AzTrials
AzTrials

Respiratory InsufficiencyRESTORENCT00814099

Sedation Management in Pediatric Patients With Acute Respiratory Failure (The RESTORE Study)

A study testing Team approach to sedation management and Usual approach to sedation management in people with Respiratory Insufficiency and Respiratory Distress Syndrome, Newborn, run by University of Pennsylvania at 31 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

People with acute respiratory failure usually require the use of an artificial breathing machine, known as a mechanical ventilator. Sedative medications, which help keep people calm and reduce anxiety, are often prescribed for children who are on mechanical ventilators. Read more about this study

Who is it for?
Ages 2 weeks to 18 years
What is being tested?
Team approach to sedation management and Usual approach to sedation management
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2,449 participants
Where
31 sitesUnited States
Study dates
Jan 2009to Dec 2013
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 2 weeks to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • At least 2 weeks of age (and at least 42 weeks post-menstrual age) and less than 18 years of age
  • Intubated and mechanically ventilated for acute lung disease

Who cannot join

  • Cyanotic heart disease with unrepaired or palliated right to left intracardiac shunt
  • History of single ventricle at any stage of repair
  • Congenital diaphragmatic hernia or paralysis
  • Primary pulmonary hypertension
  • Critical airway or anatomical obstruction of the lower airway
  • Ventilator dependent upon pediatric ICU admission
Show all 14Show fewer
  • Neuromuscular respiratory failure
  • Spinal cord injury above the lumbar region
  • Pain managed by patient-controlled analgesia or epidural catheter
  • Patient transferred from an outside ICU where sedatives had already been administered for more than 24 hours
  • Family or medical team has decided not to provide full support
  • Enrolled in any other critical care interventional clinical trial concurrently or in the 30 days before study entry
  • Known allergy to any of the study medications
  • Pregnancy

Trial locations and contacts

31 sites in 1 country.

31 sites in 1 country

United States31 sites
  • C. S. Mott Children's Hospital of the University of Michigan

    Ann Arbor, Michigan, 48109-0243

  • University of Maryland Hospital for Children

    Baltimore, Maryland, 21201-1595

  • Johns Hopkins Children's Center

    Baltimore, Maryland, 21287

  • Children's Hospital of Alabama

    Birmingham, Alabama, 35233

  • Children's Memorial Hospital, Chicago

    Chicago, Illinois, 60614-3363

  • Medical City Children's Hospital

    Dallas, Texas, 75230

  • Children's Medical Center Dallas

    Dallas, Texas, 75235

  • Duke Children's Hospital and Health Center

    Durham, North Carolina, 27710

  • Connecticut Children's Medical Center

    Hartford, Connecticut, 06106

  • Children's Mercy Hospital, Kansas City

    Kansas City, Missouri, 84108

  • Dartmouth-Hitchcock Medical Center

    Lebanon, New Hampshire, 03756-0001

  • Holtz Children's Hospital

    Miami, Florida, 33136

  • Monroe Carell, Jr. Children's Hospital at Vanderbilt

    Nashville, Tennessee, 37232-9075

  • Yale-New Haven Children's Hospital

    New Haven, Connecticut, 06520-8064

  • Cohen Children's Medical Center of New York

    New Hyde Park, New York, 11040

  • Advocate Hope Children's Hospital

    Oak Lawn, Illinois, 60453

  • Children's Hospital and Research Center at Oakland

    Oakland, California, 94609-1809

  • University of Nebraska Medical Center

    Omaha, Nebraska, 68114

  • Children's Hospital of Orange County

    Orange, California, 92868

  • Florida Hospital for Children

    Orlando, Florida, 32803

  • Lucile Salter Packard Children's Hospital at Stanford

    Palo Alto, California, 94304-0126

  • Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

  • Doernbecher Children's Hospital

    Portland, Oregon, 97239

  • University of California Davis Medical Center

    Sacramento, California, 95817

  • Primary Children's Medical Center

    Salt Lake City, Utah, 84113

  • Children's Hospital at University of California San Francisco Medical Center

    San Francisco, California, 94143

  • St. Louis Children's Hospital

    St Louis, Missouri, 63110

  • The Children's Hospital at Montefiore

    The Bronx, New York, 10467

  • University Medical Center, The University of Arizona

    Tucson, Arizona, 85724

  • Nemours/Alfred I. duPont Hospital for Children

    Wilmington, Delaware, 19803

  • University of Massachusetts Memorial Children's Medical Center

    Worcester, Massachusetts, 01655

Other trials in United States

About this study

Official title: Sedation Management in Pediatric Patients With Acute Respiratory Failure

