The nurse-implemented chronotherapeutic restoring bundle in critically ill children, RESTORE Resilience (R2): pilot testing in a two-phase cohort study, 2017–2021
Abstract
OBJECTIVES: Pilot test the nurse-led chronotherapeutic bundle in critically ill children, RESTORE Resilience (R2). DESIGN: A two-phase cohort study was carried out from 2017 to 2021. SETTING: Two similarly sized and organized PICUs in the United States. PATIENTS: Children 6 months to 17 years old who were mechanically ventilated for acute respiratory failure. INTERVENTIONS: R2 seven-item chronotherapeutic bundle, including: 1) replication of child’s pre-hospital daily routine (i.e., sleep/wake, feeding, activity patterns); 2) cycled day-night light/sound modulation; 3) minimal effective sedation; 4) night fasting with bolus enteral daytime feedings; 5) early progressive mobility; 6) nursing care continuity; and 7) parent diaries. MEASUREMENTS AND MAIN RESULTS: Children underwent environmental (light, sound) and patient (actigraphy, activity log, salivary melatonin, electroencephalogram) monitoring. Parents completed the Child’s Daily Routine and Sleep Survey (CDRSS) and Family-Centered Care Scale. The primary outcome was post-extubation daytime activity consolidation (Daytime Activity Ratio Estimate [DARE]). Twenty baseline-phase (2017–2019) and 36 intervention-phase (2019–2021) participants were enrolled. During the intervention phase, nurses used the CDRSS to construct children’s PICU schedules. Overall compliance with nurse-implemented R2 elements 1–5 increased from 18% (interquartile range, 13–30%) at baseline to 63% (53–68%) during the intervention phase (p < 0.001).…
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