Paediatric Intensive Care Adaptive Platform Trial
CLINICAL TRAINING:Core aspects of the PIVOTAL study
v1.1 09 March 2026
To navigate this training package, use the arrows on either side of the screen
Use this button to view the contents of the training and move between different sections:
Click on the three dots in the bottom right hand corner of the screen if you want to navigate to a specific page...
www.icnarc.org
www.icnarc.org
PIVOTAL training packs
There are 4 separate training packs for the PIVOTAL research study. One for ‘core’ platform training and one for each domain:
- Core platform training: Overall summary of platform, eligibility and examples of scenarios for possible randomisations
- Fluid domain
- Sedation domain
- Blood transfusion thresholds domain
It is recommended to undertake the core training first
www.icnarc.org
www.icnarc.org
PIVOTAL training packs
Core Platform
Blood transfusion thresholds domain
Fluid domain
Sedation domain
www.icnarc.org
www.icnarc.org
Contents
- Aim of PIVOTAL
- Which patients?
- Organ support – trial definition
- Strata
- Domains
- Trial design
- Why these domains?
- Definition of ‘days’
- Patient flow:
- Screening and eligibility criteria
- Randomisation
- Domain treatment allocations on randomisation
- Consent
- Review your knowledge
- Next steps
- Support and resources
- Questions
- Training confirmation form
www.icnarc.org
www.icnarc.org
Aim of PIVOTAL
- The overall aim of the PIVOTAL platform research study is to simultaneously evaluate the clinical and cost-effectiveness of multiple interventions in critically ill children
- These interventions are all core processes in PICU and are called ‘domains’
Platform trials allow multiple interventions to be tested simultaneously providing efficiency in trial delivery, time and cost. Importantly this also reduces burden on parents.
www.icnarc.org
www.icnarc.org
Which patients?
Cardiac and non-cardiac strata (groups)
All patients receiving organ support
Definitions: see next slides
www.icnarc.org
www.icnarc.org
Organ support
- Defined as receipt of respiratory, cardiovascular or renal support within PICU according to the Paediatric Critical Care Minimum Dataset.
Click each type of organ support to reveal the full list...
Renal
Respiratory
Cardiovascular
www.icnarc.org
www.icnarc.org
Strata
Cardiac
Non-cardiac
Primary cardiac disease (structural, myocardial or arrythmia) as the main reason for PICU admission
Non-cardiac cause as the main reason for admission to PICU
www.icnarc.org
www.icnarc.org
Domains
Fluid
Sedation
Transfusion
- Intervention: Conservative fluid management and active fluid removal
Usual care
Non-cardiac patients only
- Intervention: Dexmedetomidine or Clonidine
Midazolam
Non-cardiac and cardiac patients
- Intervention: Restrictive RBC transfusion strategy
- Control: Liberal RBC transfusion strategy
Non-cardiac and cardiac patients
www.icnarc.org
www.icnarc.org
Trial design
- Multi-centre, randomised, Bayesian adaptive, platform trial with an internal pilot phase
www.icnarc.org
www.icnarc.org
Trial design
Projected monthly recruitment: ~320 platform eligible patients per month
Expected to open: March 2026
A great title
Recruitment
Target: No fixed recruitment number (maximum 12,900 in current grant)
Participating nations: England, Wales, Scotland and Northern Ireland
A great title
A great title
www.icnarc.org
www.icnarc.org
Areas of treatment covered are core processes in PICU
IV fluid use is universal in PICU After resuscitation, children continue to receive large volumes of fluid, commonly leading to fluid accumulation
Fluid Management
Over 50% of UK PICU patients on invasive mechanical ventilation receive continuous sedation
Optimal sedation avoids both under-sedation (distress, agitation) and over-sedation (prolonged ventilation, PICU stay, delirium)
Sedation
Anaemia is very common in PICU – up to 74% of children
RBC transfusion is the main treatment to quickly raise haemoglobin (Hb)
Blood Transfusions
www.icnarc.org
www.icnarc.org
Why these domains in PIVOTAL?
Click below to reveal information about each domain...
Current guidelines advise restriction but supporting evidence remains weak. Other paediatric trials of restriction alone have not achieved meaningful separation – must also combine active fluid removal (AFR).
