Paediatric Intensive Care Team (PICU) at Birmingham Children’s Hospital involved in world’s largest trial for critically ill children
Professor Kevin Morris, Paediatric Intensive Care Consultant and Helen Winmill, Paediatric Intensive Care Unit (PICU) Research Sister, from our Children’s Hospital, share their insights into the recently-published SANDWICH (sedation and weaning in children) Trial – involving some of our most critical patients. The purpose of the trial was to explore if clinicians could reduce time on assisted ventilation for children and infants.
Mechanical ventilation is a lifesaving intensive care therapy that involves pumping oxygen around the body; this can however pose significant health risks caused by prolonged bed rest and issues related to the breathing tube. By reducing time spent on assisted ventilation – this provides clinicians with the potential to reduce the risks involved.
Published internationally in notable medical journals, such as the British Medical Journal (BMJ) and Journal of the American Medical Association (JAMA); the intervention was found to significantly reduce the time spent on mechanical ventilation for patients expected to be on ventilation for over 24 hours, expediting the process of weaning by six hours.
The SANDWICH Trial was led by Professor Bronagh Blackwood from Queen’s University Belfast, funded by the National Institute for Health Research (NIHR) and is deemed the largest paediatric trial of its kind. The trial accounted for two-thirds of the UK’s paediatric ICUs; involving over 10,000 young people and children admitted across 18 different UK-based paediatric intensive care units. Over 1,100 critically ill children were enrolled in the study at our Children’s Hospital between February 2018 and October 2019 - with 240 of our Paediatric Intensive Care team members being among the 2,000 doctors and nurses who were trained in the SANDWICH Intervention.
The intervention relied heavily upon the bedside nursing team, who regularly assessed the patient’s level of sedation and whether children were able to safely come off ventilation. Bedside nurses had to liaise with team members of all different medical levels to indicate when a Spontaneous Breathing Trial (SBT) could be untaken – to assess the patients effectively. This collaborative process of the trial was found to facilitate better communication and sharing of information to ensure monitoring and safety remained at the forefront.
The collaboration between all teams across Paediatric Intensive Care helped to ensure that the trial achieved the ground-breaking results that it did. The Research Team played a vital role in the implementation of the intervention – delivering clinical training across the unit to ensure all team members were supported in the trial. Professor Kevin Morris was a member of the Trial Management Group, acting as the Trial Co-Investigator and Principal Investigator for our Children’s Hospital. Side by side, PICU Research Nurse Helen Winmill successfully enrolled 60 percent of our patients in the intervention across the PICU
Professor Kevin Morris, Honorary Professor at the University of Birmingham said: “The study was a collaborative effort, encouraging nurses and doctors at the bedside to come together to adapt their routine practices and behaviours, to trial a new procedure to wean children and infants away from mechanical ventilation. This was changed in practice; to take on a whole new bundle of interventions to support recovery”
Helen Winmill, PICU Research Sister said: “We have a fantastic team at the PICU who have always been supportive of the research studies that we have been involved with which is important when up to 60 percent of our patients are involved in a research study. As a research team, we were very excited to participate in such a significant research study which allowed us to spend time educating and supporting the clinical team with the intervention leading to improved patient care.”
We’re incredibly proud of our PICU Team. The findings from this study are far-reaching, having the potential to reduce the complications associated with mechanical ventilation by ensuring patients are weaned from the ventilator at the earliest opportunity.
We’d like to offer a big ‘congratulations’ to all hospital team members involved in the SANDWICH Trial study.