A5076561459- Respiratory Support and Mechanisms
- Sepsis Diagnosis and Treatment
- Neonatal Respiratory Health Research
- Hemodynamic Monitoring and Therapy
- Cardiac Arrest and Resuscitation
- Family and Patient Care in Intensive Care Units
- Renal function and acid-base balance
- Cardiac, Anesthesia and Surgical Outcomes
- Emergency and Acute Care Studies
- Thermal Regulation in Medicine
- SARS-CoV-2 and COVID-19 Research
- Trauma and Emergency Care Studies
- COVID-19 Clinical Research Studies
- Infant Development and Preterm Care
- Childhood Cancer Survivors' Quality of Life
- Pneumonia and Respiratory Infections
- interferon and immune responses
- Intensive Care Unit Cognitive Disorders
- Anesthesia and Neurotoxicity Research
- Airway Management and Intubation Techniques
- Climate Change and Health Impacts
- Heme Oxygenase-1 and Carbon Monoxide
- Neonatal Health and Biochemistry
- Respiratory viral infections research
- Machine Learning in Healthcare
Great Ormond Street Hospital for Children NHS Foundation Trust
2015-2025
University College London
2016-2025
Great Ormond Street Hospital
2016-2025
Imperial College Healthcare NHS Trust
2016-2025
Intensive Care Society
2016-2024
Foundation for Ichthyosis and Related Skin Types
2022
National Health and Medical Research Council
2021
University of Siena
2021
NIHR Great Ormond Street Hospital Biomedical Research Centre
2019
Queensland Children’s Hospital
2019
The optimal target for systemic oxygenation in critically ill children is unknown. Liberal widely practiced, but has been associated with harm paediatric patients. We aimed to evaluate whether conservative would reduce duration of organ support or incidence death compared standard care.
Objective: The Sedation and Weaning in Children (SANDWICH) trial of a sedation weaning ventilator liberation bundle had primary outcome time to successful extubation, showed significant but small difference. We explored the impact intervention on infants with bronchiolitis. Design: Post hoc subgroup analysis cluster-randomized trial, 2018 2019 (ISRCTN16998143). Patients: Surviving patients bronchiolitis under 1 year age SANDWICH ( n = 784). Interventions: Nil. Measurements Main Results: Time...
<h3>Importance</h3> The optimal first-line mode of noninvasive respiratory support following extubation critically ill children is not known. <h3>Objective</h3> To evaluate the noninferiority high-flow nasal cannula (HFNC) therapy as extubation, compared with continuous positive airway pressure (CPAP), on time to liberation from support. <h3>Design, Setting, and Participants</h3> This was a pragmatic, multicenter, randomized, trial conducted at 22 pediatric intensive care units in United...
The optimal first-line mode of noninvasive respiratory support for acutely ill children is not known.To evaluate the noninferiority high-flow nasal cannula therapy (HFNC) as acute illness, compared with continuous positive airway pressure (CPAP), time to liberation from all forms support.Pragmatic, multicenter, randomized clinical trial conducted in 24 pediatric critical care units United Kingdom among 600 aged 0 15 years who were clinically assessed require support, recruited between August...
Objectives: A conservative oxygenation strategy is recommended in adult and pediatric guidelines for the management of acute respiratory distress syndrome to reduce iatrogenic lung damage. In recently reported Oxy-PICU trial, targeting peripheral oxygen saturations (Sp o 2 ) between 88% 92% was associated with a shorter duration organ support greater survival, compared Sp than 94%, mechanically ventilated children following unplanned admission PICU. We investigated whether this benefit those...
Complex biological systems undergo sudden transitions in their state, which are often preceded by a critical slowing down of dynamics. This results longer recovery times as approach transitions, quantified an increase measures such the autocorrelation and variance. In this study, we analysed paediatric patients intensive care for whom mechanical ventilation was discontinued through removal endotracheal tube (extubation). Some failed extubation, required re-intubation within 48 hours. We...
Many mathematical models suffer from model discrepancy, posing a significant challenge to their use in clinical decision-making. In this article, we consider methods for addressing issue. the first approach, is treated as black box system, and discrepancy defined an independent additive term that accounts difference between physical phenomena representation. A Gaussian Process (GP) commonly used capture discrepancy. An alternative approach construct hybrid grey by filling incomplete parts of...