Systematic reviews show poor reporting of sedation outcomes – trials are small and heterogeneous. No trials in children have directly compared clonidine vs dexmedetomidine despite similar mechanisms and costs.
Paediatric evidence largely informed by single trial with limitations. Guidelines provide only conditional recommendations for children with cardiac disease or acute brain injury due to lack of high-quality trials.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Blood transfusion domain
Fluid domain
Sedation domain
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
www.icnarc.org
www.icnarc.org
Definition of ‘Days’
To support practical application of the study, days are defined as either calendar days or chart days. This is only relevant for fluid calculation in the fluid domain and for all data collection (CRF) by the research team. You should continue to record patient care as usual in your PICU (i.e., use of patients' medical records, PICU charts, prescription charts etc).
Day 1 = Day/date of randomisation
Details for each domain on next slides...
www.icnarc.org
www.icnarc.org
Definition of ‘Days’: Fluid Domain
‘Days’ refer to your usual chart days.
- Day 1 = Day of randomisation
From date/time of randomisation until the end of your usual chart day
- Day 2 = From the start of your next chart day until the end of that chart day
Examples on next slide...
www.icnarc.org
www.icnarc.org
www.icnarc.org
www.icnarc.org
Definition of ‘Days’: Sedation Domain
‘Days’ refer to calendar days/dates
www.icnarc.org
www.icnarc.org
Definition of ‘Days’: Transfusion Thresholds Domain
‘Days’ refer to calendar days/dates If randomised to other domains(s) but not the transfusion domain yet, screening for eligibility is up to the end of day 4 (calendar day/date) - more detail in later slides
www.icnarc.org
www.icnarc.org
Patient flow
www.icnarc.org
www.icnarc.org
Platform eligibility
Inclusion criteria:
Gestational age at birth ≥37 weeks, or combined gestational age and post-birth age ≥37 weeks, and <16 years at the time of randomisation
Receiving at least one of respiratory, cardiovascular, or renal support
Expected to remain on organ support the following day
Face-to-face contact with PICU or transport team
Exclusion criteria:
Previously recruited to a domain in PIVOTAL either in the last 30 days or during the same hospital admission
Death perceived as imminent
www.icnarc.org
www.icnarc.org
Fluid eligibility
Patients confirmed platform eligible and meet all fluid eligibility criteria at the time of randomisation.
Click below to reveal more information about the domain...
- Admitted with a condition that requires a specific fluid management regimen (e.g. diabetic ketoacidosis, tumour lysis syndrome, diabetes insipidus)
- Participating in another research study that requires fluid management
- Receiving renal replacement therapy or Extracorporeal Membrane Oxygenation support
- Over 12 hours since meeting the platform and domain inclusion criteria
Non-cardiac ONLY (i.e. non-cardiac cause as the main reason for admission to PICU)
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Receiving invasive mechanical ventilation
Exclusion criteria
Inclusion criteria
Use this side to give more information about a topic.
Strata
Subtitle
Title
Title
Write a brief description here
Write a brief description here
www.icnarc.org
www.icnarc.org
Sedation eligibility
Patients confirmed platform eligible and meet all sedation eligibility criteria at the time of randomisation.
Click below to reveal more information about the domain...
- Known hyper-sensitivity or contraindication to one of the sedative agents
- Known pregnancy
- Over 12 hours since meeting the platform and domain inclusion criteria
- Receiving invasive mechanical ventilation
- Receiving, or about to receive, a continuous intravenous sedative
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Exclusion criteria
Inclusion criteria
Use this side to give more information about a topic.
Non-cardiac and cardiac
Strata
Subtitle
Title
Title
Write a brief description here
Write a brief description here
www.icnarc.org
www.icnarc.org
Blood transfusion thresholds eligibility
Patients confirmed platform eligible and meet all blood transfusion thresholds eligibility criteria.
Click below to reveal more information about the domain...
- Latest Hb less than or equal to the relevant threshold outlined below:
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Inclusion criteria
Title
Use this side to give more information about a topic.
Non-cardiac and cardiac
Strata
Subtitle
Title
Write a brief description here
www.icnarc.org
www.icnarc.org
Blood transfusion thresholds eligibility
Click below to reveal more information about the domain...