People with acute respiratory failure usually require the use of an artificial breathing machine, known as a mechanical ventilator. Sedative medications, which help keep people calm and reduce anxiety, are often prescribed for children who are on mechanical ventilators. However, the longer that sedative medications are used, the longer a child may need to remain on mechanical ventilation. This study will evaluate the effectiveness of a team approach to sedation management that aims to reduce the number of days that children with acute respiratory failure require mechanical ventilation.

Read the detailed description

People who are hospitalized for acute respiratory failure are typically supported on mechanical ventilation, which delivers oxygen and a continuous level of pressure to the damaged lungs. Over 90% of infants and children supported on mechanical ventilation receive some form of sedation medication, which helps keep them safe, calm, and comfortable. Unfortunately, the use of sedation medications may prolong the duration of mechanical ventilation, which can lead to an increased risk for pneumonia and other complications.

Recent studies among adults in intensive care units (ICUs) have shown that when doctors and nurses work together as a team to manage the use of sedation medication, patients are taken off mechanical ventilation sooner and with fewer side effects. This team strategy includes the following:

  • Training and discussion between doctors and nurses regarding which sedative medications should be used
  • Having doctors and nurses jointly identify the patient's progress and a daily sedation medication goal for the patient
  • Having nurses use a decision-making tool to help guide changes in a patient's sedative medication dose
  • Keeping track of patient care, which allows doctors and nurses to evaluate the effectiveness of how they manage each patient's sedative medication use

This study will examine the use of the sedation management strategy for infants and children in pediatric ICUs who have acute respiratory failure and require mechanical ventilation. The purpose of the study is to evaluate whether this team approach to sedation medication management is more effective than the usual approach at reducing the amount of time children remain on mechanical ventilators. Study researchers will also examine the cost-effectiveness of this approach and associated quality of life factors.

All participants will be enrolled within 24 hours of starting mechanical ventilation and will be monitored until they receive their last dose of sedative medication, hospital discharge, or Day 28 (whichever comes first). During a 3-month baseline period, all participating pediatric ICUs will provide their usual sedation management, and study researchers will review participants' medical records on a daily basis. Each pediatric ICU will then be randomly assigned to either the control group or the team approach group. Pediatric ICUs in the control group will continue to provide usual care for sedation management. Pediatric ICUs in the team approach group will implement the team approach sedation management guidelines. For both groups, pain and sedation levels will be monitored daily, and study researchers will review participants' medical records on a daily basis, too. Six months after hospital discharge, half of the participants and their parents will complete a follow-up survey and take part in a telephone interview to assess quality of life, psychological factors, and health-related resource use.

Being tested
Team approach to sedation management, Usual approach to sedation management
Keywords
Acute Respiratory Failure, Acute Lung Injury
Medical subject headings
Respiratory Insufficiency, Respiratory Distress Syndrome, Newborn, Lung Diseases, Acute Lung Injury

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Team approach to sedation managementBehavioural

    The team approach to sedation management includes the following:

    • Team education and consensus on the use of sedatives
    • Team identification of the patient's trajectory of illness and daily prescription of a sedation goal
    • A nurse-implemented goal-directed comfort algorithm that guides moment-to-moment titration of opioids and benzodiazepines
    • Team feedback on sedation management performance
  • Usual approach to sedation managementBehavioural

    The pediatric ICU will continue its usual approach to sedation management.

