00:00The Paediatric Adaptive Platform Trial is a UK-wide approach to learning about the basic things we do in intensive
00:08care and trying to make them better.
00:10And it's different to everything that's gone before in that we can do several things at the same time, effectively
00:16run three trials for the price of one.
00:19But also we can use the information as it comes in, so we get answers more quickly than if we
00:26had set up a standard trial, which typically takes three to five years.
00:30Every year, around 20,000 critically ill children are admitted to paediatric intensive care units.
00:36But experts say evidence is lacking on the optimal dose for some treatments.
00:42Led by intensive care team at Great Ormond Street Hospital, together with University College London and the Intensive Care National
00:51Audit and Research Centre, the new trial will start by testing free drugs and interventions, with more added later.
01:00So, we're currently at 15 centres. We could easily do 20, 24 centres.
01:07And the number of children is a more complicated answer because enough to answer the question is the correct response.
01:15Because as the information comes in, we'll look at whether the groups are separated or not, whether we know if
01:20one treatment is better than another.
01:21So we could do as few as 3,500 children. We could do as many as 12,000 children.
01:27The PIVOTAL trial stands for the Paediatric Intensive Care Adaptive Platform Trial.
01:32And essentially, a platform trial means that we're going to be answering simultaneously three different questions about three different treatment
01:40areas.
01:40So unlike a randomised controlled trial that will just compare the usual care group to an intervention group, this is
01:47testing three different treatment areas at the same time.
01:49And the treatment areas under question are regards to the fluid balance, blood transfusion and the most effective sedative agent
01:57used in critically ill children.
02:00So the ultimate aim is to improve the basics of care for critically ill children.
02:06And that includes simple things like what's the safest drug to keep them asleep with?
02:11What's the best strategy for administering intravenous fluid?
02:15And when should we transfuse with red blood cells?
02:18And all of those things are sort of everyday decisions that are made on intensive care.
02:22But at the moment, they're made largely in the absence of high quality evidence.
02:27Well, interestingly, Epidemic Intensive Care in the UK and worldwide is largely a success story.
02:33The mortality is effectively halved in the last 20 years.
02:36Vaccinations have taken out most of the major killers of previously healthy children.
02:42So it's felt like things are getting better, but they've been getting better maybe not as fast as they could
02:47have done had we had good quality evidence about some of these basic interventions.
02:51So we're trying to put that right.
02:53And we think this is a highly efficient way of doing it because, as I said, we answer maybe up
02:58to three questions at the same time.
