Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland, 4101, Australia.
Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia.
BMC Pediatr. 2022 May 13;22(1):279. doi: 10.1186/s12887-022-03232-2.
As admissions to paediatric intensive care units (PICU) rise and mortality rates decline, the focus is shifting from survival to quality of survivorship. There is paucity of internationally accepted guidelines to manage complications like over-sedation, delirium, and immobility in the paediatric setting. These have a strong adverse impact on PICU recovery including healthcare costs and long-term functional disability. The A2F bundle (ABCDEF), or ICU Liberation, was developed to operationalise the multiple evidence-based guidelines addressing ICU-related complications and has been shown to improve clinical outcomes and health-care related costs in adult studies. However, there is little data on the effect of ICU Liberation bundle implementation in PICU.
PICU-STARS will be a single centre before-and-after after trial and implementation study. It is designed to evaluate if the multidimensional, nurse-led ICU Liberation model of care can be applied to the PICU and if it is successful in minimising PICU-related problems in a mixed quaternary PICU. In a prospective baseline measurement, the present practises of care in the PICU will be assessed in order to inform the adaptation and implementation of the PICU Liberation bundle. To assess feasibility, implementation outcomes, and intervention effectiveness, the implementation team will use the Consolidated Framework for Implementation Research (CIFR) and process assessment (mixed methods). The implementation process will be evaluated over time, with focus groups, interviews, questionnaires, and observations used to provide formative feedback. Over time, the barriers and enablers for successful implementation will be analysed, with recommendations based on "lessons learned." All outcomes will be reported using standard descriptive statistics and analytical techniques, with appropriate allowance for patient differentials in severity and relevant characteristics.
The results will inform the fine-tune of the Liberation bundle adaptation and implementation process. The expected primary output is a detailed adaptation and implementation guideline, including clinical resources (and investment) required, to adopt PICU-STARS in other children's hospitals.
The authors thank the PICU education and Liberation Implementation team, and our patients and families for their inspiration and valuable comments on protocol drafts. Results will be made available to critical care survivors, their caregivers, relevant societies, and other researchers.
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随着儿科重症监护病房（PICU）入院人数的增加和死亡率的下降，关注点已从生存转移到生存质量。目前，国际上缺乏管理儿科镇静过度、谵妄和活动受限等并发症的指南。这些并发症对 PICU 康复有严重的负面影响，包括医疗费用和长期功能障碍。A2F 捆绑包（ABCDEF）或 ICU 解放，旨在实施针对 ICU 相关并发症的多项循证指南，并已被证明可改善成人研究中的临床结果和医疗保健相关成本。然而，关于 PICU 中 ICU 解放捆绑包实施效果的数据很少。
PICU-STARS 将是一项单中心前后对照试验和实施研究。其目的是评估多维、以护士为主导的 ICU 解放护理模式是否可应用于 PICU，以及它是否能成功减少混合四级 PICU 中的 PICU 相关问题。在前瞻性基线测量中，将评估 PICU 中的现行护理实践，以便为 PICU 解放捆绑包的适应和实施提供信息。为了评估可行性、实施结果和干预效果，实施团队将使用整合实施研究框架（CIFR）和过程评估（混合方法）。将随着时间的推移评估实施过程，使用焦点小组、访谈、问卷和观察提供形成性反馈。随着时间的推移，将分析成功实施的障碍和促进因素，并根据“经验教训”提出建议。所有结果将使用标准描述性统计和分析技术报告，并根据患者严重程度和相关特征的差异进行适当调整。
结果将为解放捆绑包的适应和实施过程提供微调信息。预期的主要产出是详细的适应和实施指南，包括采用 PICU-STARS 所需的临床资源（和投资），以便在其他儿童医院采用。
作者感谢 PICU 教育和解放实施团队，以及我们的患者和家属为协议草案提供的灵感和宝贵意见。结果将提供给重症监护幸存者、他们的照顾者、相关学会和其他研究人员。
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