To compare the predictive performance of 18 paediatric early warning systems (PEWS) in predicting critical deterioration.Retrospective case-controlled study. PEWS values were calculated from existing clinical data, and area under receiver operator characteristic curve (AUROC) compared.UK tertiary referral children's hospital.Patients without a 'do not attempt resuscitation' order admitted between 1 January 2011 31 December 2012. All patients on wards who suffered deterioration event...
Oxygen administration is a fundamental part of pediatric critical care, with supplemental oxygen offered to nearly every acutely unwell child. However, optimal targets for systemic oxygenation are unknown. Oxy-PICU aims evaluate the clinical effectiveness and cost-effectiveness conservative peripheral saturation (Sp o2 ) target 88-92% compared liberal more than 94%.Pragmatic, open, multiple-center, parallel group randomized control trial integrated economic evaluation.Fifteen PICUs across...
OBJECTIVES: Management of hypotension is a fundamental part pediatric critical care, with cardiovascular support in the form fluids or vasoactive drugs offered to every hypotensive child. However, optimal blood pressure (BP) targets are unknown. The PRotocolised Evaluation PermiSSive BP Targets Versus Usual CaRE (PRESSURE) trial aims evaluate clinical and cost-effectiveness permissive mean arterial (MAP) target greater than fifth centile for age compared usual care. DESIGN: Pragmatic, open,...
A conservative oxygenation strategy, targeting peripheral oxygen saturations (Sp o2 ) between 88% and 92% in mechanically ventilated children PICU, was associated with a shorter duration of organ support greater survival compared Sp than 94% our recent Oxy-PICU trial. monitors may overestimate arterial saturation (Sa patients higher levels skin pigmentation those less pigmentation. We investigated if ethnicity changes distributions F io2 outcome.
Objective Early recognition and treatment of febrile children with serious infections (SI) improves prognosis, however, early detection can be difficult. We aimed to validate the predictive rule-in value National Institute for Health Clinical Excellence (NICE) most severe alarming signs or symptoms identify SI in children. Design, Setting Participants The 16 ("red") features NICE traffic light system were validated seven different primary care emergency department settings, including 6,260...
Unsupervised feature learning methods inspired by natural language processing (NLP) models are capable of constructing patient-specific features from longitudinal Electronic Health Records (EHR). We applied document embedding algorithms to real-world paediatric intensive care (PICU) EHR data extract 1853 patients' PICU journeys using 647 unique lab tests and medication events. evaluated the clinical utility patient via a K-means clustering analysis. trained model under evaluation pipeline...
Abstract Importance Determining the optimal timing for extubation in critically ill children remains challenging, with premature leading to increased morbidity and mortality, while prolonged ventilation exposes patients ventilator-associated complications. Objective To develop validate machine learning models dynamic assessment of failure risk (nowcasting) readiness (forecasting) mechanically ventilated children. Design, Setting, Participants Retrospective cohort study using electronic...
<h3>Objectives</h3> To derive and validate a clinical score to risk stratify children presenting with acute infection. <h3>Study design participants</h3> Observational cohort study of suspected infection an emergency department in England. Detailed data were collected prospectively on features, laboratory investigations outcome. Clinical predictors serious bacterial (SBI) explored multivariate logistic regression models using part the dataset, each model was then validated independent best...
OBJECTIVES: Management of mechanically ventilated patients with bronchiolitis is not standardized and duration mechanical ventilation has been shown to vary widely between centers. The aim this study was examine practice in a large number U.K. PICUs view identify if early management choices relating fluid prescription, sedative agent use, endotracheal tube (ETT) placement were associated differences invasive (IMV). DESIGN: Retrospective multicenter cohort study. Primary outcome IMV. A...
To derive a relationship between the SpO2/FIO2 ratio and PaO2/FIO2 across entire range of SpO2 values (0-100%) to evaluate whether mortality prediction using Pediatric Index Mortality-3 can be improved by use derived from SpO2/FIO2.Retrospective analysis prospectively collected data.A regional PICU transport service.Children transported PICU.None.The was first studied several mathematical models in derivation cohort (n = 1,235) then validated separate 306). The best SpO2/FIO2-PaO2/FIO2...
The Paediatric Intensive Care Society Study Group conducted a research prioritization exercise with the aim to identify and agree priorities in Pediatric Critical United Kingdom both from healthcare professional parent/caregiver perspective.A modified three-round e-Delphi survey, followed by survey of parents top 20 priorities.U.K. PICUs.U.K. PICU professionals who are members society family children, experience U.K. admission.None.Forty-nine submitted topics round 1, 98 participated 2, 102...