In this study, the clinician-researchers are exploring whether nasal high flow (NHF) therapy can be safely and effectively used to improve health outcomes for infants with bronchiolitis in isolated remote communities, in particular for remote Indigenous Australians who have a higher incidence rate of bronchiolitis than non-Indigenous Australians. There is a desire by clinicians to implement NHF in remote areas, but this should undergo similar scientific scrutiny as previous published data.
NHF is a respiratory support system that provides support for people with respiratory conditions and is applied by high flow oxygen through nasal prongs. The therapy can avoid an escalation of care during hospitalisation. The safety of NHF has been widely studied in tertiary areas and regional hospitals, however, there is a lack of evidence to support safe use in remote settings.
In this study, the researchers are employing a two-phased approach: Firstly, an expert working party establishing agreed safe clinical boundaries for the NHF implementation and utilising expert viewpoints for implementation when managing infants with bronchiolitis. Secondly, a comparison of the outcomes before and after implementation to observe a reduction in escalation of care leading to reduced transfers. A community engagement process, with the focus to keep community members in their country/home environment, will be established to measure psychological, social-emotional and economic benefits of NHF.READ MORE
The aim of this study is to evaluate securement devices for peripheral intravenous catheters (PIVC) in the paediatric ED to determine which method is most effective for reducing PIVC failure, associated costs, acceptability and patient distress.
Infants and children depend on PIVCs for the provision of medical therapy within the emergency department and during hospitalisation. However, PIVC insertion and management is challenging and more than 25% of devices fail. PIVC failure is costly for both the patient and healthcare organisation. Failure may require the child to undergo traumatic reinsertion procedures, delay important medical treatment and prolong length of hospital stay. One way to reduce PIVC failure is with effective PIVC dressing and securement, by ensuring correct catheter position in the vein.
Our trial aims to test if new advances in catheter securement, medical grade superglue (Histoacryl) and an integrated dressing securement product (SorbaView SHIELD), are effective at preventing cannula failure and complications in paediatric patients. Using a three arm, randomised controlled trial, this study will recruit 460 paediatric patients at two regional emergency departments (Logan Hospital, Ipswich Hospital). Children will be randomised to receive PIVC securement by i) standard care, ii) advanced dressing or iii) medical grade superglue and advanced dressing. The main outcome of this trial is PIVC failure, with other important questions surrounding cost effectiveness and patient comfort also to be explored.
It is important for effective, improved cannula security to be explored as this is frequently a first line device choice for treatment, being highly effective in rapid treatment situations. A result in improved treatment delivery will benefit with cost savings in not only product but clinician time spent re-inserting, and a reduction in unnecessary, painful procedures for children.READ MORE
Sepsis is a leading cause of death and disability in children, globally accounting for more than one million childhood deaths per year. Recommended sepsis treatment currently consists of intravenous antibiotics and aggressive fluid boluses followed by inotropes and consideration for intravenous steroids. However, the evidence for interventions other than antibiotics is limited and aggressive fluid administration may be associated with harm. Therefore, fluid-sparing algorithms using early inotropes to treat shock have been proposed. Another strategy to hasten shock resolution consists in intravenous steroids, alone or in combination with thiamine and vitamin C, postulated to support metabolic dysfunction in recent studies.
In this project, the research team is conducting a randomised controlled pilot trial in children presenting with septic shock. They are assessing the feasibility of a fluid-sparing algorithm using early inotropes and early intravenous administration of Vitamin C, Thiamine and Hydrocortisone and the impact on survival free of organ dysfunction.READ MORE
Traumatic injuries in children are a leading cause of death and disability in Australia. In high income countries, 40% of child deaths are because of traumatic injuries. Fibrinogen is one of the key clotting factors that need to be replaced in severe traumatic bleeding.
Currently, fibrinogen is replaced using cryoprecipitate; a blood product obtained from healthy volunteer donors. This is a precious resource that is stored frozen in the blood bank; it can take a long time to administer and place significant strain on blood banks. Fibrinogen concentrate (FC) is an alternative product used to assist in blood clotting. It is a product that is derived from blood plasma but stored in powder form and can be reconstituted at the bedside and given quickly. The study will investigate whether it is quicker to administer FC than cryoprecipitate, which may reduce haemorrhage and improve outcomes.