- Haemoglobinopathies (e.g. sickle cell disease, thalassemia) where red blood cell transfusions may be used to prevent haemolytic or aggregation crises
- Unrepaired cyanotic congenital heart disease and/or functionally single ventricle circulation and/or palliated parallel circulation
- Known advance decision refusing blood/blood component transfusions (e.g. Jehovah’s Witnesses)
- Receiving Extracorporeal Membrane Oxygenation (ECMO)
- Receipt of RBC transfusion for a reason other than bleeding or extracorporeal support (on ECMO or for priming renal replacement circuit) since meeting the platform inclusion criteria
Exclusion criteria
Title
Use this side to give more information about a topic.
Subtitle
www.icnarc.org
www.icnarc.org
Blood transfusion threshold - eligibility
If first randomised into another domain(s), patients may become eligible for the transfusion domain at a later timepoint
Patients may be randomised at the same time as the other domains
Patients may be randomised to the transfusion domain only
OR
OR
- After domain-specific eligibility is confirmed, a second randomisation will be conducted
- Day 1 = day of first randomisation (use calendar days)
- If Hb does not meet threshold prior to the end of Day 4, patient will not be eligible for inclusion into the transfusion domain
www.icnarc.org
www.icnarc.org
Who can confirm eligibility?
- A qualified healthcare professional (does not need to be a doctor) responsible for the care of the patient on PICU
Name of person confirming eligibility is recorded on the online randomisation form (Sealed Envelope)
Trial training required to confirm eligibility
Documented on Training Log
Does not need to be on the Delegation Log or have GCP training
www.icnarc.org
www.icnarc.org
Patient flow
www.icnarc.org
www.icnarc.org
Randomisation
- Dedicated 24/7 service – “Sealed Envelope”
Name of person randomising is recorded on the online randomisation form (Sealed Envelope)
Trial training required to randomise
Documented on Training Log
Appropriate clinical staff may be involved solely in the screening and randomisation of patients e.g., out-of-hours staff
GCP training not required to randomise
www.icnarc.org
www.icnarc.org
Randomisation
Patients are randomised into one of the possible groups for each domain:
Fluid
Sedation
Transfusion
- Continuous IV infusion of Dexmedetomidine
- Continuous IV infusion of Clonidine
- Continuous IV infusion of Midazolam
- Conservative fluid management
- Restrictive transfusion threshold
- Liberal transfusion threshold
- Conservative fluid management
- Usual fluid management
www.icnarc.org
www.icnarc.org
Randomisation - Transfusion
- Patients may become eligible for Transfusion domain later
- A second randomisation can be carried out when eligible (if patient was not eligible for this domain at the first randomisation timepoint)
- Following the first randomisation, patients have until the end of day 4 (calendar days) to be randomised to transfusion
- Participant list tab on Sealed Envelope – will only show patients who are still within the window to be randomised to transfusion
www.icnarc.org
www.icnarc.org
Patient flow
www.icnarc.org
www.icnarc.org
Treatment allocation on randomisation
Patients are randomised into one of the possible groups for each domain. Details are discussed in the individual domain training packs.
www.icnarc.org
www.icnarc.org
Patient flow
www.icnarc.org
www.icnarc.org
Research Without Prior Consent
- Due to the emergency and time-sensitive nature of the clinical situation, PIVOTAL will use a research without prior consent model
- This means that patients may be recruited into the trial before consent
- After randomisation and once patient’s medical situation is no longer considered an emergency, the research team will begin consent procedures
- Parents/legal guardians may consent to all or some of the domains
- Family Room Poster and Information Leaflets (general and cardiac) available
www.icnarc.org
www.icnarc.org
Planned admissions
- E.g., following elective cardiac surgery
- Parents may be given an information leaflet in advance e.g. at pre-op clinic or appointments
- Information leaflet explains that their child may become eligible for PIVOTAL if admitted to PICU
- Parents are not consented prospectively
www.icnarc.org
www.icnarc.org
Review your knowledge
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Harry, 10 day old 3.8kg baby admitted to PICU 2 hours ago with possible sepsis. He is sedated and ventilated.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Harry, 10 day old 3.8kg baby admitted to PICU 2 hours ago with possible sepsis. He is sedated and ventilated.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Answer: Harry is eligible for both Fluid and Sedation but his eligibility for Transfusion depends on his Hb...