Study groups in NCT00814099
Study groupRoleWhat they receive
1Active comparatorParticipants will receive care at a pediatric ICU that is continuing the usual approach to sedation management.
Receives: Behavioral: Usual approach to sedation management
2ExperimentalParticipants will receive care at a pediatric ICU that is implementing the team approach to sedation management.
Receives: Behavioral: Team approach to sedation management

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Duration of mechanical ventilation

    Measured: Measured from the time of endotracheal intubation to the end of scheduled sedation therapy, hospital discharge, or Day 28 (whichever comes first)

Secondary outcomes (11)
  1. Time to recovery of acute respiratory failure

    Measured: Measured from the time of endotracheal intubation to when participants first meet the criteria to be tested for extubation readiness

  2. Duration of weaning from mechanical ventilation

    Measured: Measured from the time participants meet the criteria to be tested for extubation readiness until the time of the first successful extubation (defined as extubation for more than 24 hours)

  3. Occurrence of adverse events

    Measured: Measured for the duration of the study

  4. Detection of life-threatening neurological events

    Measured: Measured for the duration of the study

  5. Total sedative exposure

    Measured: Measured for the duration of the study

  6. Occurrence of iatrogenic withdrawal symptoms

    Measured: Measured for the duration of the study

  7. Pediatric ICU and hospital length of stay

    Measured: Measured for the duration of the study

  8. Hospital costs

    Measured: Measured for the duration of the study

  9. Study implementation costs and cost-effectiveness

    Measured: Measured for the duration of the study

  10. In-hospital mortality

    Measured: Measured for the duration of the study

  11. Post-discharge quality of life and emotional health

    Measured: Measured 6 months after pediatric ICU discharge

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Dec 2008 (estimated)
  2. Study startJan 2009
  3. Primary completionDec 2013
  4. Study completionDec 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
2,449 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00814099
Sponsor's protocol ID
611
Other IDs
U01HL086622, U01HL086649
Acronym
RESTORE
Status last verified
Apr 2026
First submitted
19 Dec 2008
Last updated
1 May 2026
Results posted
No
Data monitoring committee
Yes

Publications

  • Best KM, Asaro LA, Curley MAQ; Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators. Sedation Management for Critically Ill Children with Pre-Existing Cognitive Impairment. J Pediatr. 2019 Mar;206:204-211.e1. doi: 10.1016/j.jpeds.2018.10.042. Epub 2018 Dec 5.

    PubMed 30527750
  • Franck LS, Harris SK, Soetenga DJ, Amling JK, Curley MA. The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med. 2008 Nov;9(6):573-80. doi: 10.1097/PCC.0b013e31818c8328.

    PubMed 18838937
  • Curley MA, Harris SK, Fraser KA, Johnson RA, Arnold JH. State Behavioral Scale: a sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatr Crit Care Med. 2006 Mar;7(2):107-14. doi: 10.1097/01.PCC.0000200955.40962.38.

    PubMed 16446601
  • Ward SL, Dawkins-Henry OS, Asaro LA, Wypij D, Curley MAQ; Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators. Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children. Crit Care Explor. 2025 Feb 10;7(2):e1214. doi: 10.1097/CCE.0000000000001214. eCollection 2025 Feb 1.

    PubMed 39932727
  • Sorce LR, Asaro LA, Curley MAQ; RESTORE Study Investigators. Infant feeding and criticality in children. Nurs Crit Care. 2025 Mar;30(2):e13103. doi: 10.1111/nicc.13103. Epub 2024 Jun 26.

    PubMed 38923099
  • Flori HR, Zhang M, Xie J, Yang G, Sapru A, Calfee CS, Delucchi KL, Sinha P, Curley MAQ, Dahmer MK. Subphenotypes Assigned to Pediatric Acute Respiratory Failure Patients Show Differing Outcomes. Am J Respir Crit Care Med. 2023 Aug 1;208(3):331-333. doi: 10.1164/rccm.202301-0070LE. No abstract available.

    PubMed 37311208
  • Ardila SM, Weeks HM, Dahmer MK, Kaciroti N, Quasney M, Sapru A, Curley MAQ, Flori HR; Biomarkers in Children with Acute Lung Injury (BALI) and Randomized Evaluation for Sedation Titration for Respiratory Failure (RESTORE) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. A Targeted Analysis of Serial Cytokine Measures and Nonpulmonary Organ System Failure in Children With Acute Respiratory Failure: Individual Measures and Trajectories Over Time. Pediatr Crit Care Med. 2023 Sep 1;24(9):727-737. doi: 10.1097/PCC.0000000000003286. Epub 2023 May 17.

