The intensive care medicine clinical research agenda in paediatrics.
BACKGROUND
Intensive Care Medicine set us the task of outlining a global clinical research agenda for paediatric intensive care (PIC). In line with the clinical focus of this journal, we have limited this to research that may directly influence patient care.


METHODS
Clinician researchers from PIC research networks of varying degrees of formality from around the world were invited to answer two main questions: (1) What have been the major recent advances in paediatric critical care research? (2) What are the top 10 studies for the next 10 years?


RESULTS
(1) Inclusive databases are well established in many countries. These registries allow detailed observational studies and feasibility testing of clinical trial protocols. Recent trials are larger and more valuable, and (2) most common interventions in PIC are not evidenced-based. Clinical studies for the next 10 years should address this deficit, including: ventilation techniques and interfaces; fluid, transfusion and feeding strategies; optimal targets for vital signs; multiple organ failure definitions, mechanisms and treatments; trauma, prevention and treatment; improving safety; comfort of the patient and their family; appropriate care in the face of medical complexity; defining post-PICU outcomes; and improving knowledge generation and adoption, with novel trial design and implementation strategies. The group specifically highlighted the need for research in resource-limited environments wherein mortality remains often tenfold higher than in well-resourced settings.


CONCLUSIONS
Paediatric intensive care research has never been healthier, but many gaps in knowledge remain. We need to close these urgently. The impact of new knowledge will be greatest in resource-limited environments.
Paediatric Intensive Care Society Study Group (PICS-SG), UCL Great Ormond Street Institute of Child Health, London, UK.
Mark J
http://orcid.org/0000-0003-3653-4808
MJ
Peters
PICU, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, Republic of South Africa.
Andrew
A
Argent
Paediatric Intensive Care Unit, the Children's Hospital at Westmead, the Sydney Children's Hospital Network, Westmead, NSW, Australia.
Marino
M
Festa
Pediatric Intensive Care Unit, University Lille, CHU Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, 59000, Lille, France.
Stéphane
S
Leteurtre
Pediatric Emergency and Critical Care Department, H Clinicas, UFRGS University, Porto Alegre, Brazil.
Jefferson
J
Piva
Pediatric Acute Lung Injury and Sepsis Investigators (PALISI Network), Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Ann
A
Thompson
Executive Committee, PALISI, John Mickell Professor of Pediatric Critical Care, Children's Hospital of Richmond at VCU, Richmond, VA, USA.
Douglas
D
Willson
Réanimation Pédiatrique et Médecine Néonatale, Hôpitaux Universitaires Paris-Sud AP-HP, Le Kremlin-Bicêtre, France.
Pierre
P
Tissières
Pediatric Interest Group, Canadian Critical Care Trials Group, Montreal, Canada.|Division of Pediatric Intensive Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Sainte-Justine Hospital, Room 3431, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
Marisa
M
Tucci
Division of Pediatric Intensive Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Sainte-Justine Hospital, Room 3431, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. Jacques_lacroix@ssss.gouv.qc.ca.
Jacques
J
Lacroix
D035843:Biomedical Research; D002648:Child; D002908:Chronic Disease / Q000628:therapy; D003422:Critical Care / Q000458:organization & administration*; D004638:Emergency Treatment / Q000379:methods; D019317:Evidence-Based Medicine / Q000592:standards*; D014943:Global Health; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D008991:Monitoring, Physiologic / Q000379:methods; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods
Children; Critical care; Intensive care; Paediatrics; Research