Nurse-Led Interventions in Pediatric Critical Care: Training in Pediatric Sleep Health, Delirium, and Multi-Site Research

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PROJECT SUMMARY/ABSTRACT Delirium is a serious, potentially iatrogenic, complication of pediatric intensive care unit (PICU) care and is associated with poor clinical outcomes. Poor sleep quality during critical illness is a proposed cause of delirium. Upon admission, children experience a chaotic PICU environment that disrupts sleep/wake patterns, including lack of day/night light and sound cycling and frequent examinations and procedures. This PICU care model is neither child- nor family-centered and likely disrupts sleep health. Good sleep health requires regularity in sleep/wake patterns with appropriate sleep timing, high sleep efficiency, and adequate sleep duration to promote physical and mental well-being. The primary purpose of this research training plan (R2-PD) is to use existing data to explore associations among sleep health (i.e., timing, efficiency, duration, regularity), sleep biology (i.e., melatonin dysregulation), and pediatric delirium. The data are from RESTORE Resilience (R2; R21HD093369), a 2-center, prospective cohort trial of a nurse-driven care bundle designed to maintain sleep/wake rhythms in 54 children (6 m.o.-17 y.o.) with acute respiratory failure on mechanical ventilation. Specific aims of R2-PD include: (1) Examine relationship between sleep health (i.e., daytime activity ratio estimate [timing], sleep episode duration, total sleep time [duration], sleep efficiency) and pediatric delirium (i.e., incidence, duration). (2) Determine association between implementation of a nurse-driven care bundle that promotes sleep/wake cycle regularity and pediatric delirium (i.e., incidence, duration). (Exploratory) Explore differences in salivary melatonin levels (i.e., mesor, amplitude, acrophase) over time (i.e., study days 2 and 5) in critically ill children with and without delirium. This study will be among the first to explore links among sleep disruption, melatonin levels, and delirium in a sizeable critically ill pediatric cohort followed for 9.8 (SD=7.7) days. Combined with in-depth training in multi-site clinical trial conduct with Dr. Martha Curley (Sponsor) and pediatric sleep health with Dr. Monica Ordway (Mentor), the R2-PD analysis will provide preliminary data for future, large-scale nurse-led clinical trials of individualized sleep-promoting interventions to prevent pediatric delirium. Training goals for the 18-month post-doctoral period at the University of Pennsylvania include: (1) Expand knowledge of pediatric sleep health as a multi-dimensional construct and understand how sleep health relates to pediatric critical care and delirium. (2) Receive advanced training in multi-site clinical trial conduct and data coordination. (3) Advance scientific understanding of pediatric critical illness through research dissemination. (4) Develop professionally in preparation for career as an independent pediatric critical care researcher. This application aligns with NINR interest in training nurse scientists in intervention research with PICU nursing practice implications (NOT-NR-21-001). The long-term goal of this research program is to improve clinical outcomes and quality of life in survivors of pediatric critical illness with interventions that incorporate individual family care patterns to optimize healing in the PICU.