Priorities for paediatric critical care research: a modified Delphi study by the Australian and New Zealand Intensive Care Society Paediatric Study Group

Abstract

OBJECTIVE: Most interventions in paediatric critical care lack high grade evidence. We aimed to identify the key research priorities and key clinical outcome measures pertinent to research in paediatric intensive care patients. DESIGN: Modified three-stage Delphi study combining staged online surveys, followed by a face-to-face discussion and final voting. SETTING: Paediatric intensive care units in Australia and New Zealand. PARTICIPANTS: Medical and nursing staff working in intensive care. MAIN OUTCOME MEASUREMENTS: Self-reported priorities for research. RESULTS: 193 respondents provided a total of 267 research questions and 234 outcomes. In Stage 3, the top 56 research questions and 50 outcomes were discussed face to face, which allowed the identification of the top 20 research questions with the Hanlon prioritisation score and the top 20 outcomes. Topics centred on the use of intravenous fluids (restrictive v liberal fluids, use of fluid resuscitation bolus, early inotrope use, type of intravenous fluid, and assessment of fluid responsiveness), and patient- and family-centred outcomes (health-related quality of life, liberation) emerged as priorities. While mortality, length of stay, and organ support/organ dysfunction were considered important and the most feasible outcomes, long term quality of life and neurodevelopmental measures were rated highly in terms of their importance. CONCLUSIONS: Using a modified Delphi method, this study provides guidance towards prioritisation of research topics in paediatric critical care in Australia and New Zealand, and identifies study outcomes of key relevance to clinicians and experts in the field.

Pediatric and child health nursing: A three-phase research priority setting study in Western Australia

“…Many of the participants were also familiar with each other and the facilitators from the planning workshop. Another strength with this study was that the number of participants was higher or like previous pediatric nursing research priority settings (Brenner et al, 2014;Green et al, 2014;Raman et al, 2021;Ramelet et al, 2012;Tume et al, 2015;Tume et al, 2020;Tume et al, 2014;Wilkes et al, 2013;Wilson et al, 2010).…”

“…Priority setting for pediatric and child health nursing research is important to plan, coordinate and direct future research for the nursing care of children and their families across a range of healthcare contexts. However, previous nursing research priority studies have focused on acute care, with fewer priorities reflecting areas of child-, school-, or mental-health (Brenner et al, 2014;Raman et al, 2021;Ramelet et al, 2012;Sawin et al, 2012;Tume et al, 2015;Tume et al, 2020;Tume et al, 2014;Wilson et al, 2010).…”

Improving Outcomes for Infants After Cardiopulmonary Bypass Surgery for Congenital Heart Disease: A Commentary on Recent Randomized Controlled Trials

“…Second, given the low mortality associated with CHD in the current era, there is an unmet need to develop standardized endpoint measures for future trials. For this purpose, international consensus across multidisciplinary healthcare workers, combined with parent and patient involvement in the prioritization of topics, study design, and selection of outcomes, would greatly enhance our ability to collate results across trials for ancillary studies and meta-analyses (18). Objective measures such as duration of ventilation, duration of PICU, and hospital stay are subject to major site-to-site variation and may be impacted by other context-specific factors such as PICU staffing patterns, availability of fast-track procedures, or discharge bed block.…”

Evaluating fluid overload in critically ill children

“…In a recent survey by the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) virtually all of the 107 participating PICU clinicians considered fluid overload to be a major unmet medical health problem [5]. Recently, the Australian and New Zealand Intensive Care Society Paediatric Study Group considered studies focused on restrictive fluid therapy even a top research priority [6].…”