Pediatric critical care, or the effective and efficient care of children with critical or unstable conditions, is an important and growing subspecialty in pediatrics. The number of pediatric intensivists, pediatric intensive care units (PICUs), and pediatric intensive care beds in the United States has increased dramatically in recent years. Mortality in U.S. PICUs has fallen precipitously, yet survivors of childhood critical illness and injury remain at risk for morbidity and disability.
Much of the technology and many therapies in pediatric critical care have evolved without adequate study or have been adopted uncritically from adult, neonatal, or anesthetic practice. Because of this, the risks and benefits of much of intensive care practice remain largely unknown. Research is needed in order to make optimal decisions regarding effective critical care practices. Rigorous use of appropriate scientific methodology, deployed across a network structure, achieves the numbers of patients required to provide answers more rapidly than individual sites acting alone.
To meet this challenge, in April 2004 the NICHD put forth a request for applications (RFAs) to establish the Collaborative Pediatric Critical Care Research Network (CPCCRN). Clinical Sites and a Data Coordinating Center (DCC) were identified through a competitive application process. The Network was renewed by the same process in 2009 and 2014.
The Network is a major priority of the NICHD Pediatric Trauma and Critical Illness Branch (PTCIB) and is supported through the Cooperative Agreement mechanism (UG1 for clinical sites, and U01 for the DCC) in 5-year competitive cycles. For the 2014-2019 cycle, the CPCCRN includes seven clinical sites with large PICUs and a DCC.
The goal of the Network is to develop an infrastructure to pursue well-designed collaborative clinical trials and meaningful descriptive studies in pediatric critical care medicine. The Network seeks to reduce morbidity and mortality in pediatric critical illness and injury, and to provide a framework for the development of the scientific basis of pediatric critical care practice.
Data from CPCCRN studies constitute an important scientific resource, and public use datasets are available to qualified researchers. These data sets are administered by the Data Coordinating Center on behalf of the CPCCRN. Learn more about the CPCCRN Public Use Datasets .
The CPCCRN conducts controlled observations and objective evaluations of pediatric critical care practices, including new management and technology methodologies, in children with complex critical illnesses and injuries. The resulting data will help to balance prompt implementation of new technologies and treatments with effective evaluation of their safety, efficacy, cost/risk/benefit ratios, and effects on long-term outcomes for children and their families.
CPCCRN research priorities reflect the four topic areas described below.
Bereavement and GriefFunctional OutcomesIntensive Care Clinical Processes and ProtocolsInfection and Sepsis
Following the death of a child in the PICU, all parents grieve. Guidance for communicating about and considering the family's grief, emotional burden, and difficult decision making remains largely anecdotal. Some bereaved parents are incapacitated for a prolonged period, a situation known as "complicated grief." CPCCRN investigators explore whether a follow-up meeting with the child's PICU physician after a child's death helps decrease complicated grief in these bereaved parents. Completed projects in this area include:
Two continuing priorities of the CPCCRN Advisory Committee, especially the parents who serve on the Committee, are to improve processes of care and concentrate on functional outcomes of children requiring critical care. To provide a mechanism for measuring functional outcome, CPCCRN has undertaken the following studies.
To improve the evidence base for pediatric critical care practices, CPCCRN investigators selected clinical processes that are either frequently used or very high risk and implemented the following studies.
The Network concentrates on several major critical illness burdens including sepsis:
In addition, previous sites within the Network include Arkansas Children's Hospital, Little Rock; Children’s Hospital Los Angeles and Mattel Children’s Hospital/University of California Los Angeles; Phoenix Children’s Hospital; University of Michigan, Ann Arbor; and Seattle Children's Hospital.