New research ideas
Please use this PowerPoint template for your proposal presentation at the annual PACCMAN Meeting.
1. Pediatric severe sepsis and shock in three Asian countries: A retrospective study of outcomes in nine Pediatric intensive care units
~ Status: Manuscript Submitted ~
2. Pediatric Acute Respiratory Distress Syndrome Asia Study (PARDSProASIA) — ClinicalTrials.gov Identifier: NCT04068038
3. Does 3% hypertonic saline decrease mortality and improve long-term neurological outcomes among children with traumatic brain injury?
Data Collection: Variables defined a priori will be collected on a secure electronic data platform (Redcap) that is designed and maintained by the Singapore Clinical Research Institute (SCRI). Our team research will provide 2-monthly updates on the cases collected and clarify any missing data.
4. Severe Pneumonia in Children (S-PIC) Study: A Comparative Effectiveness Study of Children with Severe Pneumonia in Asia
Study Design: A prospective multicenter cohort study over 18 months to recruit 1800 children with severe pneumonia. Pertinent demographic, clinical, microbiological, critical care support and management data will be collected to enable an investigation of the association between risk factors and clinical outcomes in these children.
5. Pediatric Acute and Critical Care COVID-19 Registry of Asia (PACCOVRA)
Abstract: There is wide variation in the overall clinical impact of COVID-19 across countries worldwide. Changes adopted pertaining to the management of pediatric patients, in particular, the provision of respiratory support during the COVID-19 pandemic is poorly described in Asia. We performed a multicentre survey of 20 Asian pediatric hospitals to determine workflow changes adopted during the pandemic. Data from centers of high income (HIC), upper-middle income (UMIC) and lower-middle income (LMIC) countries were compared. All 20 sites over 9 countries [HIC – Japan (4), Singapore (2), UMIC – China (3), Malaysia (3), Thailand (2), and LMIC – India (1), Indonesia (2), Pakistan (1), Philippines (2)] responded to this survey. This survey demonstrated substantial outbreak adaptability. The major differences between the three income categories were that HICs were 1) more able/willing to minimise use of non-invasive ventilation or high flow nasal cannula therapy in favour of early intubation, and 2) had greater availability of negative pressure rooms and powered airpurifying respirators. Further research into best practices for respiratory support are warranted. In particular, innovation on cost-effective measures in infection control and respiratory support in the LMIC setting should be considered in preparation for future waves of COVID-19 infection.
6. Delphi Study to Establish Paediatric Critical Care Nursing Research Priorities in Asian Countries
Risk Stratification in Pediatric Acute Respiratory Distress Syndrome: A Multicenter Observational Study (To access the article, click here)
Study description: The Pediatric Acute Lung Injury Consensus Conference (PALICC) developed a pediatric speciﬁc deﬁnition for acute respiratory distress syndrome (PARDS). In this definition, severity of lung disease is stratified into mild, moderate and severe groups. We aim to describe the epidemiology of patients with PARDS across Asia and evaluate whether the PALICC risk stratification accurately predicts outcome in PARDS. This is a multicenter, retrospective, descriptive cohort study involving 10 multidisciplinary pediatric intensive care units in Asia.
Main findings: A total of 373 patients had mild [89(23.9%)], moderate [149 (39.9%)] and severe PARDS [135 (36.2%)]. Higher category of severity of PARDS was associated with lower ventilator free days [22 (17, 25), 16 (0, 23), 6 (0, 19); p<0.001 for mild, moderate and severe, respectively] and PICU free days [19 (11, 24), 15 (0, 22), 5 (0, 20); p<0.001 for mild, moderate and severe, respectively]. Overall PICU mortality for PARDS was 113/373 (30.3%), and 100-day mortality was 126/314 (39.7%). After adjusting for site, presence of comorbidities and severity of illness in the multivariate Cox proportional hazard regression model, patients with moderate [hazard ratio (HR) 1.88, 95% confidence interval (CI): 1.03, 3.45; p=0.039] and severe PARDS [HR 3.18 (95% CI 1.68, 6.02); p<0.001] had higher risk of mortality compared to those with mild PARDS.
- Differences Between Pulmonary and Extrapulmonary Pediatric Acute Respiratory Distress Syndrome: A Multicenter Analysis (To access the article, click here)
Study description: Pediatric acute respiratory distress syndrome caused by extrapulmonary (PARDSexp) and pulmonary (PARDSp) etiologies is poorly described in the literature. We aimed to describe and compare the epidemiology, risk factors for mortality, and outcomes in PARDSexp and PARDSp. This is a secondary analysis of a multicenter, retrospective, cohort study. Patients were classified into two mutually exclusive groups (PARDSexp and PARDSp) based on etiologies. Primary outcome was pediatric intensive care unit mortality. Cox proportional hazard regression was used to identify risk factors for mortality.
Main findings: Children with PARDSexp had higher admission severity scores, and had a greater proportion of organ dysfunction compared to PARDSp group. Patients in the PARDSexp group had higher mortality (48.8% vs. 24.8%; p = 0.002) and reduced ventilator-free days [median 2.0 (interquartile range 0.0, 18.0) vs. 19.0 (0.5, 24.0) days; p = 0.001] compared to the PARDSp group. However, after adjusting for site, severity of illness, comorbidities, multiorgan dysfunction, and severity of acute respiratory distress syndrome, PARDSexp etiology was not associated with mortality [adjusted hazard ratio 1.56 (95% confidence interval 0.90, 2.71)].
- Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study (To access the article, click here)
Study description: We aim to describe the coagulation profiles in children with moderate to severe TBI, identify predictors of early coagulopathy and investigate the association between early coagulopathy, mortality and functional outcomes in pediatric TBI. Using the Pediatric Acute & Critical Care Medicine Asian Network (PACCMAN) TBI retrospective cohort we identified all patients < 16 years old with a Glasgow Coma Scale (GCS) ≤ 13. We compared prothrombin time (PT), activated partial thromboplastin time (APTT), platelets, and outcomes between children with isolated TBI and those with TBI in the presence of multiple trauma. We performed logistic regression analyses to identify predictors of early coagulopathy and to study the association with mortality and poor functional outcomes.
Main findings: Among 371 children with complete coagulation profiles, the mean age was 5.4 years (SD 4.1). PT was commonly deranged in both isolated TBI (53/173, 30.6%) and multiple trauma (102/198, 51.5%). Independent predictors for early coagulopathy were young age [adjusted odds ratio aOR 0.93, 95% confidence interval (CI) 0.88 – 0.99, p=0.018], low GCS (aOR 0.91, 95%CI 0.86 – 0.97, p=0.002) and presence of multiple trauma (aOR 2.19, 95%CI 1.36 – 3.57, p=0.001). After adjusting for age, gender, GCS, multiple trauma and presence of intracranial bleed, children with early coagulopathy were more likely to die (aOR 7.70, 95%CI 3.09 – 23.53, p<0.001) and have poor neurological outcome (aOR 2.25, 95%CI 1.31 – 3.91, p=0.004). Early coagulopathy is common and independently associated with death and long term poor neurological function among children with TBI. Future trials are required to study the impact of correction of early coagulopathy on clinical outcomes.