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Goal-Directed Resuscitative Interventions During Pediatric Interfacility Transport

Stroud, Michael H. MD1; Sanders, Ronald C. Jr MD1; Moss, M. Michele MD1; Sullivan, Janice E. MD2; Prodhan, Parthak MBBS1; Melguizo-Castro, Maria MS3; Nick, Todd PhD3

doi: 10.1097/CCM.0000000000001021
Pediatric Critical Care
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Objectives: This article reports results of the first National Institutes of Health-funded prospective interfacility transport study to determine the effect of goal-directed therapy administered by a specialized pediatric team to critically ill children with the systemic inflammatory response syndrome. We hypothesized that goal-directed therapy during interfacility transport would decrease hospital length of stay, prevent multiple organ dysfunction, and reduce subsequent ICU interventions.

Design: Before-and-after intervention trial.

Setting: During interfacility transport of critically ill patients by a specialized pediatric transport team, back to a tertiary care children’s hospital.

Patients: Before-and-after intervention trial.

Design: Interfacility pediatric transport patients, age 1 month to 17 years, with systemic inflammatory response syndrome.

Interventions: Prospective data were collected on all pediatric interfacility transport patients with systemic inflammatory response syndrome transported by the Angel One Transport team at Arkansas Children’s Hospital. A 10-month data collection period was followed by institution of a goal-directed resuscitation protocol. Data were subsequently collected for 10 additional months followed by comparison of pre- and postintervention groups. All transport personnel underwent training with didactics and high-fidelity simulation until mastery with goal-directed resuscitation was achieved.

Measurements and Main Results: All transport patients were screened for systemic inflammatory response syndrome using established variables and 235 (123 preintervention and 112 postintervention) were enrolled. Univariate analysis revealed shorter hospital stay (11 ± 15 d vs 7 ± 10 d; p = 0.02) and fewer required therapeutic ICU interventions in the postintervention group (Therapeutic Intervention Scoring System-28 Scores, 19.4 ± 6.8 vs 17.3 ± 6.6; p = 0.04). ICU stay and prevalence of organ dysfunction were not statistically different. Multivariable analysis showed a 1.6-day (95% CI, 1.3–2.03; p = 0.02) decrease in hospital stay in the postintervention group.

Conclusions: This study suggests that goal-directed therapy administered by a specialized pediatric transport team has the potential to impact the outcomes of critically ill children. Findings from this study should be confirmed across multiple institutions, but have the potential to impact the clinical outcomes of critically ill children with systemic inflammatory response syndrome.

1Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.

2Section of Critical Care Medicine, Department of Pediatrics, University of Louisville, Louisville, KY.

3Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.

Clinical Trial Registry: ClinicalTrials.gov (NCT01293500; http://clinicaltrials.gov/ct2/show/NCT01293500?term=01293500&rank=1).

Dr. Stroud conceptually designed this study, secured funding, and was responsible for the day-to-day progress of the study. He drafted the initial article and approved the final article as submitted. Dr. Sanders helped with drafting the article, contributed to all editing, and approved the final article as submitted. Dr. Moss helped with drafting the article, contributed to all editing, and approved the final article as submitted. Dr. Sullivan helped with study design and contributed to drafting and editing of the article. She approved the final article as submitted. Mr. Prodhan helped with study design and contributed to drafting and editing of the article. He approved the final article as submitted. Dr. Melguizo-Castro designed the data collection instruments, oversaw data collection, conducted statistical analyses, critically reviewed the article, and approved the final article as submitted. Dr. Nick oversaw all aspects of study design and statistical analyses, critically reviewed the article, and approved the final article as submitted.

Supported, in part, by Eunice Kennedy Shriver National Institute of Child Health and Human Development (1R21HD060171-02A).

Dr. Stroud received salary support from the National Institutes of Health (NIH)/National Institute of Child Health and Human Development (NICHD) for this project. Dr. Stroud received support for article research from the NIH. His institution received grant support from the NIH/NICHD. Dr. Moss served as a board member for the Society of Critical Care Medicine Council (compensation for travel, hotel, and meals related to Council meetings). Dr. Sullivan consulted for Gruenthal and received support for article research from the NIH. Her institution received grant support from University of Arkansas for Medical Sciences (NIH) and Multiple Industry Sponsored Studies (Dr. Sullivan is the Medical Director of the Pediatric Clinical Research Unit so interact with industry on a regular basis). Dr. Melguizo-Castro received support for article research from the NIH. Her institution received grant support from the NIH. Dr. Nick received support for article research from the NIH. His institution received grant support from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: stroudmichaelh@uams.edu

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