Withdrawal from a contract

Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 checklist. Recommended items to address in a SR protocol. (PDF 147 kb

Additional file 2: of A protocol for a systematic review of the diagnostic accuracy of Loop-mediated-isothermal AMPlification (LAMP) in diagnosis of invasive meningococcal disease in children

Example search strategy. (DOCX 99 kb

Additional file 1: of A protocol for a systematic review of the diagnostic accuracy of Loop-mediated-isothermal AMPlification (LAMP) in diagnosis of invasive meningococcal disease in children

PRISMA-P Checklist. (DOCX 33 kb

Additional file 1: of Physical Rehabilitation Core Outcomes In Critical illness (PRACTICE): protocol for development of a core outcome set

Protocol for systematic review of quantitative research. (DOCX 23 kb

Additional file 1: of Fluid strategies and outcomes in patients with acute respiratory distress syndrome, systemic inflammatory response syndrome and sepsis: a protocol for a systematic review and meta-analysis

Medline search strategy. Modified versions of this strategy will be used for other databases

Standards for Reporting Qualitative Research (SRQR) checklist.

Standards for Reporting Qualitative Research (SRQR) checklist.</p

Process of theme development (following Braun & Clarke, 2006).

Process of theme development (following Braun & Clarke, 2006).</p

SANDWICH logic model.

Adapted from Blackwood et al., 2022 [14]. COMFORT is the name of the tool used to assess sedation and comfort of infants and children in paediatric intensive care. Abbreviations: MDT, multidisciplinary team; PICU, paediatric intensive care unit; SBT, spontaneous breathing trial.</p

SANDWICH implementation.

BackgroundProlonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes.Methods10,495 children admitted to 18 paediatric intensive care units (ICUs) in the United Kingdom participated in a stepped-wedge, cluster randomised controlled trial, with 1955 clinical staff trained to deliver the intervention. The intervention comprised assessment and optimisation of sedation levels, and bedside screening of respiratory parameters to indicate readiness for a spontaneous breathing trial prior to liberation from ventilation. 193 clinical staff were interviewed towards the end of the trial. Interview data were thematically analysed, and quantitative adherence data were analysed using descriptive statistics.ResultsThe intervention led to a reduced duration of IMV (adjusted median difference– 7.1 hours, 95% CI -9.6 to -5.3, p = 0.01). Overall intervention adherence was 75% (range 59–85%). Ease and flexibility of the intervention promoted it use; designated responsibilities, explicit pathways of decision-making and a shared language for communication fostered proactivity and consistency towards extubation. Delivery of the intervention was hindered by established hospital and unit organisational and patient care routines, clinician preference and absence of clinical leadership.ConclusionsThe SANDWICH trial showed a significant, although small, reduction in duration of IMV. Findings suggest that greater direction in decision-making pathways, robust embedment of new practice in unit routine, and capitalising on the skills of Advanced Nurse Practitioners and physiotherapists would have contributed to greater intervention effect.Trial registrationisrctn.org Identifier: ISRCTN16998143.</div

The proportion (%) of intervention adherence in each paediatric intensive care unit.

The proportion (%) of intervention adherence in each paediatric intensive care unit.</p