Institute of Nursing Research, which is co-funding this grant along with NHLBI. “This approach may not only decrease the amount of time patients are required to be on a ventilator, it may shorten the time they spend in the hospital, improve their long-term outcomes, and lower the overall cost of care.”

“Our goal is to tightly manage sedation so that children can be weaned from mechanical ventilators earlier in hopes they will have fewer complications and spend less time in the hospital while continuing to ensure they are comfortable,” said associate professor of nursing Dr. Martha A.Q. Curley, the principal investigator of the study. “Too much sedation can actually prolong hospital stays by preventing the body from healing quickly and can cause health issues such as overdependence on medication.”

“Using their clinical judgment, nurses will implement a goal-directed comfort algorithm guiding titration of sedative drugs. This new procedure changes the collaborative nature of critical care to immediately benefit the patient by having nurses, those closest to the patient, make decisions about how best to help very sick children be comfortable,” said Dr. Curley.

Researchers will follow a team of physicians, nurses, clinical pharmacists, respiratory therapists and others who will jointly set daily goals for sedation management. Nurses will then administer medications in adherence with the overall goal, rather than awaiting a specific order. The new technique will be assessed to see whether the number of days spent on a ventilator can be safely and humanely reduced to promote patient recovery.

“Dr. Curley’s innovative program of research exemplifies a commitment to interdisciplinarity in developing the evidence for best practices in managing care of children,” said Dean of the School of Nursing Dr. Afaf Meleis.

“Currently, patients can be sedated for longer periods of time than needed which can delay recovery,” Dr. Curley said. Only about nine percent of physicians surveyed indicate they consistently follow all elements of the new protocol on sedation management.

Some of the 18 sites will continue to manage the patient’s comfort as they do now, and others will use the new protocol, closely titrating sedative medications. Researchers will conduct telephone surveys six months after patients go home to determine the long-term effect of the change in care.

The study will be conducted over five years involving 18 sites.




Almanac - April 22, 2008, Volume 54, No. 30