Goal-directed Resuscitative Interventions During Pediatric Inter-facility Transport (The GRIPIT Trial)
| Status: | Completed |
|---|---|
| Conditions: | Infectious Disease |
| Therapuetic Areas: | Immunology / Infectious Diseases |
| Healthy: | No |
| Age Range: | Any - 17 |
| Updated: | 4/2/2016 |
| Start Date: | October 2010 |
| End Date: | September 2012 |
| Contact: | Michael H Stroud, MD |
| Email: | StroudMichaelH@uams.edu |
| Phone: | 501-364-1861 |
Recent advances in critical care medicine have dramatically improved morbidity and mortality
of critical illness. Goal-directed therapy protocols have been instrumental in this change.
Goal-directed therapy standardizes the rapid delivery of definitive care in illnesses such
as SIRS (Systemic Inflammatory Response Syndrome) and head trauma. Although this treatment
approach has been shown to improve clinical outcomes, it has not been widely adopted outside
academic medical centers. Further improvement in outcomes of critical illness is likely if
goal-directed therapy is utilized early in the course of care. To facilitate this early
adoption, goal-directed therapeutic protocols should be developed and implemented by
specialized pediatric transport teams. The investigators hypothesize that the institution of
goal-directed therapy during pediatric interfacility transport will improve the outcomes of
critically ill children.
The GRIPIT Trial (Goal-directed Resuscitative Interventions during Pediatric Inter-facility
Transport) will compare outcomes of pediatric SIRS patients before and after the
implementation of a goal-directed therapeutic protocol during transport. This will be the
first test of goal-directed therapy in the transport environment. Data will be collected on
pediatric SIRS patients transported by the Angel One Transport Team at Arkansas Children's
Hospital before and after protocol implementation. Outcome measures will include length of
hospital stay, length of intensive care unit (ICU) stay, incidence of multiple organ
dysfunction syndrome (MODS), and required therapeutic interventions during ICU stay (TISS-28
scores). In addition, NIRS (Near-Infrared Spectroscopy) monitoring will be used as a
cerebral and somatic oxygenation trend monitor, to determine its effectiveness as a
resuscitation guide for pediatric SIRS during transport. NIRS trends are useful as a
surrogate marker for systemic venous saturations, known to decrease with severe SIRS.
of critical illness. Goal-directed therapy protocols have been instrumental in this change.
Goal-directed therapy standardizes the rapid delivery of definitive care in illnesses such
as SIRS (Systemic Inflammatory Response Syndrome) and head trauma. Although this treatment
approach has been shown to improve clinical outcomes, it has not been widely adopted outside
academic medical centers. Further improvement in outcomes of critical illness is likely if
goal-directed therapy is utilized early in the course of care. To facilitate this early
adoption, goal-directed therapeutic protocols should be developed and implemented by
specialized pediatric transport teams. The investigators hypothesize that the institution of
goal-directed therapy during pediatric interfacility transport will improve the outcomes of
critically ill children.
The GRIPIT Trial (Goal-directed Resuscitative Interventions during Pediatric Inter-facility
Transport) will compare outcomes of pediatric SIRS patients before and after the
implementation of a goal-directed therapeutic protocol during transport. This will be the
first test of goal-directed therapy in the transport environment. Data will be collected on
pediatric SIRS patients transported by the Angel One Transport Team at Arkansas Children's
Hospital before and after protocol implementation. Outcome measures will include length of
hospital stay, length of intensive care unit (ICU) stay, incidence of multiple organ
dysfunction syndrome (MODS), and required therapeutic interventions during ICU stay (TISS-28
scores). In addition, NIRS (Near-Infrared Spectroscopy) monitoring will be used as a
cerebral and somatic oxygenation trend monitor, to determine its effectiveness as a
resuscitation guide for pediatric SIRS during transport. NIRS trends are useful as a
surrogate marker for systemic venous saturations, known to decrease with severe SIRS.
Inclusion Criteria:
- Pediatric patients transported to Arkansas Children's Hospital by the Angel One
Transport Team
- Age Group: 1 month - 17 years
- Systemic Inflammatory Response Syndrome (Age-specific SIRS criteria)
Exclusion Criteria:
- Known or suspected congenital heart disease
- Known or suspected cardiomyopathy or myocarditis
- Diabetic Ketoacidosis (DKA) as SIRS-inducing illness
- Traumatic Brain Injury (TBI) as SIRS-inducing illness
- Burn Injury as SIRS-inducing illness
- Patients with known or suspected active hemorrhage
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