Research

 

Faculty in the Division of Pediatric Critical Care are actively involved in a wide variety of research across multiple disciplines, including:

 

Basic Science, Translational, and Clinical Research

Several faculty members maintain active research laboratories. 

  • Thomas Arnold Lab 
  • Matthew Zinter Lab 
  • Pulmonary Vascular Biology Research Group (Jason Boehme/Sanjeev Datar/Jeffrey Fineman Lab) (link to be provided)

Collaborative Pediatric Critical Care Research Network (CPCCRN)

UCSF is one of seven clinical centers participating in collaborative clinical trials in pediatric critical care medicine through the CPCCRN network. CPCCRN sponsored studies in which UCSF participates include:

CPCCRN Core Data Project (CCDP) – a project to develop an automated electronic database to be used for hypothesis generation, study design and preliminary power analyses. The study gathers information on all PICU discharges from the network clinical centers.

ICU Resus – a randomized clinical trial to investigate the impact of an ICU bundle focusing on CPR education and CPR quality on resuscitation and outcome of in-hospital cardiac arrests.

Life after Pediatric Sepsis (LAPSE) – a prospective observational study to describe short and long term outcomes among a modern cohort of children surviving septic shock. 

Inhaled Nitric Oxide Use in PICU (iNO) – a prospective observational study of contemporary use of iNO in the PICU.

Microbiome, Virome, and Host Responses Preceding Ventilator-Associated Pneumonia (VAP) – a prospective longitudinal study of mechanically ventilated children studying whether changes in the microbiome, virome, and proteome predict ventilator-associated pneumonia.

Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

PALISI is a network with representation from over 70 PICUs in North America and Europe with the goal of collaborating to identify preventive and therapeutic strategies for acute lung injury, sepsis, multi-organ failure, and other life-threatening syndromes that affect children. UCSF has been a key member since 2004 and actively participates at the primary conferences and within several sub-committees, including BloodNet, Pedal (focusing on use of large database resources), and HSCT (bone marrow transplant focused research). PALISI supported studies in which UCSF participates include:

Age of Blood in Children (ABC PICU)  a multicenter double blinded randomized clinical trial comparing the risk of multi-organ dysfunction syndrome between critically ill children transfused with red blood cells of decreased storage age versus those transfused standard issue RBCs.

Pediatric Heart and Brain Research Program

UCSF has created a multi-specialty research program to understand brain development, risk factors for brain injury, and targets for intervention to optimize outcomes in children with congenital heart disease: https://pedheartbrain.ucsf.edu

Cardiac MRI Study – a two-center observational study is using advanced magnetic resonance imaging (MRI) to understand how brain development is affected by congenital heart disease (CHD). This study has enrolled more than 100 newborns since 2002, with findings reported in over 12 publications. http://www.radiology.ucsf.edu/research/labs/baby-brain

Pediatric Cardiac Critical Care Consortium (PC4)

UCSF is a participating center in PC4, clinical registry that collects data on patients with primary cardiac disease admitted to the cardiac ICU of participating hospitals to support research and quality improvement initiatives.

Pediatric Pulmonary Hypertension Clinical Research

The Pediatric Pulmonary Hypertension group at UCSF contributes data to both the Pediatric Pulmonary Hypertension Network Registry and the Pulmonary Hypertension Association Registry and has an active research program:

Obesity in Fontan patients – an observational study looking at the interaction between obesity and endovascular function in patients with Fontan physiology

MicroRNA in pulmonary hypertension – a study to determine if specific MicroRNA patterns correlate with the severity of pulmonary hypertension and its reactivity to acute vasodilator testing

Cardiac catheterization versus echocardiogram in pulmonary hypertension – a study comparing echocardiographic parameters of pulmonary hypertension with cardiac catheterization data in different underlying disease processes

Subcutaneous Remodulin for pediatric pulmonary hypertension – a descriptive, multi-center study of the use of subcutaneous remodulin for the treatment of pediatric pulmonary hypertension

BNP as predictor of response to iNO – a study to correlate BNP levels before and after initiation of iNO with response, using a variety of clinical outcome measures

Metabolic markers in infants with persistent pulmonary hypertension of the newborn – an exploratory study using newborn screening data of term and near-term infants to identify differences in metabolomic patterns in infants who suffer from PPHN compared to controls.

VPS database study - an observational study of hospital course and outcomes of children with primary and secondary pulmonary hypertension admitted to the ICU using the VPS database. As a secondary aim, this study uses the VPS database to develop a predictive score for patients with pulmonary hypertension admitted to the ICU

Other Ongoing Clinical Studies

Pathogen Identification in Pediatric Hematopoietic Stem Cell Transplant Patients with Suspected Lower Respiratory Tract Infection

This is a UCSF-initiated, multicenter study of children who have undergone stem cell transplantation and have developed respiratory dysfunction. This study seeks to improve diagnosis of infectious and alloreactive lung injury by performing metagenomic next generation sequencing on bronchoalveolar lavage fluid. This study is funded by the Pediatric Blood and Marrow Transplant Foundation and the NIH Eunice Kennedy Shriver National Institute of Child Health and Development.

