PROSpect: Prone and Oscillation Pediatric Clinical Trial
Acute Respiratory Distress Syndrome in Children
About this trial
This is an interventional treatment trial for Acute Respiratory Distress Syndrome in Children focused on measuring Pediatric Acute Respiratory Distress Syndrome (PARDS), Acute Respiratory Distress Syndrome (ARDS), acute respiratory failure, child, pediatric intensive care unit
Eligibility Criteria
Inclusion criteria:
Intubated and mechanically ventilated with high moderate-severe PARDS for <48 hours per PALICC guidelines (chest imaging consistent with acute pulmonary parenchymal disease and OI ≥12 or OSI ≥10). We require two blood gases meeting moderate-severe PARDS criteria (separated by at least 4 ± 2 hours during which time the clinical team is actively working to recruit lung volume and optimize the patient's hemodynamic status per PALICC guidelines; specifically, incremental and decremental PEEP changes to optimize lung volume). A second blood gas is not required for OI ≥16.
Exclusion criteria:
- Perinatal related lung disease
- Congenital diaphragmatic hernia or congenital/acquired diaphragm paralysis
- Respiratory failure explained by cardiac failure or fluid overload
- Cyanotic heart disease
- Cardiomyopathy
- Unilateral lung disease
- Primary pulmonary hypertension
- Intubated for status asthmaticus
- Obstructive airway disease (e.g., Severe airways disease without parenchymal involvement or disease characterized by hypercapnia with FiO2 <0.30 and/or evidence of increased resistance visible on the flow - time scalar and/or presence of intrinsic PEEP)
- Active air leak
- Bronchiolitis obliterans
- Post hematopoietic stem cell transplant; specifically, patients receiving continuous supplemental oxygen for three or more days prior to intubation; receiving noninvasive ventilation for more than 24 hours prior to intubation; receiving more than one vasoactive medication at time of meeting inclusion criteria; spending more than four days in the PICU prior to intubation; supported on or with immediate plans for renal replacement therapies; with two or more allogeneic transplants; who relapsed after the transplant; or with diffuse alveolar hemorrhage
- Post lung transplant
- Home ventilator dependent with baseline Oxygen Saturation Index (OSI) >6
- Neuromuscular respiratory failure
- Critical airway (e.g., post laryngotracheal surgery or new tracheostomy) or anatomical obstruction of the lower airway (e.g., mediastinal mass)
- Facial surgery or trauma in previous 2 weeks
- Head trauma (managed with hyperventilation)
- Intracranial bleeding
- Unstable spine, femur or pelvic fractures
- Open abdomen
- Currently receiving either prone positioning or any high-frequency mode of MV with current illness (Up to 4 hours of prone positioning and/or any mode of high-frequency mode of MV is allowed as long as the therapies are off for least 4 hours prior to the subject meeting oxygenation criteria.)
- Supported on ECMO during the current admission
- Family/medical team not providing full support (patient treatment considered futile)
- Previously enrolled in current study
- Enrolled in any other interventional clinical trial not approved for co-enrollment
- Known pregnancy
Sites / Locations
- Children's of Alabama
- Arkansas Children's Hospital
- Children's Hospital Orange County
- Stanford Children's Health
- UCSF Benioff Children's
- Connecticut Children's Medical Center
- Yale University
- Kapiolani Medical Center for Women and Children
- Ann & Robert Lurie Children's Hospital of Chicago
- Riley Hospital for Children at IU Health
- University of Iowa Stead Family Chlldren's Hospital
- Norton Children's Hospital
- Bloomberg Children's Center, Johns Hopkins University
- CS Mott Children's Hospital
- Children's Hospital and Medical Center
- University of New Mexico Children's Hospital
- The Children's Hospital of Montefiore
- Cohen Children's Medical Center
- Duke Children's Hospital
- Children's Hospital at Oklahoma University Medical Center
- Penn State Children's Hospital
- Children's Hospital of Philadelphia
- Medical University of South Carolina
- LeBonheur Children's Hospital
- Medical City Dallas
- Children's Health Dallas
- Children's Hospital of San Antonio
- Seattle Children's Hospital
- Children's Hospital of Wisconsin
- Queensland Children's Hospital
- Perth Children's Hospital
- Children's Hospital at Westmead
- Sabara Hospital Infantil
- Centre Hospitalier Universitaire Sainte Justine
- Guangzhou Women & Children's Hospital (Newtown)
- Guangzhou Women & Children's Hospital (Yuexiu)
- Rainbow Children's Hospital
- Hadassah Medical Center
- Policlinico S. Orsola-Malpighi University Hospital
- Meyer Children's Hospital
- Instituto Giannina Gasilini
- Bambino Gesu Children's Hospital (Area Rossa Unit)
- Bambino Gesu Children's Hospital
- University of Malaysia Medical Center
- University Medical Center Groningen
- Starship Children's Hospital
- Cruces University Hospital
- King Chulalongkorn Memorial Hospital
- Faculty of Medicine Siriraj Hospital, Mahidol University
- Faculty of Medicine Ramathibodi Hospital
- Shaikh Khalifa Medical City
- Birmingham Children's Hospital
- University Hospital Leicester NHS Trust
- University Hospital Southampton NHS Foundation Trust
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Experimental
Experimental
Experimental
Supine / CMV
Prone / CMV
Supine / HVOF
Prone / HFOV
Supine positioning and conventional mechanical ventilation
Prone positioning and conventional mechanical ventilation
Supine positioning and high-frequency oscillatory ventilation
Prone positioning and high-frequency oscillatory ventilation