    PubMed 37195096
  • Olszewski AE, Dervan LA, Smith MB, Asaro LA, Wypij D, Curley MAQ, Watson RS. Risk Factors for Positive Post-Traumatic Stress Disorder Screening and Associated Outcomes in Children Surviving Acute Respiratory Failure: A Secondary Analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure Clinical Trial. Pediatr Crit Care Med. 2023 Mar 1;24(3):222-232. doi: 10.1097/PCC.0000000000003150. Epub 2022 Dec 23.

    PubMed 36728954
  • Broden EG, Hinds PS, Werner-Lin AV, Curley MAQ; for the RESTORE Study Investigators. "I Didn't Want My Baby to Pass, But I Didn't Want Him Suffering Either": Comparing Bereaved Parents' Narratives With Nursing End-of-Life Assessments in the Pediatric Intensive Care Unit. J Hosp Palliat Nurs. 2022 Oct 1;24(5):271-280. doi: 10.1097/NJH.0000000000000884. Epub 2022 Jun 6.

    PubMed 35666188
  • Watson RS, Beers SR, Asaro LA, Burns C, Koh MJ, Perry MA, Angus DC, Wypij D, Curley MAQ; RESTORE-Cognition Investigators. Association of Acute Respiratory Failure in Early Childhood With Long-term Neurocognitive Outcomes. JAMA. 2022 Mar 1;327(9):836-845. doi: 10.1001/jama.2022.1480.

    PubMed 35230393
  • Broden EG, Werner-Lin A, Curley MAQ, Hinds PS. Shifting and intersecting needs: Parents' experiences during and following the withdrawal of life sustaining treatments in the paediatric intensive care unit. Intensive Crit Care Nurs. 2022 Jun;70:103216. doi: 10.1016/j.iccn.2022.103216. Epub 2022 Feb 24.

    PubMed 35219558
  • Broden EG, Hinds PS, Werner-Lin A, Quinn R, Asaro LA, Curley MAQ. Nursing Care at End of Life in Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation. Am J Crit Care. 2022 May 1;31(3):230-239. doi: 10.4037/ajcc2022294.

    PubMed 35466341
  • Rudolph MW, Kneyber MCJ, Asaro LA, Cheifetz IM, Wypij D, Curley MAQ; for the Randomized Evaluation of Sedation Titration for Respiratory Failure ( RESTORE ) Study Investigators. Early Neuromuscular Blockade in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome. Crit Care Med. 2022 May 1;50(5):e445-e457. doi: 10.1097/CCM.0000000000005426. Epub 2022 Jan 6.

    PubMed 35029869
  • Kachmar AG, Watson RS, Wypij D, Perry MA, Curley MAQ; for the Randomized Evaluation of Sedation Titration for Respiratory Failure ( RESTORE ) Investigative Team. Association of Socioeconomic Status With Postdischarge Pediatric Resource Use and Quality of Life. Crit Care Med. 2022 Feb 1;50(2):e117-e128. doi: 10.1097/CCM.0000000000005261.

    PubMed 34495879
  • Carlton EF, Donnelly JP, Prescott HC, Asaro LA, Barbaro RP, Watson RS, Curley MAQ; RESTORE Study Investigators. School and Work Absences After Critical Care Hospitalization for Pediatric Acute Respiratory Failure: A Secondary Analysis of a Cluster Randomized Trial. JAMA Netw Open. 2021 Dec 1;4(12):e2140732. doi: 10.1001/jamanetworkopen.2021.40732.

    PubMed 34940862

Questions about this trial

What is this clinical trial studying?

A study testing Team approach to sedation management and Usual approach to sedation management in people with Respiratory Insufficiency and Respiratory Distress Syndrome, Newborn, run by University of Pennsylvania at 31 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 1 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 31 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Duration of mechanical ventilation (time frame: Measured from the time of endotracheal intubation to the end of scheduled sedation therapy, hospital discharge, or Day 28 (whichever comes first)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00814099, which also lists 51 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 May 2026.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in