He would be eligible for the Transfusion domain if his Hb is less than or equal to 85g/L, now or within 4 days of randomisation into the other domains of PIVOTAL. This is because he is non-cardiac, non-ABI.
- Latest Hb less than or equal to the relevant threshold outline below:
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Harry’s Hb is 100g/L.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Harry was entered into the Fluid and Sedation domains two days ago. He was allocated to:
- Fluid domain: Conservative fluid management
- Sedation domain: Clonidine
Today his Hb is 80g/L.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 2
Joe, 4 year old boy admitted post cardiac surgery today. Sedated and ventilated.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 3
Jasmine, a 7 year old, 22kg, girl admitted with pneumonia two days ago. She remains sedated and ventilated. She was entered into the Fluid and Sedation domains on the day of admission and randomised to:
- Fluid domain: Usual care
- Sedation domain: Midazolam
www.icnarc.org
www.icnarc.org
Next steps
Other PIVOTAL training packs available
- Domains:
- Fluid
- Sedation
- Blood transfusion thresholds
www.icnarc.org
www.icnarc.org
Support and resources
Click here
- Administration guides (one per domain)
- Trial summary for bedside teaching
- Bedside notices
- Stickers for charts
- AFR assessment form
www.icnarc.org
www.icnarc.org
Questions
If you have any questions on this domain or any part of the PIVOTAL trial, please ask your PICU research team first or contact the clinical trials unit at PIVOTAL@icnarc.org
www.icnarc.org
www.icnarc.org
Training confirmation form
Once you have completed this training pack, complete the online form via this link:
Click here
www.icnarc.org
www.icnarc.org
Renal support:
- Peritoneal dialysis
- Hemofiltration
- Haemodialysis
Cardiovascular support:
- Continuous infusion of inotrope or vasodilator
- Mechanical – ECMO
- Mechanical – ventricular assist device (VAD)
Respiratory support:
- Invasive ventilation via endotracheal tube
- Invasive ventilation via tracheostomy tube
- Non-invasive ventilatory support
- Heated humidified high flow therapy (HHHFT)
PIVOTAL Clinical Training - Core v1.0 21.01.2026
ICNARC CTU
Created on January 21, 2026
Start designing with a free template
Discover more than 1500 professional designs like these:
View
SWOT Challenge: Classify Key Factors
View
Vision Board
View
Explainer Video: Keys to Effective Communication
View
Explainer Video: AI for Companies
View
Corporate CV
View
Flow Presentation
View
Discover Your AI Assistant
Explore all templates
Transcript
Paediatric Intensive Care Adaptive Platform Trial
CLINICAL TRAINING:Core aspects of the PIVOTAL study
v1.1 09 March 2026
To navigate this training package, use the arrows on either side of the screen
Use this button to view the contents of the training and move between different sections:
Click on the three dots in the bottom right hand corner of the screen if you want to navigate to a specific page...
www.icnarc.org
www.icnarc.org
PIVOTAL training packs
There are 4 separate training packs for the PIVOTAL research study. One for ‘core’ platform training and one for each domain:
It is recommended to undertake the core training first
www.icnarc.org
www.icnarc.org
PIVOTAL training packs
Core Platform
Blood transfusion thresholds domain
Fluid domain
Sedation domain
www.icnarc.org
www.icnarc.org
Contents
www.icnarc.org
www.icnarc.org
Aim of PIVOTAL
Platform trials allow multiple interventions to be tested simultaneously providing efficiency in trial delivery, time and cost. Importantly this also reduces burden on parents.
www.icnarc.org
www.icnarc.org
Which patients?
Cardiac and non-cardiac strata (groups)
All patients receiving organ support
Definitions: see next slides
www.icnarc.org
www.icnarc.org
Organ support
Click each type of organ support to reveal the full list...
