Dilemmas in undertaking research in paediatric intensive care

Kanthimathinathan, H. K.; Scholefield, B. R.

doi:10.1136/archdischild-2013-304871

Cited by 26 publications

(25 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the need to bridge this knowledge gap is frequently acknowledged, 30,89 there are unique challenges inherent to conducting research in the pediatric population. 90 As with other areas of PICU practice where recommendations are not supported by high level of evidence, expert consensus opinion may inform the majority of the guidelines, while increasing research in this area may ultimately support and refine these guidelines. 91 Once a guideline is created, development of an education curriculum that can be completed online or in the classroom setting may be beneficial on a unit-wide level for all staff.…”

Section: Pediatric-specific Challengesmentioning

confidence: 99%

Transforming PICU Culture to Facilitate Early Rehabilitation

Hopkins

Choong

Zebuhr

et al. 2015

J Pediatr Intensive Care

View full text Add to dashboard Cite

Children who survive a critical illness are at risk of developing significant, long-lasting morbidities that may include neuromuscular weakness, cognitive impairments, and new mental health disorders. These morbidities, collectively known as post–intensive care syndrome (PICS), may lead to functional impairments, difficulty in school and social settings, and reduced quality of life. Interventions aimed at rehabilitation such as early mobilization, sedation minimization and prevention of ICU-acquired weakness, delirium, and posttraumatic stress disorder may lead to improved clinical outcomes and functional recovery in critically ill children. Acute rehabilitation is challenging to implement in a pediatric intensive care unit (PICU), and a culture change is needed to effect widespread transformation in this setting. Our objectives in this article are to review the evidence on PICS in children and strategies for affecting culture change to facilitate early rehabilitation in the PICU.

show abstract

Section: Pediatric-specific Challengesmentioning

confidence: 99%

Transforming PICU Culture to Facilitate Early Rehabilitation

Hopkins

Choong

Zebuhr

et al. 2015

J Pediatr Intensive Care

View full text Add to dashboard Cite

show abstract

“…CA in adults is usually coronary artery disease related with sudden onset; in neonates, this is rare but may be related to perinatal events; whereas in children, this often follows respiratory insufficiency, hypoxia and acidosis. These significant differences prevent direct extrapolation of adult or neonatal evidence to paediatric population (11). Evidence for association between PaO 2 and outcomes after paediatric CA remains limited.…”

Section: Editorialmentioning

confidence: 99%

Blowing hot or cold? Oxygenation and temperature after paediatric cardiac arrest

Kanthimathinathan

Scholefield

2015

Resuscitation

View full text Add to dashboard Cite

“…It is accepted that the medical care of critically ill and injured infants and children should be based on the best available research evidence in order to optimise patient outcome [ 3 – 9 ] and ensure rational and equitable use of scarce resources [ 10 ]. However clinical research in this population has been severely limited, particularly in low and middle-income countries including South Africa, due to both lack of prioritisation and concerns about protecting vulnerable children from potential harm in clinical trials [ 11 – 14 ]. This has led to the situation where some of the sickest, most vulnerable children are subjected to the most anecdotally based medical practice, including the use of untested, off-label or unlicensed medications [ 5 , 11 , 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…In order for research involving children to be approved, the child’s parent/s or authorised legal representative are required to provide informed consent for their child’s participation [ 11 , 12 , 22 ]. For a number of reasons which will be explored in this article, obtaining comprehensive, voluntary prospective informed consent may be particularly challenging in both emergency situations and paediatric research [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Informed consent in paediatric critical care research – a South African perspective

2015

View full text Add to dashboard Cite

BackgroundMedical care of critically ill and injured infants and children globally should be based on best research evidence to ensure safe, efficacious treatment. In South Africa and other low and middle-income countries, research is needed to optimise care and ensure rational, equitable allocation of scare paediatric critical care resources.Ethical oversight is essential for safe, appropriate research conduct. Informed consent by the parent or legal guardian is usually required for child research participation, but obtaining consent may be challenging in paediatric critical care research. Local regulations may also impede important research if overly restrictive.By narratively synthesising and contextualising the results of a comprehensive literature review, this paper describes ethical principles and regulations; potential barriers to obtaining prospective informed consent; and consent options in the context of paediatric critical care research in South Africa.DiscussionVoluntary prospective informed consent from a parent or legal guardian is a statutory requirement for child research participation in South Africa. However, parents of critically ill or injured children might be incapable of or unwilling to provide the level of consent required to uphold the ethical principle of autonomy. In emergency care research it may not be practical to obtain consent when urgent action is required. Therapeutic misconceptions and sociocultural and language issues are also barriers to obtaining valid consent.Alternative consent options for paediatric critical care research include a waiver or deferred consent for minimal risk and/or emergency research, whilst prospective informed consent is appropriate for randomised trials of novel therapies or devices.SummaryWe propose that parents or legal guardians of critically ill or injured children should only be approached to consent for their child’s participation in clinical research when it is ethically justifiable and in the best interests of both child participant and parent. Where appropriate, alternatives to prospective informed consent should be considered to ensure that important paediatric critical care research can be undertaken in South Africa, whilst being cognisant of research risk. This document could provide a basis for debate on consent options in paediatric critical care research and contribute to efforts to advocate for South African law reform.

show abstract

Dilemmas in undertaking research in paediatric intensive care

Cited by 26 publications

References 40 publications

Transforming PICU Culture to Facilitate Early Rehabilitation

Transforming PICU Culture to Facilitate Early Rehabilitation

Blowing hot or cold? Oxygenation and temperature after paediatric cardiac arrest

Informed consent in paediatric critical care research – a South African perspective

Contact Info

Product

Resources

About