Critical Care

Pediatric Critical Care is committed to cutting-edge research to improve the care of our patients. Our division participates in multi-center, National Institutes of Health (NIH) funded projects and have original research to investigate novel approaches to care.

Current Research:




Age of Blood in Children in the PICU (ABC-PICU)

Site Principal Investigator: Katri V. Typpo, MD, MPH

The ABC PICU Trial is a randomized clinical trial that compares the clinical consequences of red blood cell (RBC) storage duration in critically ill children.  Laboratory and observational evidence points to serious concerns about the lack of safety and effectiveness of older RBCs, especially in more vulnerable populations.  Physicians and institutions have been systematically transfusing fresh RBCs to some pediatric patients primarily because of beliefs that short storage cells improve outcomes.  Conversely, the standard practice of blood banks is to deliver the oldest RBC unit in order to decrease blood wastage.  To provide much needed high quality evidence to answer the question “do RBCs of reduced storage duration improve outcomes,” ABC PICU compares clinical outcomes in critically ill children transfused with either RBCs stored ≤ 7 days or standard issue RBCs.

Genetic Epidemiology and Immune Response of Life-Threatening Influenza Infection in Children and Young Adults (PICFlu)

Site Principal Investigator: Katri V. Typpo, MD, MPH

Seasonal influenza annually infects 5 to 20% of the population, leading to 200,000 hospitalizations and approximately 36,000 deaths. This study of life-threatening influenza in children, actively enrolling at over 30 sites across the United States, evaluates how the patient’s immune response is associated with disease susceptibility, severity and outcome. By better understanding why some children experience severe illness or fatality from influenza, we can identify potential novel treatment strategies.  We believe that the genetic makeup of the patient strongly influences susceptibility to life-threatening influenza infection and survival. As the first very large multicenter study characterizing the role of innate immunity in life-threatening influenza in children, we are focusing on answering questions that can assist us in designing future clinical trials to prevent and ameliorate life-threatening influenza in children.

Supplemental Parenteral Nutrition in Pediatric Respiratory Failure (SuPPeR)

Principal Investigator: Katri V. Typpo, MD, MPH

Acute hypoxemic respiratory failure (AHRF) accounts for 10% of all PICU admissions.  Nutritional support is central to appropriate PICU management of AHRF, and yet fundamental gaps in knowledge exist regarding best practice for timing, route, dose, and type of nutrition. Optimized nutritional support during pediatric critical illness is important because even brief periods of malnutrition in infancy result in permanent negative effects on neurocognitive development, an outcome with lifelong impact. Parenteral nutrition, nutrition provided through an IV, supplementation in combination with normal feeding practices could improve long-term neurocognitive outcome for pediatric AHRF by preventing acute malnutrition, but has unknown effects on intestinal barrier function; a proposed mechanism for late sepsis and infectious complications during critical illness.   

Ventilator-Associated Infections Point Prevalence Study (VAIN Study)

Site Principal Investigator: Katri V. Typpo, MD, MPH
Ventilator-associated infections (VAI), (infections like pneumonia, that are caused from the use of a breathing machine) are among the most common hospital acquired infections in the pediatric ICU and are responsible for over half of all antibiotic use.  There is currently no common standard for diagnosis of ventilator-associated infections.  The existing Centers for Disease Control criteria are ambiguous and appear to be variably applied.  This prospective observational study aims to identify the prevalence of “clinically suspected VAI”, the diagnostic criteria used to identify VAI, and subsequent antibiotic treatment across participating institutions 

Past Research:

Eliminating Catheter-Associated Bloodstream Infections in Pediatric ICUs (NACHRI-CLABSI)
Site Principal Investigators: Robyn Meyer, MD and Mary Gaspers, MD, MPH

Epithelial Permeability in Children after Cardiopulmonary Bypass (EPIC-Cardiac)
Principal Investigator: Katri V. Typpo, MD, MPH

Hypertonic Fluid Selection in the Treatment of Pediatric Patients with Traumatic Brain Injury
Principal Investigators: Michele Munkwitz, MD and Britany Shutes, MD

Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE)
Site Principal Investigator: Marc D. Berg, MD
Co-Investigators: Brent Hall, PharmD, Michele Munkwitz, MD, Claire Wells, CNP

RESTORE Ancillary Studies:

Genetic Variations and Biomarkers in Acute Lung Injury (BALI)

Pharmacologic Impact on Sedation Assessments (PISA)

Sepsis Prevalence, Outcomes, and Therapy (SPROUT)
Site Principle Investigator: Katri V. Typpo, MD, MPH

Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA)
Site Principal Investigator: Andreas A. Theodorou, MD
Co-Investigator: Katri V. Typpo, MD, MPH

THAPCA Ancillary Study:
Hypothermia’s Impact on Pharmacology (HIP)

Other projects and research interests:

  • Clinical nutrition
  • CPR performance and ventricular fibrillation
  • Medication safety and error reduction
  • Patient safety and quality of patient care
  • Traumatic brain injury

If you have any questions about any of our research projects, please contact our Program Coordinator.