This study will enrol 30 children from three major paediatric trauma centres in Queensland admitted with severe traumatic bleeding. Time to administration of fibrinogen replacement and the effect of fibrinogen levels will be measured.READ MORE
When a child presents to an emergency department, or is admitted to the intensive care unit because of a life-threatening condition, they may need immediate treatment to support their breathing. In these circumstances a child is given medication to put them to sleep and the airway is secured with the insertion of a tube into the windpipe. This transition from spontaneous breathing when a child is awake to controlled respiration under anaesthetic via a breathing tube is called intubation. This procedure is technically challenging and is often associated with low oxygen levels in children.
New methods of intubation which reduce the risk of oxygen levels becoming low are continually developed and safely tested through clinical trials. The Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergency intubation (Kids THRIVE) is one of these clinical trials. In this study, we investigated a new approach to prevent a drop in oxygen levels during intubation using high flow oxygen delivery. We tested this method in children with healthy lungs undergoing anaesthesia for elective surgery and we found that we can maintain oxygen levels more than twice as long as using standard intubation methods. These findings would allow the operator in emergency settings more time and a safer condition to secure the airway in a sick child.
By comparing the current standard practice for intubating a child in an emergency situation, we aim to demonstrate that the THRIVE method will reduce the risk for low oxygen levels in the blood and increase the likelihood that the treating doctor is able to insert the breathing tube on the first attempt.READ MORE
The Townsville Hospital Emergency Department (ED) aimed to increase research capacity in the ED . The vision was to create a sustainable research culture within the ED, with a positive research profile and a clear point of contact making Townsville attractive for collaborative research and to establish a track record of research success and outputs ensuring the long-term future of ED research.READ MORE
Shortness of breath is one of the most common reasons for presentation to Australian Emergency Departments, with millions of presentations each year.
A new patient, unable to speak properly because they cannot breathe present difficulties in immediate diagnosis and therefore treatment, to emergency doctors and nurses. Immediate management involves the application of oxygen via a face-mask in addition to drug therapy and investigations including x-rays and blood tests. If breathlessness gets worse, the patient may need invasive support for breathing; a process that involves more staff, expensive machines, and resultant considerable cost to the health care system.
A simpler support device that provides non-invasive humidified high flow nasal cannula is one alternative to the provision of oxygen and is currently utilised safely in adult and paediatric patients. The “high flow” delivery of humidified oxygen and air provides moderate support, which reduces the work that the exhausted patient does while breathing in and to help splint the airways open. This support is a driving pressure, which is not present during simple mask oxygen therapy. If we treat patients early with high flow therapy rather than standard facemask, we may be able to relieve symptoms of breathlessness sooner and avoid worsening of breathing difficulties.READ MORE
In this study, clinicians looked at all children presenting to the ED over a 12 month period for the assessment of possible cervical spine injury to better understand how children are treated in hospital and how further investigation into the use of these rules can be undertaken.
Children rarely break their necks but if they do, they can risk spinal injury or death. Many more children present for assessment of possible cervical spine (neck) injuries than are subsequently diagnosed with cervical spine injury. The challenge for the emergency doctor is to identify the rare cases without subjecting too many children to unnecessary tests.
These tests, x-rays and scans, have risks including exposure to radiation and associated danger of long term cancer development, as well as the possible need for sedation to perform the scan in young children. Awaiting these tests is often a time of prolonged distress for the patient and family as the child needs to be kept lying flat and still without moving their neck. Considerable staff time and Emergency Department costs are associated with these tests. Rules have been proposed to assist doctors in deciding whether tests are needed.
Bronchiolitis in infants is the leading cause of paediatric hospitalisation in Australia accounting for approximately 8000 admissions annually, of which approximately 500-600 are admitted to a paediatric intensive care unit (PICU) requiring respiratory support. None of the current treatments have successfully changed the outcome of the disease or the burden on health care systems. High flow nasal cannula (HFNC) therapy has been used over the last few years in paediatrics with reports showing a reduction in the need for non-invasive and invasive respiratory support.
HFNC reduces the work of breathing, improves the gas exchange and can be applied very early in the disease process as there is little inference with the patients comfort. There has been no “best practice” and many centres do not use the HFNC for bronchiolitis as there are opposing reports about its benefit and a lack of consensus on how to use it. This study aims to develop a multi-centre trial and to assess which patients with bronchiolitis benefit using HFNC.
In an earlier pilot study, the team found the use of HFNC therapy in PICUs significantly reduced the need for invasive ventilation and intubation, with a 40% reduced PICU admission rate, a 2.5 times reduction in intubation. They also showed the use of HFNC therapy in a paediatric ward was safe and delivered high quality care for infants with bronchiolitis. They also showed that infants <2 years of age could be safely transported on HFNC to tertiary facilities.READ MORE