Patient ventilator asynchrony in critically ILL children

Active Project Grant Awarded Last action

Award ID
R01HL164397
Recipient
Awarding agency
Obligated
$7,490,356

Award facts

Assistance listing
93.837 Cardiovascular Diseases Research
Completion date 69% complete
Place of performance
Los Angeles, CA 90027, USA

Award details come from USAspending.gov.

Description

As the agency reported it.

Abstract
Mechanically ventilated children often have patient-ventilator asynchrony (PVA) although this is incompletely characterized in the literature and infrequently recognized at the bedside. When a ventilated patient has spontaneous effort, the ventilator attempts to synchronize with the patient, but PVA represents a mismatch between what the patient wants and what the ventilator delivers. PVA is common in ventilated adults and is associated with longer duration of ventilation, increased risk of infection, lung injury, diaphragm dysfunction, and adverse neurocognitive effects. While there are many types of PVA, they are not equally harmful or prevalent. Therapeutic strategies should focus on the most harmful forms of PVA. Although we still DON't know which PVA subtypes are truly most harmful, double cycled (DC) breaths (where a second breath is delivered before the first breath is complete) have the strongest biological plausibility for harm, because DC induces lung stress, strain, ventilator induced lung injury and eccentric contraction of the diaphragm. PVA is understudied in children, even though IT may be more common and goes largely unrecognized even by highly trained clinicians. Moreover, existing pediatric studies have failed to identify a clear relationship between PVA and worse clinical outcomes, although these studies have not focused on the highest risk patients (such as those with acute respiratory distress syndrome (ARDS)), have used different definitions for PVA and its subtypes, and have been inadequately powered to evaluate the relationship between PVA subtypes and outcome. This proposal will set the stage for therapeutic strategies to manage PVA in children and will fill crucial knowledge and implementation gaps including: (1) harmonizing how PVA is measured and defined, (2) identifying the most harmful PVA subtypes and the patients at risk, and (3) using innovative and accurate bedside tools to improve the recognition of PVA. We will leverage the expertise and preliminary data from three premier pediatric research groups who have the expertise to use precise methods to capture the patient's neural respiratory effort, which is crucial to correctly identify PVA subtypes. This proposal will include prospective, multi-center collection of ventilator waveforms from 200 ventilated children using precise techniques to capture neural respiratory effort, in addition to detailed secondary analysis of existing waveforms and clinical data from over 350 children. We will use causal inference and mediation approaches to evaluate the relationship between PVA subtypes and clinical and mechanistic outcomes by leveraging data from a randomized controlled trial (redvent, R01HL124666) where PVA rates and subtypes likely differ between intervention and control groups. This trial is prescribing a mechanical ventilation strategy promoting more spontaneous breathing to achieve lung and diaphragm protective ventilation, compared to usual care.

Transactions

Action Obligated Date
Amendment $0
Amendment $0
Amendment $28,792
Amendment $28,792
Amendment $28,792
Amendment $652,815
Amendment $652,815
Amendment $652,815
Amendment $68,107
Amendment $612,963
Amendment $612,963
Amendment $54,486
Amendment $54,486
Amendment $612,963
Amendment $612,963
Amendment $612,963
Amendment $734,547
Amendment $734,547
Original award $734,547
Show all 19

Subawards

Subrecipient Amount Awarded
The Regents Of The University Of Colorado Patient Ventilator Asynchrony in Critically Ill Children $63,000
Centre Hospitalier Universitaire Sainte-Justine $21,594
Centre Hospitalier Universitaire Sainte-Justine $118,400
The Regents Of The University Of Colorado $104,433
Universitair Medisch Centrum Groningen $118,800
Centre Hospitalier Universitaire Sainte-Justine $79,177
Universitair Medisch Centrum Groningen $107,968

Quick answers

Who received award R01HL164397?

R01HL164397 was awarded to Children's Hospital LOS Angeles by National Heart Lung and Blood Institute (National Institutes of Health) on June 15, 2023.

How much is award R01HL164397 worth?

$7,490,356 has been obligated on R01HL164397.

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