Renal
Respiratory
Cardiovascular
www.icnarc.org
www.icnarc.org
Strata
Cardiac
Non-cardiac
Primary cardiac disease (structural, myocardial or arrythmia) as the main reason for PICU admission
Non-cardiac cause as the main reason for admission to PICU
www.icnarc.org
www.icnarc.org
Domains
Fluid
Sedation
Transfusion
- Control:
Usual care- Strata:
Non-cardiac patients only- Control:
Midazolam- Strata:
Non-cardiac and cardiac patients- Strata:
Non-cardiac and cardiac patientswww.icnarc.org
www.icnarc.org
Trial design
www.icnarc.org
www.icnarc.org
Trial design
Projected monthly recruitment: ~320 platform eligible patients per month
Expected to open: March 2026
A great title
Recruitment
Target: No fixed recruitment number (maximum 12,900 in current grant)
Participating nations: England, Wales, Scotland and Northern Ireland
A great title
A great title
www.icnarc.org
www.icnarc.org
Areas of treatment covered are core processes in PICU
IV fluid use is universal in PICU After resuscitation, children continue to receive large volumes of fluid, commonly leading to fluid accumulation
Fluid Management
Over 50% of UK PICU patients on invasive mechanical ventilation receive continuous sedation Optimal sedation avoids both under-sedation (distress, agitation) and over-sedation (prolonged ventilation, PICU stay, delirium)
Sedation
Anaemia is very common in PICU – up to 74% of children RBC transfusion is the main treatment to quickly raise haemoglobin (Hb)
Blood Transfusions
www.icnarc.org
www.icnarc.org
Why these domains in PIVOTAL?
Click below to reveal information about each domain...
Current guidelines advise restriction but supporting evidence remains weak. Other paediatric trials of restriction alone have not achieved meaningful separation – must also combine active fluid removal (AFR).
Systematic reviews show poor reporting of sedation outcomes – trials are small and heterogeneous. No trials in children have directly compared clonidine vs dexmedetomidine despite similar mechanisms and costs.
Paediatric evidence largely informed by single trial with limitations. Guidelines provide only conditional recommendations for children with cardiac disease or acute brain injury due to lack of high-quality trials.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Blood transfusion domain
Fluid domain
Sedation domain
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
www.icnarc.org
www.icnarc.org
Definition of ‘Days’
To support practical application of the study, days are defined as either calendar days or chart days. This is only relevant for fluid calculation in the fluid domain and for all data collection (CRF) by the research team. You should continue to record patient care as usual in your PICU (i.e., use of patients' medical records, PICU charts, prescription charts etc).
Day 1 = Day/date of randomisation
Details for each domain on next slides...
www.icnarc.org
www.icnarc.org
Definition of ‘Days’: Fluid Domain
‘Days’ refer to your usual chart days.
- Day 1 = Day of randomisation
From date/time of randomisation until the end of your usual chart dayExamples on next slide...
www.icnarc.org
www.icnarc.org
www.icnarc.org
www.icnarc.org
Definition of ‘Days’: Sedation Domain
‘Days’ refer to calendar days/dates
www.icnarc.org
www.icnarc.org
Definition of ‘Days’: Transfusion Thresholds Domain
‘Days’ refer to calendar days/dates If randomised to other domains(s) but not the transfusion domain yet, screening for eligibility is up to the end of day 4 (calendar day/date) - more detail in later slides
www.icnarc.org
www.icnarc.org
Patient flow
www.icnarc.org
www.icnarc.org
Platform eligibility
Inclusion criteria:
Gestational age at birth ≥37 weeks, or combined gestational age and post-birth age ≥37 weeks, and <16 years at the time of randomisation
Receiving at least one of respiratory, cardiovascular, or renal support
Expected to remain on organ support the following day
Face-to-face contact with PICU or transport team
Exclusion criteria:
Previously recruited to a domain in PIVOTAL either in the last 30 days or during the same hospital admission
Death perceived as imminent
www.icnarc.org
www.icnarc.org
Fluid eligibility
Patients confirmed platform eligible and meet all fluid eligibility criteria at the time of randomisation.
Click below to reveal more information about the domain...
Non-cardiac ONLY (i.e. non-cardiac cause as the main reason for admission to PICU)
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Receiving invasive mechanical ventilation
Exclusion criteria
Inclusion criteria
Use this side to give more information about a topic.
Strata
Subtitle
Title
Title
Write a brief description here
Write a brief description here
www.icnarc.org
www.icnarc.org
Sedation eligibility
Patients confirmed platform eligible and meet all sedation eligibility criteria at the time of randomisation.