PROSpect Study – an international clinical research study funded by the National Institutes of Health (NIH) Heart, Lung and Blood Division (NHLBI) to study the effects of high-frequency oscillatory ventilation and prone positioning for pediatric ARDS https://prospect-network.org

Stress Hydrocortisone In Pediatric Septic Shock (SHIPSS) – a multi-institutional, controlled, randomized, double-blinded interventional trial to examine the benefits and risks of adjunctive hydrocortisone for children with fluid and vasoactive-inotropic refractory septic shock https://clinicaltrials.gov/ct2/show/NCT03401398

 

 

 

Selected Published Multicenter Trials

Heart and Lung Failure Insulin Titration Trial (HALF-PINT) – UCSF was one of 35 centers participating a randomized controlled trial to determine if tight glucose control would improve outcomes in critical ill children requiring mechanical ventilation or vasoactive support. This trial was stopped early owing to a low likelihood of benefit and evidence of the possibility of harm.

Therapeutic Hypothermia to Improve Survival After Cardiac Arrest in Pediatric Patients (THAPCA) Trial

UCSF was one of 37 centers participating in this multicenter randomized trial of hypothermia after cardiac arrest. This study tested the effect of therapeutic hypothermia compared with normothermia on survival rates and risk of brain injury in infants and children who experience a cardiac arrest both in and out of the hospital. For more information about this study see: http://www.thapca.org/index.html or view results from the out of hospital trial.

Protocolized Sedation vs. Usual Care in Pediatric Respiratory Failure (RESTORE) – UCSF was one of 17 sites in this cluster randomized trial testing the effects of a protocol that included targeted sedation, arousal assessments, extubation readiness testing and sedation management versus usual care on duration of mechanical ventilation. Read the results from this study.

Effect of Prone Positioning on Outcomes in Children with Acute Lung Injury (PRONE) –UCSF was the leading enrolling site out of seven PICUs in this randomized, prospective trial of prone positioning during pediatric ARDS. View results from this study.

 

Medical Education

Several members in the division engage in educational scholarship, spanning a broad spectrum of activities including educational research, curriculum development, promoting learner well-being, and developing assessment programs. Using both quantitative and qualitative research methods, recent studies have focused on interprofessional simulation-based team training, gender bias in medical education, impact of using the entrustable professional activity framework in assessment, amongst others. Several faculty in our division have educational leadership roles in the residency program, in UCSF’s Kanbar Center for Simulation and the Center for Faculty Educators.

Quality Improvement Research

The division is a hub for a variety of collaborative quality improvement endeavors that leverage its participation in PC4, VPS, CPCCRN, Solutions for Patient Safety, SCCM, and more.    Focuses of quality improvement research have included resuscitation training and debriefs to improve code performance and outcomes,  engaging families in quality and safety through novel mobile tools, delirium reduction, safe and early extubation, and reducing cardiac arrest in the CICU. Quality improvement research and collaborations funding sources include institutional awards, NIH, and AHRQ.

Selected Publications:

The ICU-RESUS and Eunice Kennedy Shriver National Institute of Child Health, and Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups. Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUsA Randomized Clinical TrialJAMA. 2022;327(10):934–945. doi:10.1001/jama.2022.1738

Alten J, Cooper DS, Klugman D, et al. Preventing Cardiac Arrest in the Pediatric Cardiac Intensive Care Unit Through Multicenter Collaboration [published online ahead of print, 2022 Jul 5]. JAMA Pediatr. 2022;10.1001/jamapediatrics.2022.2238. doi:10.1001/jamapediatrics.2022.2238

Funded Projects in progress:

UCSF Caring Wisely

Rehabilitation in the PICU: Implementing an Interdisciplinary Team Based Early Mobilization Program in PICU at UCSF BCH-SF                           

7/1/2022- 6/30/2023

This interdisciplinary QI project, aims to implement and early mobilization program in the PICU to improve outcomes, help reduce delirium, and shorten ICU length of stay.

NIH/NHlBI 

6/9/2022-6/8/2024

Predicting earliest safe extubation time in pediatric patients 

In the pediatric intensive care unit, deciding when critically ill children are well enough to be taken off of ventilators and have their breathing tubes removed (extubation) is a challenge clinicians face each day.  This study aims to apply artificial intelligence to create a tool that predicts the earliest safe extubation time for children which clinicians can use to help them make decisions that improve quality, safety, and value of care.

NIH

4/1/2021-3/31/2026

FIQS: Family Input in Quality and Safety 

In this proposal, we use an untapped source of safety event reporting—patients and family members of hospitalized pediatric patients—to address knowledge gaps identified by the NICHD: This innovative proposal will analyze real-time data on patient safety event. Our mobile phone-based approach, the Family Input for Quality and Safety (FIQS), was developed in partnership with families and clinicians, and was pilot-tested (PI Bardach) on an academic pediatric medical-surgical unit, with enthusiastic engagement from family members, patients & staff.