Click below to reveal more information about the domain...
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Exclusion criteria
Inclusion criteria
Use this side to give more information about a topic.
Non-cardiac and cardiac
Strata
Subtitle
Title
Title
Write a brief description here
Write a brief description here
www.icnarc.org
www.icnarc.org
Blood transfusion thresholds eligibility
Patients confirmed platform eligible and meet all blood transfusion thresholds eligibility criteria.
Click below to reveal more information about the domain...
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Inclusion criteria
Title
Use this side to give more information about a topic.
Non-cardiac and cardiac
Strata
Subtitle
Title
Write a brief description here
www.icnarc.org
www.icnarc.org
Blood transfusion thresholds eligibility
Click below to reveal more information about the domain...
Exclusion criteria
Title
Use this side to give more information about a topic.
Subtitle
www.icnarc.org
www.icnarc.org
Blood transfusion threshold - eligibility
If first randomised into another domain(s), patients may become eligible for the transfusion domain at a later timepoint
Patients may be randomised at the same time as the other domains
Patients may be randomised to the transfusion domain only
OR
OR
www.icnarc.org
www.icnarc.org
Who can confirm eligibility?
Name of person confirming eligibility is recorded on the online randomisation form (Sealed Envelope)
Trial training required to confirm eligibility
Documented on Training Log
Does not need to be on the Delegation Log or have GCP training
www.icnarc.org
www.icnarc.org
Patient flow
www.icnarc.org
www.icnarc.org
Randomisation
Name of person randomising is recorded on the online randomisation form (Sealed Envelope)
Trial training required to randomise
Documented on Training Log
Appropriate clinical staff may be involved solely in the screening and randomisation of patients e.g., out-of-hours staff
GCP training not required to randomise
www.icnarc.org
www.icnarc.org
Randomisation
Patients are randomised into one of the possible groups for each domain:
Fluid
Sedation
Transfusion
www.icnarc.org
www.icnarc.org
Randomisation - Transfusion
www.icnarc.org
www.icnarc.org
Patient flow
www.icnarc.org
www.icnarc.org
Treatment allocation on randomisation
Patients are randomised into one of the possible groups for each domain. Details are discussed in the individual domain training packs.
www.icnarc.org
www.icnarc.org
Patient flow
www.icnarc.org
www.icnarc.org
Research Without Prior Consent
www.icnarc.org
www.icnarc.org
Planned admissions
www.icnarc.org
www.icnarc.org
Review your knowledge
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Harry, 10 day old 3.8kg baby admitted to PICU 2 hours ago with possible sepsis. He is sedated and ventilated.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Harry, 10 day old 3.8kg baby admitted to PICU 2 hours ago with possible sepsis. He is sedated and ventilated.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Answer: Harry is eligible for both Fluid and Sedation but his eligibility for Transfusion depends on his Hb...
He would be eligible for the Transfusion domain if his Hb is less than or equal to 85g/L, now or within 4 days of randomisation into the other domains of PIVOTAL. This is because he is non-cardiac, non-ABI.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Harry’s Hb is 100g/L.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 1
Harry was entered into the Fluid and Sedation domains two days ago. He was allocated to:
- Fluid domain: Conservative fluid management
- Sedation domain: Clonidine
Today his Hb is 80g/L.www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 2
Joe, 4 year old boy admitted post cardiac surgery today. Sedated and ventilated.
www.icnarc.org
www.icnarc.org
Review knowledge: Scenario 3
Jasmine, a 7 year old, 22kg, girl admitted with pneumonia two days ago. She remains sedated and ventilated. She was entered into the Fluid and Sedation domains on the day of admission and randomised to:
www.icnarc.org
www.icnarc.org
Next steps
Other PIVOTAL training packs available
www.icnarc.org
www.icnarc.org
Support and resources
Click here
www.icnarc.org
www.icnarc.org
Questions
If you have any questions on this domain or any part of the PIVOTAL trial, please ask your PICU research team first or contact the clinical trials unit at PIVOTAL@icnarc.org
www.icnarc.org
www.icnarc.org
Training confirmation form
Once you have completed this training pack, complete the online form via this link:
Click here
www.icnarc.org
www.icnarc.org
Renal support:
Cardiovascular support:
Respiratory support: